Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo原发性肝癌诊治进展Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo流行病学n 全世界每年新发病例30万100万 n 全世界每年38.6万死于肝癌 n 我国每年发病率 20.40/10万n19.98/10万(城市）23.59/10万（农村） n 全国每年肝癌死亡率为20.4010万 n死亡率居肿瘤死亡率第二位n 手术切除率仅为20%30% Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo病毒性肝炎及肝炎后肝硬化 黄曲霉毒素 饮水污染及化学致癌物 代谢紊乱有关病 因 学Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoHBVHCVAlcoholMetabolic disordersChronic injury inflammationRegenerationGenetic/epigenetic alterationsHCCEnvironmential Factors(AFB1) Growth factor activation发病机制Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoHepatitisCirrhosisHCC15-20% develop Cirrhosis in 5 years Liaw et al. Hepatology 1988, Fattovich et al Gut 1991Risk of HCC increased by 200 folds Beasley et al. Lancet 1981, Liaw et al. Liver 19895-year survival 55% 40% of Asian men with CHB die of complications Weissberg et al. Ann Intern Med 1984, Beasley Lancet 1981乙肝病程Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo我国肝癌患者中有乙型肝炎病毒感染的约占90% 我国HBV的携带率约为10%，欧美为1% 每年还有100万新生儿在围产期获得HBV感染 五年内15%乙型肝炎发生肝硬化 肝硬化发生原发性肝癌的概率为9.9%16.6%乙肝流行病学Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoEuropean Association for the Study of the Liver (EASL) surveillance and recall strategy for HCCEuropean Association for the Study of the Liver (EASL) surveillance and recall strategy for HCC原发性肝癌诊断流程Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo原发性肝癌超声造影检查Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo原发性肝癌CT三期成像1231：平扫 2：动脉期 3：门脉后期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoTriphase Liver Protocol原发性肝癌诊断流程Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoT1WI、Varied T2WI原发性肝癌诊断流程Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo简单分期 AJCC/UICC分期 CLIP（Cancer of the Liver Italian Program）分期 Okuda 分期 BCLC（Barcelona Clinic liver Cancer）分期原发性肝癌分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo期：（亚临床期）无明显症状和 体征。期：出现临床症状或体征但无 期表现期：有黄疸、腹水、远处转移或恶液质之一者。原发性肝癌简单分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoPrimary Tumor (T)TXPrimary tumor cannot be assessedT0No evidence of primary tumorT1Solitary tumor without vascular invasionT2Solitary tumor with vascular invasion or multiple tumors none more than 5 cmT3Multiple tumors more than 5 cm or tumor involving a major branch of the portal or hepatic vein(s)T4Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneumAJCC/UICC分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoRegional Lymph Nodes (N)NXRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN1Regional lymph node metastasisDistant Metastasis (M)MXDistant metastasis cannot be assessedM0No distant metastasisM1Distant metastasisAJCC/UICC分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoStage GroupingStage IT1N0M0Stage IIT2N0M0Stage IIIAT3N0M0Stage IIIBT4N0M0Stage IIICAny TN1M0Stage IVAny TAny NM1AJCC/UICC分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoCLIP 分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoOkuda 分期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo5060年代肝脏外科解剖学基础上的极量切除 7080年代局部根治性切除理论 8090年代以手术治疗为主的综合治疗观念我国肝癌诊治的三个发展时期Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logol 手术治疗方法- 肝切除术，肝移植术 l微创治疗 TACE、PEI、 RFA l非手术治疗方法- 放疗 内放射（131I,90Y),立体定向- 化疗- 分子靶向治疗原发性肝癌治疗现状Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoBCLA原发性肝癌诊治流程Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logon患者全身状况n肿瘤部位、大小、数量n门静脉、肝静脉及胆管侵犯n肝内及肝外转移n肝硬化程度及肝功能代偿状况肝癌切除前评估Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoICG R15Pugh-Childs classificationCT volumetric study肝功能评估Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoChild-Turcotte-Pugh (CTP) ClassificationVariableVariable1 12 23 3Encephalopathy gradeEncephalopathy gradenonenone1-21-23-43-4AcitesAcitesAbsentAbsentSlightSlightmordermorder ateate Albumin(g/dL)Albumin(g/dL)3.53.52.8-2.8- 3.53.566Bilirubin(mg/dL)Bilirubin(mg/dL)33for cholestatic diseasefor cholestatic disease1010A:5-6, B:7-9, C:10-15Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo解剖第一肝门Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo解剖第二肝门Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany Logo解剖第三肝门Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoVIII Segment tumor VIII Segment tumorCASE-1Copyright by ARTCOM PT All rights reserved. www.art-com.co.krCompany LogoCUSA resection protect M