本文關鍵詞：轉移性肝癌患者的臨床特征分析　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 轉移性肝癌 原發(fā)性肝癌 生化肝功 腫瘤標志物 影像學

【摘要】：目的:本文通過分析轉移性肝癌患者的臨床資料,總結其常見原發(fā)灶,并同原發(fā)性肝癌的臨床表現(xiàn)、生化指標、影像學特點及治療方法相比較,為早期診斷轉移性肝癌和及時準確查找原發(fā)灶提供依據(jù),進一步為轉移性肝癌臨床診療及預后評估提供參考。方法:采用回顧性分析的方法,收集整理2014年9月至2016年10月于大連醫(yī)科大學附屬第一醫(yī)院首次確診的221例轉移性肝癌患者的臨床資料,總結其原發(fā)灶來源及臨床特征,并與同期首次住院確診的200例原發(fā)性肝癌患者的臨床資料進行對比,分析兩組患者性別、年齡分布、既往史、臨床表現(xiàn)、生化指標、影像學檢查等方面的差異。采用受試者工作特征曲線(receiver operating characteristic,ROC)分析腫瘤標志物在兩者鑒別診斷中的價值。結果:1.一般資料:221例轉移性肝癌患者中,男性128例,女性93例,男女比例=1.37:1,年齡范圍16-87歲,平均年齡62.13± 12.99歲;200例原發(fā)性肝癌患者中男性165例,女性35例,男女比例=4.71:1,年齡范圍31-84歲,平均年齡58.87±9.34 歲。2.轉移性肝癌腫瘤原發(fā)灶的構成:無論男性、女性患者,均以消化系統(tǒng)來源惡性腫瘤多見,其中大腸癌所占比例最高,其次為胃癌,第三是胰腺癌。除消化系統(tǒng)原發(fā)腫瘤病灶以外,男性患者以肺癌最多見,女性以乳腺癌、婦科腫瘤更多見。3.性別比較:轉移性肝癌及原發(fā)性肝癌患者均以男性多見,轉移性肝癌患者中,女性所占比例高于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.01)。4.年齡比較:兩組患者發(fā)病年齡均以老年患者為多。年齡在60-69歲者轉移性肝癌患者所占比例低于原發(fā)性肝癌組,而年齡在70-79歲、80歲者高于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.01)。5.臨床癥狀、體征、既往史的比較:轉移性肝癌組患者中,被體檢發(fā)現(xiàn)者、腰背痛者、消化道出血者、具有腹部包塊者分別高于原發(fā)性肝癌組,而具有腹痛、乏力、納差、肝大、蜘蛛痣及肝掌的患者所占的比例低于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.05)。轉移性肝癌組患者中,有吸煙、飲酒史者,有乙肝、丙肝者,有肝硬化病史者均分別低于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.05)。6.腫瘤標志物比較:轉移性肝癌組患者中AFP陽性率低于原發(fā)性肝癌組,CEA、CA125、CA199陽性率分別高于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.01)。其中AFP、CEA在ROC曲線下面積分別為0.908、0.840,提示有較好的診斷性能。7.生化肝功比較:兩組患者生化肝功均高于正常對照組,原發(fā)性肝癌組患者升高更明顯。轉移性肝癌組患者中ALP、GGT、CHE均高于原發(fā)性肝癌組,而ALT、AST、TBIL、DBIL、TBA、AFU均低于原發(fā)性肝癌組,差異有顯著統(tǒng)計學意義(P0.01)。8.影像學特點比較:轉移性肝癌組患者中腫瘤位于肝左、右兩葉者、腫瘤數(shù)目3個者、直徑5cm者均高于原發(fā)性肝癌組,而位于肝右葉者、數(shù)目為單發(fā)者、直徑5cm者、有門靜脈癌栓者均低于原發(fā)性肝癌組,差異有統(tǒng)計學意義(P0.01)。轉移性肝癌患者CT平掃多表現(xiàn)為類圓形或團片狀低密度影或混雜密度影,邊緣清楚或模糊,增強掃描多表現(xiàn)為門脈期環(huán)形強化,部分呈"牛眼征"。原發(fā)性肝癌組患者CT增強可見病灶迅速增強又迅速消退的特點,即"快進快出"。9.治療方法:轉移性肝癌組患者行保守治療和化療者最多,而原發(fā)性肝癌組行TACE、外科手術治療者最多。結論:1.轉移性肝癌患者中老年男性占絕大多數(shù),原發(fā)灶多來源于消化系統(tǒng)。除消化道來源惡性腫瘤外,男性患者以肺癌多見,女性患者以乳腺及婦科腫瘤多見。2.轉移性肝癌患者臨床特征無特異性,與原發(fā)性肝癌相比,肝功能損傷程度較輕,血清ALP、GGT水平較高,腫瘤標志物以CEA、CA125、CA199升高為主,其中AFP、CEA的診斷性能較好。3.AFP、CEA對于轉移性肝癌和原發(fā)性肝癌有較好的診斷性能。4.轉移性肝癌患者中,肝轉移癌灶以多發(fā)小結節(jié)為主,常散在分布于肝左右兩葉,多無靜脈癌栓,CT表現(xiàn)多樣,平掃以不規(guī)則低密度灶為主,增強掃描部分顯示"牛眼征"。5.針對轉移性肝癌應積極采取外科治療為主的綜合治療,延長生存期。
[Abstract]:Objective: through the analysis of the clinical data of patients with hepatocellular carcinoma metastasis, summarize the common primary clinical manifestations, with primary carcinoma of the liver biochemical index, compared the imaging characteristics and treatment methods for early diagnosis of liver metastases and primary tumor to provide timely and accurate search basis, further to provide the reference for the transfer of the clinical diagnosis and treatment of hepatocellular carcinoma and prognosis. Methods: a retrospective analysis of the collected from September 2014 to October 2016 in the First Affiliated Hospital of Dalian Medical University was first diagnosed 221 cases of hepatic metastasis in patients with clinical data, summarize the clinical features of primary foci and sources, and compared with the first hospital diagnosed 200 cases of patients with primary liver cancer the clinical data were compared, analysis of two groups of patients with gender, age, medical history, clinical manifestations, biochemical indexes, differences in imaging examination. Using receiver operating Characteristic curve (receiver operating characteristic, ROC) analysis of the value of tumor markers in the differential diagnosis of the two. Results: 1. general information: 221 cases of metastatic liver cancer patients, 128 were male, 93 were female, male to female ratio =1.37:1, age range 16-87 years, mean age 62.13 + 12.99 years; 200 cases of patients with primary hepatocellular carcinoma in 165 cases were male, 35 were female, male to female ratio =4.71:1, age range 31-84 years, mean age 58.87 + 9.34 years old.2. hepatocellular carcinoma metastasis of primary tumor: whether male and female patients, with digestive system malignant tumor is more common source, including colorectal cancer accounted for the highest proportion, followed by for gastric cancer, third pancreatic cancer. In addition to the digestive system of primary tumor, the most common in male patients with lung cancer, female breast cancer, gynecological cancer is more common in.3.: gender comparison of liver metastases and primary liver cancer patients were more common in male, transfer Hepatocellular carcinoma patients, the proportion of women is higher than that of primary liver cancer group, the difference was statistically significant (P0.01).4. age comparison: the two groups of patients with age of onset in old patients. At the age of 60-69 patients with metastatic liver cancer is lower than the proportion of primary liver cancer group, and at age of 70-79 years at the age of 80, were higher than in HCC group, the difference was statistically significant (P0.01.5.) clinical symptoms, signs, comparative history: metastatic liver cancer patients, were found in physical examination, low back pain, gastrointestinal bleeding, with abdominal mass were higher than that of primary liver cancer, and with abdominal pain, fatigue, anorexia, liver, liver palm spider nevus and the proportion of patients is lower than that of primary hepatocellular carcinoma group, the difference was statistically significant (P0.05). Patients with metastatic liver cancer, smoking, drinking history, hepatitis B, hepatitis C, cirrhosis were lower than those of the original history hepatocellular carcinoma Cancer group, the difference was statistically significant (P0.05).6. tumor markers: the metastatic rate of hepatocellular carcinoma in patients with AFP was lower than that of primary liver cancer group, CEA, CA125, CA199 positive rate is higher than that of primary liver cancer group, the difference was statistically significant (P0.01). The AFP, CEA in the area under the ROC curve were 0.908,0.840, suggesting the diagnosis performance of.7. biochemical liver function better comparison: the two groups of patients with biochemical liver function were higher than the normal control group, primary liver cancer patients increased obviously. Liver metastasis in patients with ALP, GGT, CHE were higher than that of primary liver cancer group, ALT, AST, TBIL, DBIL. TBA, AFU were lower than that of primary hepatocellular carcinoma group, the difference was statistically significant (P0.01) compared with.8. imaging features of hepatocellular carcinoma: tumor metastasis group is located in the left hepatic lobe, right two, tumor number 3, the diameter of 5cm was higher than that of primary liver cancer group, and is located in the right lobe of the liver the number of single. The hair, 5cm diameter, portal vein tumor thrombus were lower than that in primary hepatocellular carcinoma group, the difference was statistically significant (P0.01). Metastatic liver cancer patients with CT scan showed round or patchy low density or mixed density, clear edge or fuzzy enhancement scanning, performance enhancement door pulse period ring, part of a "bull eye sign". Primary liver cancer patients CT enhancement features of visible lesions increased rapidly and quickly subsided, namely "Kuaijinkuaichu".9.: treatment of metastatic liver cancer patients underwent conservative treatment and chemotherapy, and primary liver cancer group underwent TACE surgery most. Conclusion: the majority of elderly men in 1. patients with liver metastasis, primary tumor originated from the digestive system. In addition to the digestive tract malignant tumor source, male patients with lung cancer, female patients with breast and gynecological tumor is more common clinical features of patients with hepatocellular carcinoma.2. metastasis No specific, compared with primary liver cancer, liver function damage degree is lighter, higher levels of serum ALP, GGT, tumor markers CEA, CA125, CA199 increased, AFP.3.AFP CEA, better diagnostic performance, CEA has a good performance of.4. diagnosis of metastatic hepatocellular carcinoma in patients with metastatic liver cancer and for primary liver cancer, with multiple nodules based cancer liver metastases, often scattered in the liver around two leaves, no vein tumor thrombus, CT manifestations, plain with irregular low density lesions, enhanced scan shows "bull eye sign".5. for metastatic liver cancer should adopt comprehensive surgical treatment treatment, prolong the survival period.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7
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本文編號：1381929