转移性肝癌患者的临床特征分析

发布时间：2018-01-05 06:22

  本文关键词：转移性肝癌患者的临床特征分析　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 转移性肝癌 原发性肝癌 生化肝功 肿瘤标志物 影像学

【摘要】：目的:本文通过分析转移性肝癌患者的临床资料,总结其常见原发灶,并同原发性肝癌的临床表现、生化指标、影像学特点及治疗方法相比较,为早期诊断转移性肝癌和及时准确查找原发灶提供依据,进一步为转移性肝癌临床诊疗及预后评估提供参考。方法:采用回顾性分析的方法,收集整理2014年9月至2016年10月于大连医科大学附属第一医院首次确诊的221例转移性肝癌患者的临床资料,总结其原发灶来源及临床特征,并与同期首次住院确诊的200例原发性肝癌患者的临床资料进行对比,分析两组患者性别、年龄分布、既往史、临床表现、生化指标、影像学检查等方面的差异。采用受试者工作特征曲线(receiver operating characteristic,ROC)分析肿瘤标志物在两者鉴别诊断中的价值。结果:1.一般资料:221例转移性肝癌患者中,男性128例,女性93例,男女比例=1.37:1,年龄范围16-87岁,平均年龄62.13± 12.99岁;200例原发性肝癌患者中男性165例,女性35例,男女比例=4.71:1,年龄范围31-84岁,平均年龄58.87±9.34 岁。2.转移性肝癌肿瘤原发灶的构成:无论男性、女性患者,均以消化系统来源恶性肿瘤多见,其中大肠癌所占比例最高,其次为胃癌,第三是胰腺癌。除消化系统原发肿瘤病灶以外,男性患者以肺癌最多见,女性以乳腺癌、妇科肿瘤更多见。3.性别比较:转移性肝癌及原发性肝癌患者均以男性多见,转移性肝癌患者中,女性所占比例高于原发性肝癌组,差异有统计学意义(P0.01)。4.年龄比较:两组患者发病年龄均以老年患者为多。年龄在60-69岁者转移性肝癌患者所占比例低于原发性肝癌组,而年龄在70-79岁、80岁者高于原发性肝癌组,差异有统计学意义(P0.01)。5.临床症状、体征、既往史的比较:转移性肝癌组患者中,被体检发现者、腰背痛者、消化道出血者、具有腹部包块者分别高于原发性肝癌组,而具有腹痛、乏力、纳差、肝大、蜘蛛痣及肝掌的患者所占的比例低于原发性肝癌组,差异有统计学意义(P0.05)。转移性肝癌组患者中,有吸烟、饮酒史者,有乙肝、丙肝者,有肝硬化病史者均分别低于原发性肝癌组,差异有统计学意义(P0.05)。6.肿瘤标志物比较:转移性肝癌组患者中AFP阳性率低于原发性肝癌组,CEA、CA125、CA199阳性率分别高于原发性肝癌组,差异有统计学意义(P0.01)。其中AFP、CEA在ROC曲线下面积分别为0.908、0.840,提示有较好的诊断性能。7.生化肝功比较:两组患者生化肝功均高于正常对照组,原发性肝癌组患者升高更明显。转移性肝癌组患者中ALP、GGT、CHE均高于原发性肝癌组,而ALT、AST、TBIL、DBIL、TBA、AFU均低于原发性肝癌组,差异有显著统计学意义(P0.01)。8.影像学特点比较:转移性肝癌组患者中肿瘤位于肝左、右两叶者、肿瘤数目3个者、直径5cm者均高于原发性肝癌组,而位于肝右叶者、数目为单发者、直径5cm者、有门静脉癌栓者均低于原发性肝癌组,差异有统计学意义(P0.01)。转移性肝癌患者CT平扫多表现为类圆形或团片状低密度影或混杂密度影,边缘清楚或模糊,增强扫描多表现为门脉期环形强化,部分呈"牛眼征"。原发性肝癌组患者CT增强可见病灶迅速增强又迅速消退的特点,即"快进快出"。9.治疗方法:转移性肝癌组患者行保守治疗和化疗者最多,而原发性肝癌组行TACE、外科手术治疗者最多。结论:1.转移性肝癌患者中老年男性占绝大多数,原发灶多来源于消化系统。除消化道来源恶性肿瘤外,男性患者以肺癌多见,女性患者以乳腺及妇科肿瘤多见。2.转移性肝癌患者临床特征无特异性,与原发性肝癌相比,肝功能损伤程度较轻,血清ALP、GGT水平较高,肿瘤标志物以CEA、CA125、CA199升高为主,其中AFP、CEA的诊断性能较好。3.AFP、CEA对于转移性肝癌和原发性肝癌有较好的诊断性能。4.转移性肝癌患者中,肝转移癌灶以多发小结节为主,常散在分布于肝左右两叶,多无静脉癌栓,CT表现多样,平扫以不规则低密度灶为主,增强扫描部分显示"牛眼征"。5.针对转移性肝癌应积极采取外科治疗为主的综合治疗,延长生存期。
[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.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
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本文编号：1381929