摘要
背景与目的:同时性双原发性肝细胞癌和肝内胆管癌(sdpHCC-ICC)极为罕见。在此,笔者报告9例sdpHCC-ICC病例的诊治过程,探讨该病的临床特点及手术预后,以提高临床认识。方法:回顾性收集2016年1月—2022年12月中国人民解放军总医院第五医学中心9例经术后病理证实为sdpHCC-ICC患者的临床资料,分析其临床表现、发病机制、影像学与病理特征及手术预后。结果:所有患者均为男性,均合并慢性肝炎,其中8例为乙型肝炎病毒感染,7例有长期饮酒史。肝细胞癌和肝内胆管癌肿瘤标志物均升高2例,术前影像均未能正确诊断。所有患者均接受手术治疗,经术后病理组织学证实均为sdpHCC-ICC,6例患者肝内病灶同时表达CD34。术后随访时间为2~58个月,2例分别于术后6个月与20个月复发,另7例至撰稿日未见复发。结论:sdpHCC-ICC的肿瘤细胞起源不一,可表现为单克隆起源,也可表现为多克隆起源,长期饮酒可能是其危险因素之一,手术切除仍是有效治疗方法,肝内胆管癌成分及其肿瘤分期为影响手术预后的主要因素之一,淋巴结清扫应纳入手术规划,肝动脉化疗栓塞对肝细胞癌成份有效。
Background and Aims:Synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma(sdp HCC-ICC)is extremely rare.Here,the authors report the diagnosis and treatment process of 9 cases of sdp HCC-ICC,and investigate the clinical characteristics and postoperative prognosis of this condition,so as to raise clinical awareness.Methods:The clinical data of 9 patients with sdp HCC-ICC(as confirmed by postoperative pathology)treated in the Fifth Medical Center of Chinese PLA General Hospital between January 2016 and December 2022 were retrospectively collected.The clinical manifestations,pathogenesis,imaging features,pathological characteristics,treatment strategy,and prognosis were evaluated.Results:All patients were male with a history of chronic hepatitis,including 8 patients infected with hepatitis B,7 patients with long-term alcohol consumption,2 patients with elevated hepatocellular carcinoma and intrahepatic cholangiocarcinoma markers.Preoperative imaging examinations failed to make the correct diagnosis in all patients.All patients received surgical treatment and were identified as sdp HCC-ICC by postoperative pathological diagnosis.The intrahepatic lesions in 6 patients simultaneously expressed CD34.The postoperative follow-up was conducted for 2 to 58 months,relapse occurred in 2 patients on 6 and 20 months after operation,respectively,and no relapse occurred in the other 7 patients as of this manuscript writing.Conclusion:The tumor cells of sdp HCC-ICC have different origins,which can be a monoclonal or multiclonal origin.Long-term alcohol consumption may be one of the risk factors.Surgical resection is still an effective treatment.The tumor stage of the intrahepatic cholangiocarcinoma components is one of the main factors affecting the prognosis of surgery.Lymph node dissection should be included in the surgical plan.Transcatheter arterial chemoembolization is effective for HCC components.
作者
高远
李虎城
邵艳玲
严锦
曹李
GAO Yuan;LI Hucheng;SHAO Yanling;YAN Jin;CAO Li(Department of General Surgery,Beijing Mentougou District Hospital,Beijing 102300,China;Department of Hepatobiliary Surgery,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2023年第2期200-210,共11页
China Journal of General Surgery
关键词
肝肿瘤
癌
肝细胞
胆管上皮癌
肝祖细胞
预后
Liver Neoplasms
Carcinoma,Hepatocellular
Cholangiocarcinoma
Hepatic Progenitor Cells
Prognosis
