布加综合征合并肝癌的临床特征分析和文献复习

发布时间：2018-03-01 01:32

本文关键词： 布加综合征肝癌临床特征影像特征　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:布加综合征(Budd-Chiari syndrome,BCS)是以肝静脉或下腔静脉于肝静脉下腔静脉开口处至右心房处的一段部分或全部梗阻而引起的以门静脉高压或门静脉高压合并下腔静脉高压为特征的一组疾病。终末期的布加综合征可能发展成为肝癌。尽管目前不同国家和地区,甚至单纯我国的不同省份已报道了较多的临床病例数,目前关于布加综合征合并肝癌的临床特征、肝癌结节的影像学特征以及肝静脉流出道阻塞的特征尚不十分明确。另外,针对布加综合征合并肝癌的治疗方法选择亦无明确的诊疗规范或专家共识。本研究的目的是总结在山东大学齐鲁医院诊疗的布加综合征合并肝癌病人的临床资料,描述布加综合征合并肝癌的临床和影像学特征,对布加综合征合并肝癌的诊断、治疗以及预后进行总结,并对其可能机制做一定的探讨。资料方法:回顾性分析了自2009年1月至2016年9月间于山东大学齐鲁医院就诊的113例布加综合征病人的临床资料。将12例合并有肝癌病人的年龄、性别、症状持续或诊断为布加综合征的时间、HBV/HCV病毒感染情况、Child-Puth分级、AFP、下腔静脉阻塞情况以及肝癌结节的大小、数量、生长方式、肿瘤位置、有无门静脉及肝静脉侵犯等影像学特征进行了深入分析,并对针对布加综合征及肝癌的不同的治疗方法的效果进行了比较。结果:在我们收集的病例中,男性病人占多数。下腔静脉阻塞或下腔静脉阻塞合并肝静脉阻塞的混合型是主要类型。梗阻的类型包括静脉节段性狭窄、静脉膜性狭窄以及静脉血栓形成等。所有的病例中均存在有不同程度的肝硬化表现。在合并有肝癌的病人中仅有1例出现了门静脉侵犯,无胆管侵犯出现。大多数肿瘤结节位于肝脏右叶,尤其是右后叶。肿瘤的位置均靠近肝脏边缘。大多数肿瘤直径超过3cm并为单一结节。在肿瘤结节的影像学方面,肿瘤的表现与乙肝等其他原因相关的原发性肝癌类似,在动脉期结节呈现不均匀强化,延迟期强化造影剂快速流出,呈现"快进快出"的表现。2例行肝切除的病人的病理结果均显示高分化、低度恶性的病理特征。在治疗方面,针对布加综合征可以采用门体分流术、布加综合征根治术以及下腔静脉支架并血管成形术;针对原发性肝癌则可以采用TACE、射频消融治疗以及肝部分切除术进行治疗。结论:下腔静脉狭窄或阻塞是布加综合征合并肝癌的危险因素。肝癌结节呈现靠近肝脏边缘、单一结节的特征。结节强化检查特征与其他类型相关因素的肝癌类似。布加综合征合并肝癌病人的肝癌结节侵袭性更小且其侵袭性仅与肿瘤结节的直径相关。治疗方面早期解除布加综合征病人的肝静脉流出道梗阻可延缓肝硬化及肝癌的发生,针对肝癌结节肝部分切除可以取得较好的疗效,不能行肿瘤切除者可行消融治疗以及序贯的TACE治疗等。对行下腔静脉支架植入术的病人,术后应当常规进行定期复查。
[Abstract]:Objective: Budd Chiari syndrome (Budd-Chiari syndrome, BCS) with hepatic vein or inferior vena cava in hepatic vein and inferior vena cava to right atrium at the opening of a part or all of the obstruction of portal hypertension of portal hypertension complicated with inferior vena cava pressure characteristics of a group of diseases caused by end-stage. Budd Chiari syndrome may become HCC. Although different countries and regions, and even simple in China in different provinces have reported the number of cases more, at present about the clinical features of Budd Chiari syndrome with liver cancer, hepatocellular carcinoma and the imaging features of hepatic venous outflow obstruction in a feature is not very clear. In addition, for the treatment of Budd Chiari method there is no choice syndrome with liver cancer diagnosis standard or expert consensus clear. The purpose of this study was to summarize the diagnosis and treatment of Budd Chiari in Qilu Hospital of Shandong University syndrome with liver disease The clinical data, describe the clinical and imaging features of Budd Chiari syndrome complicated with liver cancer characteristics of Budd Chiari syndrome with liver cancer diagnosis, treatment and prognosis were summarized, and the possible mechanisms are discussed. Methods: a retrospective analysis of clinical data of patients from January 2009 to September 2016, 113 cases of Budd Chiari in Qilu Hospital of Shandong University treatment of the syndrome. 12 cases with liver cancer patient's age, gender, duration of symptoms or diagnosis of Budd Chiari syndrome, HBV/HCV virus infection, Child-Puth classification, AFP, as well as the size, the number of nodules of inferior vena cava obstruction, tumor location, growth pattern, there is no portal vein and hepatic vein invasion and imaging characteristics were analyzed, and the different methods of treatment for Budd Chiari syndrome and liver cancer were compared. Results: in our series In male patients, the majority. Obstruction of the inferior vena cava or inferior vena cava mixed with hepatic vein obstruction is the main type. The obstruction types include venous segmental stenosis, membranous stenosis and venous venous thrombosis. The liver sclerosis have varying degrees of all cases in patients with liver cancer. The patient only 1 patients had portal vein invasion, no bile duct invasion. Most tumor nodules located in the right lobe of the liver, especially the right posterior lobe. The tumor location was near the edge of liver. Most tumor diameter more than 3cm and a single nodule. In the field of tumor nodules images, tumor and other manifestations of hepatitis B the related primary hepatic carcinomas, showed uneven nodular enhancement in the arterial phase, delayed phase enhanced contrast agent rapid outflow, pathological results showed.2 underwent hepatic resection Kuaijinkuaichu "patients Showed high differentiation, pathological features of low-grade malignant. In the treatment of Budd Chiari syndrome, can be used for portosystemic shunt, radical surgery for Budd Chiari syndrome and inferior vena cava stent and angioplasty; for primary liver cancer can be used TACE, radiofrequency ablation and liver resection treatment. Conclusion: inferior vena cava stenosis or obstruction is a risk factor for Budd Chiari syndrome with liver cancer. Liver nodules appear near the edge of liver, characteristics of single nodules. Nodular enhancement examination of factors related to characteristics with other types of liver cancer. Similar liver nodules in Budd Chiari syndrome patients with liver cancer less invasive and the diameter of the invasive tumor nodules and only related treatment. Early termination of Budd Chiari syndrome in patients with hepatic venous outflow obstruction can delay the occurrence of liver cirrhosis and hepatocellular carcinoma, liver resection for hepatocellular carcinoma nodules can be obtained Good curative effect is not acceptable for patients with tumor resection, feasible ablation treatment and sequential TACE treatment. For patients with inferior vena cava stent implantation, regular postoperative reexamination should be carried out.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R575

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