發(fā)布時間：2018-03-01 01:32

  本文關(guān)鍵詞： 布加綜合征 肝癌 臨床特征 影像特征　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:布加綜合征(Budd-Chiari syndrome,BCS)是以肝靜脈或下腔靜脈于肝靜脈下腔靜脈開口處至右心房處的一段部分或全部梗阻而引起的以門靜脈高壓或門靜脈高壓合并下腔靜脈高壓為特征的一組疾病。終末期的布加綜合征可能發(fā)展成為肝癌。盡管目前不同國家和地區(qū),甚至單純我國的不同省份已報道了較多的臨床病例數(shù),目前關(guān)于布加綜合征合并肝癌的臨床特征、肝癌結(jié)節(jié)的影像學(xué)特征以及肝靜脈流出道阻塞的特征尚不十分明確。另外,針對布加綜合征合并肝癌的治療方法選擇亦無明確的診療規(guī)范或?qū)＜夜沧R。本研究的目的是總結(jié)在山東大學(xué)齊魯醫(yī)院診療的布加綜合征合并肝癌病人的臨床資料,描述布加綜合征合并肝癌的臨床和影像學(xué)特征,對布加綜合征合并肝癌的診斷、治療以及預(yù)后進行總結(jié),并對其可能機制做一定的探討。資料方法:回顧性分析了自2009年1月至2016年9月間于山東大學(xué)齊魯醫(yī)院就診的113例布加綜合征病人的臨床資料。將12例合并有肝癌病人的年齡、性別、癥狀持續(xù)或診斷為布加綜合征的時間、HBV/HCV病毒感染情況、Child-Puth分級、AFP、下腔靜脈阻塞情況以及肝癌結(jié)節(jié)的大小、數(shù)量、生長方式、腫瘤位置、有無門靜脈及肝靜脈侵犯等影像學(xué)特征進行了深入分析,并對針對布加綜合征及肝癌的不同的治療方法的效果進行了比較。結(jié)果:在我們收集的病例中,男性病人占多數(shù)。下腔靜脈阻塞或下腔靜脈阻塞合并肝靜脈阻塞的混合型是主要類型。梗阻的類型包括靜脈節(jié)段性狹窄、靜脈膜性狹窄以及靜脈血栓形成等。所有的病例中均存在有不同程度的肝硬化表現(xiàn)。在合并有肝癌的病人中僅有1例出現(xiàn)了門靜脈侵犯,無膽管侵犯出現(xiàn)。大多數(shù)腫瘤結(jié)節(jié)位于肝臟右葉,尤其是右后葉。腫瘤的位置均靠近肝臟邊緣。大多數(shù)腫瘤直徑超過3cm并為單一結(jié)節(jié)。在腫瘤結(jié)節(jié)的影像學(xué)方面,腫瘤的表現(xiàn)與乙肝等其他原因相關(guān)的原發(fā)性肝癌類似,在動脈期結(jié)節(jié)呈現(xiàn)不均勻強化,延遲期強化造影劑快速流出,呈現(xiàn)"快進快出"的表現(xiàn)。2例行肝切除的病人的病理結(jié)果均顯示高分化、低度惡性的病理特征。在治療方面,針對布加綜合征可以采用門體分流術(shù)、布加綜合征根治術(shù)以及下腔靜脈支架并血管成形術(shù);針對原發(fā)性肝癌則可以采用TACE、射頻消融治療以及肝部分切除術(shù)進行治療。結(jié)論:下腔靜脈狹窄或阻塞是布加綜合征合并肝癌的危險因素。肝癌結(jié)節(jié)呈現(xiàn)靠近肝臟邊緣、單一結(jié)節(jié)的特征。結(jié)節(jié)強化檢查特征與其他類型相關(guān)因素的肝癌類似。布加綜合征合并肝癌病人的肝癌結(jié)節(jié)侵襲性更小且其侵襲性僅與腫瘤結(jié)節(jié)的直徑相關(guān)。治療方面早期解除布加綜合征病人的肝靜脈流出道梗阻可延緩肝硬化及肝癌的發(fā)生,針對肝癌結(jié)節(jié)肝部分切除可以取得較好的療效,不能行腫瘤切除者可行消融治療以及序貫的TACE治療等。對行下腔靜脈支架植入術(shù)的病人,術(shù)后應(yīng)當(dāng)常規(guī)進行定期復(fù)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R575

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