Early diagnosis of hepatocellular carcinoma in the patients with hepatic schistosomiasis japonica

山梨县医学院所在的多马町是日本血吸虫病的流行地区之一。该地区许多40岁以上的居民有血吸虫感染史，常伴有门脉高压伴广泛间质纤维化或肝钙化。乙型肝炎和酒精性肝硬化也常见于这些居民。因此，该区域被认为是肝细胞癌的高危区。血吸虫病肝超声检查可见明显的纤维化或钙化，有时妨碍无症状肝细胞癌的早期发现。在这种情况下，x线CT是进一步检查的选择。在1985年和1986年，我们对有血吸虫感染史的城市居民进行了调查，并试图找出这种隐匿的肝细胞癌病例。在260名住院医师的超声检查中，发现1例肝癌和1例胃癌合并肝转移。前者经肝动脉肿瘤栓塞治疗，后者因大量呕血而行胃切除术。1例经超声检查及高AFP值怀疑为肝细胞癌的患者转介进一步检查。73例居民因间质纤维化而行x线CT检查，发现2例疑似肝细胞癌，1例疑似肺癌。630例居民血清检测发现AFP阳性6例。其中2人恰好是同一癌症患者，1人是超声检查发现的疑似患者，AFP值高。另有3例无肝肿瘤。到目前为止，两年的经验告诉我们，在这些居民中发现肝细胞癌的有效研究如下。1) 40岁以上尽可能多的居民进行血清AFP的研究，2)超声检查肝恶性肿瘤，3)对血吸虫病肝纤维化明显者进行肝恶性肿瘤的x线CT检查。少

Tamahocho, where Yamanashi Medical College is located, was one of the endemic areas of schistosomiasis japonica in Japan. Many inhabitants older than 40 Years of age in this area have histories of schistosomas infection, and are often suffering from portal hypertension with extensive interstitial fibrosis or calcification of the liver. The hepatitis B and alcholic liver cirrhosis are also frequently found among these inhabitants. The area therefore is thought under the high risk condition for the hepatocellular carcinoma. Marked fibrosis or calcification, found in schistosomiasis liver with ultrasonographic examination, some time prevents early detection of silent hepatocellular carcinoma. X-ray CT is the choice of further examination in such a case. In 1985 and 1986, we examined our city inhabitants who have histories of schistomomas infection, and tried to find out such a occult case of hepatocellular carcinoma. Of 260 residents examined by ultrasonography, a patient with hepatocellu … More lar carcinoma and a patient with gastric carcinoma with hepatic metastases were found. The former was treated with hepatic transarterial tumor embolization, and the latter with gastrectomy for his massive hematoemesis. A patient, suspected of hepatocellular carcinoma by ultrasonography and high AFP value, was refered to further examination. Among 73 residents who were examined by X-ray CT in case ultrasonography had given poor information on hepatic tumors because of interstitial fibrosis, 2 patients suspected of hepatocellular carcinoma and a patient suspected of pulmonary carcinoma were found. Among 630 residents whose sera were examined, 6 patients with positive AFP were found. Of them, 2 were happend to be the same patients treated for their cancer, and one was the suspect found by ultrasonography and high AFP value. Another 3 had no hepatic tumors. Two-year experience taught us so far that the effective study of finding hepatocellular carcinoma among those residents are as follows. 1) Serum AFP study for as many residents of more than 40 years of age as possible, 2) screening with ultrasonography in detecting hepatic malignancy, and 3) X-ray CT in detecting hepatic malignancy for those who displayed marked hepatic fibrosis of schistosomiasis. Less