(
课件网) 第八章 消化系统疾病 Alimentary system ① 低蛋白血症 Hypoalbuminaemia ② 出血 ③ Ascites 腹水 ④ 肝性脑病 ⑤ 激素灭活障碍 肝功能衰竭 Hepatic failure Palmar erythema Spider angioma (nevus) in skin “SPIDER” ANGIOMA, CIRRHOSIS Gynecomastia A 32 year old male patient with normal secondary sex characteristics, no testicular mass, no history of drug ingestion, no other endocrine abnormalities and a normal neurological examination. Nevertheless, he had a history of more than 15 years of large amounts of alcohol intake and a liver biopsy confirm alcoholic cirrhosis (Laennec's Cirrhosis). Primary carcinoma of the liver I . Definition 起源于肝细胞或肝内胆管上皮细胞的恶性肿瘤 II . Etiology ① Aflatoxin, which contaminates food stored in humid conditions ② Inflammatory of HBV （80%） or HCV ③ Excessive drinking 酗酒 Hepatic cirrhosis （70%）肝硬化 It is a premalignant condition and associated with an increased risk of liver cell carcinoma III . Pahthological changes Grossly : 早期肝癌 （小肝癌 ） 单个癌结节 D ＜ 3cm 结节数目 ≤ 2 ，∑D ＜ 3cm 球状或分叶状，界清 切面无出血坏死 患者无临床症状 AFP （+） 中晚期肝癌 ① 巨块型 D ＞ 5 ~ 10 cm 单个 ，右叶 中央出血坏死 周围散布卫星病灶 Unifocal Unifocal Unifocal ② 结节型 （ 最多见 ） 继发于严重肝硬化，多个，D ＜ 5 cm 切面黄褐色，肝表面凹凸不平 ③ 弥漫型 （ 少见 ） 无明显结节 Multifocal Histologically : ① Hepatocellular carcinoma 80 ~ 90 % 多角形 ，胞浆丰富红染 可合成胆汁 癌组织呈灰绿色 癌巢之间有丰富的血窦 ② adenocarcinoma of bile ducts 胆管细胞癌 20 % ， 腺癌 （ 单纯癌 ），源于肝内小胆管上皮细胞 Ⅳ. Spread of the carcinoma 淋巴道转移 肝门淋巴结 左锁骨上淋巴结 种植性转移 肝包膜波及 ③ 混合细胞型肝癌 两种癌结构共存，少见 血道转移 肝静脉 肝外转移 （ 肺、骨、肾上腺 ） 直接蔓延 肝内门静脉转移 卫星癌结节 癌栓 结肠腺癌肝转移 Metastases Ⅴ. Clinical features and prognosis 早期 AFP （+），* 胆管细胞癌 AFP （—） 中晚期 肝区疼痛 （ 胀痛、钝痛 ）、肝肿大 （ 进行性 ） 门脉高压症状、转移灶症状 The patients will die in half a year without treatments. 自然生存期 Surgical resection is the most efficient way , only when it is early 早期手术 5 – year survival after the operation 术后5年生存率 is less than 20% in the patients who have symptoms and 60% in the patients without symptoms Multifocal In the better differentiated variants, globules of bile may be found within the cytoplasma of cells and in pseudocanaliculi between cells Cholangiocarcinoma Clinical features Patients with cirrhosis Rapid increase in liver size Sudden worsening of ascites Bloody ascites Fever, pain Very high levels of a-fetoprotein >1000ng/ml Clinical features Death caused by Profound cachexia Gastrointestinal or esophageal variceal bleeding Liver failure with hepatic coma Rupture of the tumor with fatal hemmorrhage Media survival is 7months Clinical features HCC tend to remain confined to the liver until late in the course Surgical resection with recurrence rate of 60% in 5 years Liver tra ... ...
