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肝硬化小肝细胞癌的管理:重点关注门静脉高压症。

Management of small hepatocellular carcinoma in cirrhosis: focus on portal hypertension.

机构信息

Hepatocellular Carcinoma Translational Research Laboratory, Barcelona-Clinic Liver Cancer Group, Institut d'Investigacions Biomediques August Pi i Sunyer, Liver Unit, Hospital Clinic, 08036 Barcelona, Spain.

出版信息

World J Gastroenterol. 2013 Feb 28;19(8):1193-9. doi: 10.3748/wjg.v19.i8.1193.

DOI:10.3748/wjg.v19.i8.1193
PMID:23482437
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3587475/
Abstract

The incidence of hepatocellular carcinoma (HCC) is rising worldwide being currently the fifth most common cancer and third cause of cancer-related mortality. Early detection of HCC through surveillance programs have enabled the identification of small nodules with higher frequency, and nowadays account for 10%-15% of patients diagnosed in the West and almost 30% in Japan. Patients with small HCC can be candidates for potential curative treatments: liver transplantation, surgical resection and percutaneous ablation, depending on the presence of portal hypertension and co-morbidities. This review will analyze recent advancements in the clinical management of these individuals, focusing on issues related to the role of portal hypertension, the debate between resection and ablative therapies and the future impact of molecular technologies.

摘要

原发性肝癌(HCC)的发病率在全球范围内呈上升趋势,目前已成为全球第五大常见癌症和癌症相关死亡的第三大原因。通过监测计划早期发现 HCC,使得能够更频繁地识别出小结节,目前在西方约占 10%-15%的患者,在日本则几乎占 30%。对于小 HCC 患者,可以根据是否存在门脉高压和合并症选择潜在的治愈性治疗方法:肝移植、手术切除和经皮消融。本综述将分析这些患者临床管理的最新进展,重点关注与门脉高压的作用、切除与消融治疗之间的争论以及分子技术的未来影响有关的问题。

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本文引用的文献

1
Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis.肝功能 A 级肝硬化患者的门静脉高压严重程度与肝切除术后肝功能衰竭的预测。
Br J Surg. 2012 Dec;99(12):1701-10. doi: 10.1002/bjs.8951.
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Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.弹性成像、脾脏大小和血小板计数可用于诊断代偿性肝硬化患者的门静脉高压。
Gastroenterology. 2013 Jan;144(1):102-111.e1. doi: 10.1053/j.gastro.2012.10.001. Epub 2012 Oct 8.
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Notch signaling is activated in human hepatocellular carcinoma and induces tumor formation in mice.Notch 信号在人肝癌中被激活,并在小鼠中诱导肿瘤形成。
Gastroenterology. 2012 Dec;143(6):1660-1669.e7. doi: 10.1053/j.gastro.2012.09.002. Epub 2012 Sep 11.
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Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis.测量脾脏硬度评估丙型肝炎相关肝硬化患者的门静脉高压和食管静脉曲张的存在。
Gastroenterology. 2012 Sep;143(3):646-654. doi: 10.1053/j.gastro.2012.05.035. Epub 2012 May 27.
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A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma.射频消融与手术切除治疗小肝癌的随机对照研究。
J Hepatol. 2012 Oct;57(4):794-802. doi: 10.1016/j.jhep.2012.05.007. Epub 2012 May 23.
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Liver resection for hepatocellular carcinoma ≤3 cm: results of an Italian multicenter study on 588 patients.肝切除术治疗 ≤3 cm 肝癌:意大利多中心 588 例患者研究结果。
J Am Coll Surg. 2012 Aug;215(2):244-54. doi: 10.1016/j.jamcollsurg.2012.04.013. Epub 2012 May 26.
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Transient elastography and prognosis of cirrhosis.瞬时弹性成像与肝硬化的预后
Hepatology. 2012 May;55(5):1629-31. doi: 10.1002/hep.25620.
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Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis.肝硬化患者肝切除术前评估门静脉高压的肝静脉压力梯度。
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10
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma.欧洲肝脏研究学会-欧洲肿瘤内科学会临床实践指南:肝细胞癌的管理
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