Toyosaka A, Okamoto E, Mitsunobu M, Oriyama T, Nakao N, Miura K
First Department of Surgery, Hyogo College of Medicine, Japan.
HPB Surg. 1996;10(2):97-103; discussion 103-4. doi: 10.1155/1996/75210.
The efferent vessel of hepatocellular carcinoma (HCC) and the mechanism and pathogenesis of the high frequency of intrahepatic metastasis in HCC has not yet been clarified. Three hundred ninety-three resected specimens of HCC were examined for tumor thrombosis in the portal vein and the hepatic vein: 231 tumors < or = 5 cm in diameter were examined for the relationship between mode of tumor spread and tumor size. Efferent vessels in HCC were identified by direct injection of radiopaque material into the tumor in 23 resected liver specimens and by percutaneous infusion of radiopaque media into tumor nodules in 8 patients. The mode of tumor spread in HCC progressed from capsular invasion to extracapsular invasion, then to vascular invasion, and finally to intrahepatic metastasis. There was a strong statistical correlation between the presence of intrahepatic metastasis and portal vein thrombosis (p < 0.05, R = 0.998). Radiopaque material injected directly into 23 resected tumors entered only the portal vein in 17 tumors and into both the portal and hepatic veins in 6 tumors. In all 8 patients with unresectable lesions, radiopaque media injected percutaneously into tumor nodules flowed only into the portal vein. These findings suggest that intrahepatic invasion by HCC may occur through the portal vein as an efferent tumor vessel.
肝细胞癌（HCC）的输出血管以及HCC肝内转移高发生率的机制和发病原因尚未阐明。对393例HCC切除标本进行门静脉和肝静脉肿瘤血栓检查：对231例直径≤5 cm的肿瘤检查肿瘤扩散方式与肿瘤大小之间的关系。通过向23例切除肝标本中的肿瘤直接注射不透射线物质以及向8例患者的肿瘤结节经皮注入不透射线介质来识别HCC中的输出血管。HCC的肿瘤扩散方式从包膜侵犯发展为包膜外侵犯，然后是血管侵犯，最后是肝内转移。肝内转移的存在与门静脉血栓形成之间存在很强的统计学相关性（p <0.05，R = 0.998）。直接注入23例切除肿瘤的不透射线物质，17例肿瘤仅进入门静脉，6例肿瘤进入门静脉和肝静脉。在所有8例不可切除病变的患者中，经皮注入肿瘤结节的不透射线介质仅流入门静脉。这些发现表明，HCC的肝内侵犯可能通过门静脉作为肿瘤输出血管发生。
