Butt A K, Khan A A, Alam A, Ahmad S, Shah S W, Shafqat F, Naqvi A B
Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore.
J Pak Med Assoc. 1998 Jul;48(7):197-201.
Hepatocellular carcinoma is one of the most common malignancies world wide. We present data on 76 patients admitted to the Shaikh Zayed Hospital. Mean age was 52.2 +/- 11.3 years. Eighty six percent were males and 14% females. Eighty-six percent patients had underlying cirrhosis documented on ultrasound examination. Seventy-five percent were positive for anti HCV, 10% for HBsAg positive, 10% for both HBsAg and anti HCV and 5% cases had negative viral serology. Main clinical features were abdominal pain, weight loss, jaundice, hepatomegaly and ascites. Forty-three percent patients were Child-Pugh class A, 30% class B and 13% class C and 14% were non cirrhotic. Mean alfa fetoprotein levels were 142 +/- 155 ng/ml (range 2.7 to 1470). Diagnosis of hepatocellular carcinoma was established in 60 patients by fine needle aspiration biopsy under ultrasound guidance. Two patients died after biopsy due to uncontrollable bleeding. Fifty-four percent patients had a solitary lesion and 46% had multifocal or diffuse lesions. The average size of lesion was 7.8 x 8.1 cm. Twenty-two patients received intralesional alcohol injection. Fifty-four percent of these with a tumor size greater than 8 cm died during follow up. The major cause of death was liver failure in 8 patients and fatal bleeding occurred in 4 patients. Hepatocellular carcinoma has a high prevalence in middle aged males with a strong association with anti HCV positive cirrhosis. Patients with a tumour size greater than 8 cm have a poor response to intralesional alcohol injection.
肝细胞癌是全球最常见的恶性肿瘤之一。我们呈现了谢赫·扎耶德医院收治的76例患者的数据。平均年龄为52.2±11.3岁。86%为男性，14%为女性。86%的患者经超声检查证实有潜在肝硬化。75%的患者抗丙型肝炎病毒（HCV）呈阳性，10%的患者乙肝表面抗原（HBsAg）呈阳性，10%的患者HBsAg和抗HCV均呈阳性，5%的病例病毒血清学呈阴性。主要临床特征为腹痛、体重减轻、黄疸、肝肿大和腹水。43%的患者为Child-Pugh A级，30%为B级，13%为C级，14%为非肝硬化患者。甲胎蛋白平均水平为142±155 ng/ml（范围为2.7至1470）。60例患者通过超声引导下细针穿刺活检确诊为肝细胞癌。两名患者活检后因无法控制的出血死亡。54%的患者有单个病灶，46%的患者有多灶性或弥漫性病灶。病灶平均大小为7.8×8.1 cm。22例患者接受了瘤内酒精注射。其中肿瘤大小大于8 cm的患者中有54%在随访期间死亡。主要死亡原因是8例患者出现肝衰竭，4例患者发生致命性出血。肝细胞癌在中年男性中患病率较高，与抗HCV阳性肝硬化密切相关。肿瘤大小大于8 cm的患者对瘤内酒精注射反应较差。
