Iwamura K
Medizinische Universitätsklinik III, Tokai-Universität Isehara, Kanagawa, Japan.
Leber Magen Darm. 1988 Feb;18(1):56-60.
70-80% of hepatocellular carcinoma arise from liver cirrhosis. Therefore early diagnostic attempts to identify hepatic carcinoma appear to be mandatory. In 345 patients with liver cirrhosis the following examinations were routinely performed on several occasions: alpha-fetoprotein, ultrasound, scintigraphy, CT scan, angiography, laparoscopy or ultrasound directed biopsy of the liver. The sex ratio of 4:1 (m:f) revealed a clearly higher incidence of hepatocellular carcinoma in men. The peak incidence occurred between age 55 and 59. In our study the diagnosis of liver cirrhosis was established in a group of 345 patients during a period of 7 years. Two years later primary liver cell carcinoma had developed in 37 patients. By ultrasonographic or CT examination in 36 patients the tumor appeared nodular with a nodule size between 1 and 3 cm, while in 1 patient a diffuse pattern was found. Forming capsules in the liver (77%) often was the first sign that a tumor existed and seems to be characteristic for hepatocellular carcinomas. 63% of tumors are found within the right hepatic lobe, 27% within the left lobe and 10% occur in both. In further studies complications of hepatocellular carcinomas were examined. 10 out of 33 patients died of intraabdominal bleeding due to decay of the tumor perfused with chemotherapeutic agents prior to the event. A possible form of therapy of hepatocellular carcinoma in early stage appears to be arterial embolisation.
70%-80%的肝细胞癌由肝硬化发展而来。因此，早期诊断肝细胞癌的尝试似乎是必不可少的。对345例肝硬化患者，在不同时间常规进行了以下检查：甲胎蛋白、超声、闪烁扫描、CT扫描、血管造影、腹腔镜检查或超声引导下肝活检。男女比例为4:1，表明男性肝细胞癌的发病率明显更高。发病高峰年龄在55至59岁之间。在我们的研究中，在7年期间对345例患者确诊为肝硬化。两年后，37例患者发生了原发性肝细胞癌。通过超声或CT检查，36例患者的肿瘤呈结节状，结节大小在1至3厘米之间，而1例患者表现为弥漫性。肝脏中形成包膜（77%）常常是肿瘤存在的首个迹象，似乎是肝细胞癌的特征。63%的肿瘤位于肝右叶，27%位于肝左叶，10%发生于双侧。在进一步的研究中，对肝细胞癌的并发症进行了检查。33例患者中有10例死于腹腔内出血，原因是肿瘤在出血前接受了化疗药物灌注后发生坏死。早期肝细胞癌一种可能的治疗方式似乎是动脉栓塞。
