Manterola C, Roa I, Araya J C, Aretxabala X, Silva J
Servicio de Cirugía, Hospital Regional de Temuco, Chile.
Rev Med Chil. 1996 Apr;124(4):469-79.
Hepatocellular carcinoma is the most frequent form of primary hepatic cancer and has a high dissemination capacity. About 90% of tumors develop over a pre-existing cirrhosis but they also may occur in a normal liver. It has a higher frequency among males and 80% of tumors have clinical manifestations. It is associated to hepatitis B and C virus infection, alcoholism, cirrhosis of any etiology, consumption of aflatoxin Bl, oriental race and familial history. Patients are staged using classifications proposed by Okuda, Child-Pugh and the performance status test. Alpha feto protein is useful for diagnosis and follow up Abdominal ultrasound, hepatic scintiscan, angiography with lipiodol, CAT scan and nuclear magnetic resonance have a high diagnostic yield. Non surgical therapeutic alternatives include intratumoral alcoholization, chemoembolization and other such as tamoxifen and monoclonal antibodies. Surgical treatment is based on hepatic resection, whose magnitude depends on hepatic function. Hepatic transplantation is a new therapeutic alternative for patients in whom resection is not feasible and have a single small tumor without metastases.
肝细胞癌是原发性肝癌最常见的形式，具有很高的扩散能力。约90%的肿瘤在先前存在的肝硬化基础上发生，但也可能发生在正常肝脏中。男性发病率较高，80%的肿瘤有临床表现。它与乙型和丙型肝炎病毒感染、酗酒、任何病因的肝硬化、黄曲霉毒素B1摄入、东方人种及家族史有关。患者采用奥田、Child-Pugh分类法及体能状态测试进行分期。甲胎蛋白对诊断和随访有用。腹部超声、肝脏闪烁扫描、碘油血管造影、CT扫描和核磁共振具有很高的诊断率。非手术治疗选择包括瘤内酒精注射、化疗栓塞以及他莫昔芬和单克隆抗体等其他治疗方法。手术治疗基于肝切除术，其范围取决于肝功能。肝移植是一种新的治疗选择，适用于无法进行切除且有单个无转移小肿瘤的患者。
