ISSN:0253-4886    

DOI:10.1159/000172307

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172308

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172309

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Relevant studies on the etiology and pathogenesis of hepatocellular carcinoma (HCC) have been reviewed. Chronic hepatitis B virus infection and food aflatoxin B1 contamination have been identified as the major and possibly synergistic risk factors for HCC in endemic areas. Chronic hepatitis C virus is also an important risk factor. Cirrhosis of any etiology, particularly viral and alcoholic, is an important step toward HCC. Many other factors, such as alcohol drinking, cigarette smoking, hormone and even vitamins may also contribute to the development of HCC. Tumor suppressor p53 gene mutation was demonstrated in 25-30% of the patients with HCC from endemic regions. Hepatocarcinogenesis is therefore a multifactorial and multistep process involving initiator-induced multiple genetic alterations and promoter-induced proliferation and progression. Preventive measures to reduce risk factors and adequate therapy to prevent cirrhosis development could be effective ways to reduce or eradicate HCC.

ISSN:0253-4886    

DOI:10.1159/000172310

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The pathological features and diagnostic criteria of hepatocellular carcinoma are described. Tumour cells differentiate in a way similar to that of normal liver cells, in aspects of cytological and histological appearance, growth pattern or production of a biosynthetic product. The morphological and biological features of the tumour, including proliferative indices, DNA ploidy and genetic expression, have been studied. Some of them have shown to provide good prognostic significance and they are discussed. These help to guide the clinicians in the management of patients and in assessment of long-term prognosis.

ISSN:0253-4886    

DOI:10.1159/000172311

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We reviewed recent advances in the imaging of hepatocellular carcinoma (HCC), with particular emphasis on the early detection of small nodular HCC. In high-risk patients, periodic ultrasound screening with tumor marker (α-fetoprotein and PIVKA-11) measurement is the most useful method to detect small HCC. Computed tomography (CT) is the second choice, and an incremental dynamic technique using spiral CT is useful in the detection and differentiation. Magnetic resonance (MR) imaging is used to differentiate HCC from cavernous hemangioma and some tumor-like conditions including adenomatous hyperplasia. In selected patients, CT during arterial portography and superparamagnetic iron oxide-enhanced MR imaging are diagnostic. Characteristic findings of HCC are a peritumoral fibrous capsule, an intratumoral mosaic appearance and hypervascularity; however, these findings are not frequently seen in HCC < 2 cm. Imaging characteristics of some variants of HCC and the differentiation of HCC from other hepatic tumors and tumorlike conditions are also discussed

ISSN:0253-4886    

DOI:10.1159/000172312

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Intraoperative blood loss is well associated with the immediate outcome after hepatic resection particularly in cirrhotic patients. Temporary occlusion of the hepatic inflow (Pringle’s maneuver) effectively suppresses the blood loss and postoperative mortality. This technique is safe for 60-70 min in noncirrhotic and for 30 min in cirrhotic patients. Total vascular exclusion of the liver is rarely indicated but useful in resecting tumors adjacent to or growing in the main hepatic veins or inferior vena cava. Hypothermia may be used when the ischemic time is longer than the above-mentioned times. Extrahepatic control of the hepatic veins is possible in most cases. A Cavitron ultrasonic surgical aspirator is widely used to transect noncirrhotic livers but without diminishing blood loss. Autotransplantation of the liver with bench procedures may be indicated for only very selected patients. Although it is still controversial to place or not to place drains after hepatic resection, a routine drainage is probably not necessar

ISSN:0253-4886    

DOI:10.1159/000172313

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This paper describes the selection criteria for the most appropriate type of liver resection in patients with hepatocellular carcinoma (HCC) associated with liver cirrhosis. Key steps of sub segmentectomy, such as staining and counterstaining techniques with intraoperative ultrasound, are also presented. The results of liver resection in patients with HCC in our recent series and in a survey by the Liver Cancer Study Group of Japan are briefly reviewed.

ISSN:0253-4886    

DOI:10.1159/000172314

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Regardless of geography, late clinical presentation with advanced disease and concurrent chronic liver disease confound surgical management. Although epidemiologic and etiologic differences between patients from the East and West exist, surgical management by subtotal hepatectomy is strikingly similar in both technical approach and outcome. A comparative analysis of the surgical management of patients with HCC for the East and West is presented.

ISSN:0253-4886    

DOI:10.1159/000172315

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Peri-operative care of patients with hepatocellular carcinoma is critical for the survival of cirrhotic patients undergoing major hepatectomy. Peri-operative nutritional support in the form of branched-chain amino-acid-enriched solution, medium chain triglyceride, inorganic phosphate and multivitamins may be beneficial in sustaining liver function after hepatectomy. Intra-operatively, anaesthetic agents which are potentially harmful to the liver should be avoided, and haemodynamic monitoring to ensure adequate volume replacement should be made to maintain hepatic blood flow. The surgeon has to prevent unnecessary liver injury and excessive bleeding, and to exercise the technique meticulously avoiding bile leakage, haematoma and excessive rotation of the liver which may result in twisting of inflow and outflow vascular pedicles. Postoperatively, prolonged monitoring of haemodynamics is essential; the use of mechanical ventilation enables adequate administration of intravenous analgesics without respiratory depression and provides appropriate oxygenation of the liver and prevents pleural effusion. In the immediate postoperative period, continuation of parenteral nutrition would be beneficial to maintain a higher level of short half-life carrier proteins, decrease the requirement of diuretics to control ascites, induce less weight loss and reduce septic morbidity. Early resumption of enteral feeding may positively affect hepatic function and regeneration, and should be instituted as soon as the bowel function returns.

ISSN:0253-4886    

DOI:10.1159/000172316

出版商:S. Karger AG    

年代:1995

数据来源: Karger