The diagnosis of hepatocarcinoma and standard _'s symptom by stages

The diagnosis of hepatocarcinoma and standard _'s symptom by stages
Primary hepatocarcinoma (call hepatocarcinoma in the following text) It is the common malignant tumour in our country. The diagnosis of hepatocarcinoma, especially diagnose, rely on various more auxiliary examination in early days. Is not mastered by a training doctor in order to standardize the diagnostic program and benefit, it is necessary to make a diagnostic standard. Hepatocarcinoma is a disease of going on development, healing solutions adopted in different disease period are different, the prognosis is also different, so there should also be one about phased standard. Wait for author one the intersection of hepatocarcinoma and diagnose and person who divide that put forward 1977 phased standard prevent and cure, study, cooperate at the meeting passing in national hepatocarcinoma, adopted by our country's medical personnels. Writing " norm of making a diagnosis and giving treatment of national malignant tumour " in 1990 and writing in 1997 although had change on a few characters while " newly organizing the norm of making a diagnosis and giving treatment of malignant tumour ", but the basic content has been continued to use for already more than 20 years so far. The diagnosis and treating the respect to make considerable progress of hepatocarcinoma over the past 20 years, the diagnostic standard should be revised, treat the intersection of respect and the intersection of surgery and enlargement of indication, perform the operation development of treatment make the intersection of hepatocarcinoma and phased standard need, make corresponding adjustment also. In recent years, the main suggestion on the diagnostic standard that the experts publish is the development that is diagnosed because of the image on some meetings or magazines, should not have a simple standard that relies on AFP to diagnose hepatocarcinoma again, the hepatocarcinoma case negative to AFP should do other hepatocarcinoma marks to check etc.. But standard opinion 2 stage step, spend loud in the past standard mainly by stages to hepatocarcinoma. It is too simple to describe, is unfavorable to differentiating the detailed conditions and should consider TNM standard issued of entering into an alliance with international anticancer to integrate etc.. Once have a simplicity that relied on AFP to diagnose the standard of hepatocarcinoma in the hepatocarcinoma diagnostic standard of 1977 truly, it describes as " AFP> 400 g/L, lasts 4 weeks, and can getting rid of gestation, active hepatopathy, gonadial embryo source tumour and shifting hepatocarcinoma person ", can diagnose as primary hepatocarcinoma " . This standard is that the case of detection AFP high density was set up in large-scale hepatocarcinoma general survey for adapting to at that time. Really, it is primary hepatocarcinoma to really accord with the above-mentioned standard case overwhelming majority, but it is difficult to carry out, because active hepatopathy is difficult to get rid of. Moreover, the diagnosis of hepatocarcinoma should include the diagnosis of determining the nature and makes a reservation and diagnose two parts, even diagnosed hepatocarcinoma according to the above-mentioned standard, but the unable treatment of injecting surgery excising, radiotherapy, some alcohol etc. that hepatocarcinoma can't make a reservation. The purpose to diagnose is to treat, if can't meet the needs of treating, diagnose that can't be regarded as completely. So discussed on November 29, 1999 to the national hepatocarcinoma academic meeting on the fourth that is held on December 1 through everybody warmly, passed a new hepatocarcinoma in principle to diagnose Standard (see the page 135 countermeasure of number 3 of Vol. 8 of " Chinese liver disease magazine " study the column) . Standard article 1 this at the intersection of AFP and positive foundation in addition, image learn, check, have the intersection of hepatocarcinoma and characteristic nature take the intersection of location and the intersection of and pathological change. This accords with and determines the nature, orients the requirement of two respects. Natural and AFP positive to need, get rid of false and positive having, taking the intersection of location and the intersection of and pathological change, taking with hepatocarcinoma characteristicking also also, it should be accurate. Article 2 has explained AFP fails to reach the above-mentioned generally acknowledged standard, no matter it increases or normal, all should have two the intersection of image and diagnose or two mark positive to add one evidence that image diagnoses hepatocarcinoma. The case finding AFP negative in the clinical work in recent years is increasing constantly, the arrangement of this string is very essential. Because of failing to have AFP positive such an effective diagnosis basis, diagnoses in the image the respect should seek more evidences. Or increase again other the intersection of hepatocarcinoma and the intersection of diagnosis and basis of mark, but other the intersection of hepatocarcinoma and specificity that mark diagnose inferior to AFP, so it is positive to demand to have two kinds of comparatively reliable marks at least, its purpose is for increasing the dependability diagnosed naturally. Article 3 is set up by case in later period, the symptom physical sign of hepatocarcinoma has been already clear, in addition, shift the focus, it is not that shifting hepatocarcinoma should be unlikely to be wrong. The phased purpose of hepatocarcinoma is to choose the healing solution and estimate the prognosis for helping. Take an exam of all history, put forward one on Zeng with liver function and dissect the position as the accurate phased standard as far back as an thematic meeting of international hepatocarcinoma in Canberra of Uganda of 1971. Japan field Nation male and proposes another phased method according to characteristic of the Japanese hepatocarcinoma patient after their. The phased method that our country put forward in 1977 is and put forward according to the fact of a lot of clinical previous hepatocarcinoma of large-scale hepatocarcinoma general survey detection of the beginning of the seventies, namely hepatocarcinoma which does not have symptom and physical sign is a issue of hepatocarcinoma, jaundice, ascites, evil liquid quality or persons who are shifted of distant place are one, it is 2 stage that is between the two. Brief and concise and applicable. Certainly, the stepping and is spent greatly and failing to state it with the portal vein cancer bolt again of 2 stage, such phased key elements as liver door and coeliac lymph node are shifted, entered into an alliance with international anticancer TNM released has been there far by stages, so should indeed revise. TNM T by stages means tumour, N point liver door lymph node, M and mean shifting in the distant place. Whether T is greater than 2cm, have blood vessels to soak and subdivide in a leaf,etc. into T1- T4 in accordance with tumour, different T, N, M make up, 2, A, B, A, the intersection of B and 6. TNM is very fine and smooth by stages, hitting depending on whether there is little and vascular infiltration in week of cancer by stages of T1- T3 by stages of especially T, it is phased so actually a building on the basis of checking in pathology. Can it makes cases that operations excises to be little because of hepatocarcinoma, it obtains chances that pathology checks to be little, so TNM a lot of difficulties in practical application by stages. Especially TNM has not considered that amalgamate the situation of liver cirrhosis by stages, but the liver function situation of liver cirrhosis restrains the healing solution from choosing and estimating the important factor of the prognosis especially, so we proposed a phased standard after gathering some expert opinions at the national hepatocarcinoma academic meeting on the fourth. The new phased standard should be able to roughly communicate with our country's past standard and TNM standard, in order to utilize the past materials and international academic exchange of participation. Have different opinion still at present as to the standard, as follows, mainly (1)In line with international standards and adopt TNM by stages, needn't another draft the phased standard directly. (2) Answer the diameter while being interim (3)Needn't list liver function in, grade in the phased standard of hepatocarcinoma, can hierarchical situation another row of liver function. We think we carry on hepatocarcinoma
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