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目的 为探讨乙型肝炎病毒 (HBV)相关性原发性肝癌 (PHC)的临床和病理特征。方法 经手术和病理证实的 2 0 0例PHC患者 ,依据病史、肝功能和乙肝五项标志的检测了解HBV感染史和感染模式 ,以及肝功能异常情况 ;分析肝组织病理学变化和手术所见 ,以探讨HBV相关性PHC的病理特征。结果 2 0 0例PHC患者中有 181例乙肝五项标志阳性 ,其总HBV感染率为90 5 %。以HBsAg、抗 -HBe和抗HBc的阳性率 ( 5 0 83 %)为最高 ,而HBsAg、HBeAg和抗 -HBc的阳性率仅为 4 97%。在PHC发生前 ,无HBV感染史和无症状HBV携带者分别占 61 3 3 %和 6 63 %。 8 2 9%的患者曾患肝炎治愈后无复发 ,有慢性乙肝和肝硬化病史及临床表现者仅分别占 2 2 10 %和 1 66%。约半数肝功能正常 ,异常者大都为轻度低蛋白血症 ,SB和ALT、AST轻～中度升高。肝组织病理特征如下 :肝细胞癌 (HCC)占 91 95 %,结节型、巨块型和小肝癌分别占 5 5 2 5 %、3 0 94%和 13 81%。多分布于肝右叶。静脉癌栓发生率为 12 71%。 86 3 2 %患者伴有肝硬化 ,多为活动期。结论 ⑴HBV与PHC关系密切 ,感染模式以HBsAg、抗 -HBe和抗 -HBc阳性为主。⑵HBV感染后肝脏病变隐匿进展。⑶多伴有活动性肝硬化。⑷PHC有诸多病理特征
Objective To investigate the clinical and pathological features of Hepatitis B virus (HBV) -related primary liver cancer (PHC). Methods Totally 200 patients with PHC confirmed by surgery and pathology were divided into two groups according to their history, liver function and the five markers of hepatitis B to find out the history of HBV infection and the mode of infection as well as the abnormal liver function. The pathological changes of liver and the findings of surgery To investigate the pathological features of HBV-associated PHC. Results Of the 200 patients with PHC, 181 were positive for hepatitis B with a total HBV infection rate of 90.5%. The positive rate of HBsAg, anti-HBe and anti-HBc (5 0 83%) was the highest, while the positive rate of HBsAg, HBeAg and anti-HBc was only 4 97%. Prior to PHC, 61.3% and 63.5% of patients had no history of HBV infection and asymptomatic HBV carriers, respectively. Eighty-nine percent of patients had no recurrence after being cured of hepatitis, and those with history of chronic hepatitis B and cirrhosis and clinical manifestations only accounted for 22 10% and 166%, respectively. About half of the normal liver function, abnormalities are mostly mild hypoalbuminemia, SB and ALT, AST mild to moderate increase. Pathological features of liver tissue were as follows: hepatocellular carcinoma (HCC) accounted for 91 95%, and nodular, massive and small hepatocellular carcinoma accounted for 55.25%, 3094% and 13.81%, respectively. More distributed in the right lobe of the liver. The incidence of venous thrombosis was 12 71%. 86 3 2% patients with cirrhosis, mostly active. Conclusion ⑴HBV and PHC are closely related to infection patterns to HBsAg, anti-HBe and anti-HBc positive. ⑵ HBV infection in liver disease occult progress. ⑶ accompanied by active cirrhosis. Â ’¢ PHC has many pathological features