超声引导下经皮肝穿注射缓释剂治疗原发性肝癌

目的研究超声引导下经皮肝穿注射缓释剂治疗原发性肝癌。方法随机选取我院经病理活检确诊为原发性肝癌的患者78例,并观察治疗前后所有患者的肝功能、AFP、肿瘤大小、生存时间和分析超声引导下经皮肝穿注射无水乙醇以及5-氟尿嘧啶缓释剂治疗原发性肝癌临床疗效。结果经皮肝穿注射缓释剂治疗3个月、6个月后原发性肝癌患者与术前对比,患者的肝功能显著改善,AFP值显著减少(P0.01)。8例患者经治疗后6个月肿瘤消失,62例患者经治疗后肿瘤直径缩小以及边界模糊,5例患者经治疗后肿瘤边界清晰。经治疗后,患者的半年存活率为94.9%(74/78),1年存活率为64.1%(50/78),三年存活率为19.2%(15/78)。结论原发性肝癌患者经超声引导下经皮肝穿注射无水乙醇以及5-氟尿嘧啶缓释剂的治疗方法有可靠的临床疗效,且操作方便、安全、快捷,临床上宜大力提倡。     

经皮射频消融治疗巨大肝癌

目的总结冷循环射频消融(RFA)治疗巨大肝癌的临床疗效和经验。方法采用CT引导下经皮穿刺冷循环RFA治疗巨大肝癌24例,每个病灶进行射频消融1～4次,其中22例患者结合1～6次TACE治疗,术后通过增强CT或MR评价疗效,所有病例随访12～37个月。结果10例病灶完全坏死,余14例病灶大部分坏死,1年生存率83%,中位生存时间20个月,13例患者现仍存活。结论CT引导下经皮穿刺冷循环RFA治疗巨大肝癌安全、有效。     

CT引导下乙醇消融术治疗肝转移瘤

目的 探讨CT引导下无水乙醇消融术(PEI)在肝转移性肿瘤治疗中的价值.方法 53例肝转移性肿瘤,共计87个病灶.18个病灶直径≤1 cm;56个病灶直径1～3 cm;13个病灶直径3～5 cm.采用CT引导下无水乙醇瘤内注射进行治疗,经过1次或多次治疗,观察肝转移瘤的坏死情况.结果 PEI治疗后1个月MR或CT复查,18个直径≤1 cm的病灶完全坏死率为100%;直径1～3 cm 56个病灶完全坏死率为87.5%,再次治疗后完全坏死;13个病灶直径3～5 cm的病灶完全坏死率为61.5%,经过2～3次治疗,病灶彻底坏死.结论 CT引导下无水乙醇消融术治疗肝转移性肿瘤疗效满意,尤其适用于直径≤3 cm的单个病灶.     

超声引导微波热凝联合无水乙醇注射和门脾静脉灌注对肝癌的治疗研究

目的:探讨综合性超声介入疗法对中晚期肝癌的疗效。方法:50例经活检证实的肝癌依据肿瘤的大小和数目分为:一组,肿块直经<3.0cm,个数<2个。二组:肿块直径3.1~5.0cm,个数<2个。三组:肿块直径>5.0cm,个数≥1。超声引导下经皮经肝穿刺肿瘤,分别采用单纯微波热凝(PMCT)(方案1a)、或单纯无水乙醇肿瘤间质内注射(PEIT)(方案1b)、微波热凝 无水乙醇肿瘤间质内注射(方案2)、微波热凝 无水乙醇肿瘤间质内注射 门(脾)静脉穿刺灌注化学药物(方案3),不同的介入治疗方法。治疗后定期行超声、CT、肝穿活检、随访观察其疗效并加以比较。随访时间10个月至5年。结果:直经<3.0cm,个数<2个小肝癌单纯微波热凝和单纯无水乙醇注射1、23、、年生存率无差异。肿块直经3.0~5.0cm者方案2优于方案1a、1b。肿块>5.0cm多结节肝癌或伴门脉癌栓者,方案3优于方案2。综合性介入治疗肝癌的总有效率均高于方案1a和方案1b。结论:该方案设计合理,疗效确切,操作便利,安全可靠,费用低,值的推广。     

超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿

目的评价超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿的效果。方法46例单纯性肾囊肿患者(男性26例,女性20例,平均年龄65岁)均经超声引导经皮穿刺抽吸和注射无水乙醇硬化治疗。全部操作是在局部麻醉下完成的。治疗后,全部病人经超声或CT随访1至6个月。囊肿与治疗前比较,减小2/3以上为有效,完全消失为治愈。结果46个囊肿中,2个囊肿抽出液蛋白定性试验阴性,抽液后未注入无水乙醇,其余44个囊肿于治后1,3,6个月呈进行性缩小,6个月时复查有效率为100%,治愈率为90.6%。结论超声引导经皮穿刺抽吸和注射无水乙醇是治疗单纯性肾囊肿的一种操作简单、痛苦小、费用低、安全有效的方法,值得临床推广应用。     

CT引导下射频消融术在肝脏恶性肿瘤治疗中的临床应用

目的评价肝动脉化疗栓塞(TACE)联合全麻下CT引导下经皮穿刺射频消融(RFA)治疗肝脏恶性肿瘤的疗效。资料与方法原发性肝癌患者20例,肿瘤切除术后复发6例,肝转移瘤5例,男23例,女8例,年龄40～74岁。所有患者均先行TACE术(1～2次),然后在全麻CT引导下经皮穿刺行RFA治疗,其中2例联合手术行RFA治疗,2例做了2次RFA治疗。随诊2～36个月,观察并发症和疗效。结果 31例患者共进行43次RFA治疗,未出现任何严重并发症。23个肿瘤完全坏死,11个部分坏死。结论 TACE联合全麻下CT引导下RFA治疗肝脏恶性肿瘤是一种有效的微创治疗方法。     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

肝动脉化疗栓塞结合经皮肝穿刺瘤内注射醋酸治疗原发性肝癌的疗效观察

目的　观察肝动脉化疗栓塞 (TACE)结合B超引导下经皮肝穿瘤内注射 30 %醋酸 (PAI)治疗原发性巨块型肝癌的临床疗效。方法　对 2 3例中、晚期巨块型肝癌均先采用TACE ,术后 15～ 2 0d再在B超引导下PAI 2～ 3次。结果　治疗 2个周期后比较患者治疗前后AFP降低程度和肿块缩小情况 ,差异有显著性 (P <0 .0 1) ,1、2年生存率分别为 91%和 82 %。结论　TACE结合B超下PAI治疗中、晚期巨块型肝癌有较好的临床疗效。     

CT导向下无水乙醇硬化治疗肝囊肿

目的评价在CT导向下经皮穿刺硬化治疗肝囊肿的临床价值。方法63例肝囊肿患者,其中41例单发,22例多发,均任CT导向下经皮穿刺注射无水乙醇行硬化治疗。结果63例患者随访3～15个月,疗效指数0级4例(6.3%),Ⅰ级8例(12.7%),Ⅱ级23例(36.5%),Ⅲ级28例(44.4%)。硬化治疗总有效率为93.6%。未出现严重的并发症。结论无水乙醇硬化治疗肝囊肿安全、经济、简单、有效。     

超声引导下穿刺置管引流加无水乙醇注射治疗单纯性肾囊肿

目的　探讨彩超引导下穿刺置管引流加无水乙醇注射治疗单纯性肾囊肿的疗效。方法　在彩超引导下 ,对 60例直径在 5～ 15cm的单纯性肾囊肿穿刺置管引流 ,并且间断注射无水乙醇 1～ 3次 ,彩超复查囊肿大小变化。结果　穿刺治疗后 1,3 ,6个月复查彩超 ,治愈 49例(81.1% ) ,显效 8例 (13 .4% ) ,无效 3例 (5 .0 % )。结论　 (1)彩超引导下穿刺置管引流加无水乙醇注射是治疗单纯性肾囊肿的有效方法 ,操作简单、创伤小。 (2 )防止置管脱落是保证疗效的关键。     

Computed tomography demonstration of immediate and delayed complications of computed tomography-guided transthoracic percutaneous ethanol injection of hepatocellular carcinoma at the liver dome

OBJECTIVE: We conducted this study to correlate computed tomography (CT) images with the complications induced by CT-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). METHODS: Twenty-two patients with ultrasonographically unreachable HCC were treated with CT-guided transthoracic PEI. The procedures and the CT findings were recorded to correlate with the various complications of PEI. RESULTS: After the ethanol injection, 3 patterns of CT images were identified according to the distribution of ethanol (ie, intratumoral, extrahepatic, and intrahepatic patterns). The intrahepatic pattern was further classified as the branch, tubular, and infiltrative types. During the follow-up period, 3 patients developed biliary stricture, portal vein thrombosis, or tumor seeding. The tubular type was associated with the development of biliary stricture, whereas the branch type was related to the occurrence of portal vein thrombosis. These complications were considered to be caused by a greater amount of ethanol leakage into bile ducts or portal veins than in cases without complications (median = 17 mL vs. 0 mL, P = 0.002). CONCLUSIONS: Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.     

Large infiltrative hepatocellular carcinomas: treatment with percutaneous intraarterial ethanol injection alone or in combination with conventional percutaneous ethanol injection

PURPOSE: To retrospectively evaluate patients' tolerance and the effectiveness of percutaneous intraarterial ethanol injection (PIAEI), alone or combined with conventional percutaneous ethanol injection (PEI), for treatment of advanced hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for this retrospective study; however, all patients had given their consent to be treated with PIAEI. Fourteen men and four women with cirrhosis and HCC who were ineligible for conventional curative treatment (largest tumor diameter, 35-90 mm; mean, 52 mm +/- 16 [standard deviation]) and whose supplying arteries were visible on computed tomographic (CT) and color Doppler ultrasonographic (US) images were treated with US-guided PIAEI-either alone or combined with PEI. Twelve patients had infiltrative tumors, and six had nodular tumors. Four patients had portal venous tumor involvement. Tumor necrosis and recurrence were evaluated with CT, and 1- and 2-year survival rates were evaluated with Kaplan-Meier analysis. RESULTS: In four patients, the main tumor was treated with PIAEI only, and in 14 patients, the main tumor was treated with combined PIAEI and PEI. One patient died of myocardial infarction before CT evaluation. Tumor necrosis was complete in 15 (88%) and incomplete in two (12%) of 17 patients. Results of subsequent surgery performed in three patients confirmed the radiologic findings: complete tumor necrosis in two patients and incomplete necrosis in one patient. Two severe PIAEI-related complications occurred: liver abscess, which resolved, and fatal acute pancreatitis. During the follow-up period (mean, 15 months +/- 6.7), six patients died owing to recurrent HCC, and 10 patients were alive with no detectable tumor after a mean follow-up period of 18 months +/- 11. One- and 2-year survival rates were 76.6% and 44.5%, respectively. CONCLUSION: For patients with advanced HCC who are ineligible for other curative options, PIAEI could be an effective treatment, despite the associated risk of severe complications.     

经肝动脉灌注131I-HAb18F(ab'''')2治疗肝癌合并门静脉癌栓疗效分析

目的 探讨经肝动脉灌注131I-HAb18F(ab')2治疗肝癌合并门脉癌栓的价值.方法 8例合并门脉癌栓的晚期肝癌患者行经肝动脉超选择灌注131I-HAb18F(ab')2临床治疗性试验,剂量:0.75 mCi/kg.分析症状、卡氏评分、肝功能、AFP及肿瘤CT等影像变化,随访近期疗效.结果 7例疼痛患者中,3例症状缓解.3例卡氏评分增加、4例稳定.6例AFP异常患者治疗后3例下降.全组病例用药后肝功能损害均无明显加重.1例无明显症状的弥漫型肝癌患者治疗后病灶减少;余7例中,瘤体增大5例、缩小2例,其中,PR 2例,临床有效率28.6%.本组1例1年随访时生存.结论 经肝动脉灌注0.75 mCi/kg 131I-HAb18F(ab')2对合并门脉癌栓的肝癌患者肝功影响小,对门脉分支癌栓患者有较好的疗效.     

Percutaneous ethanol injection as a possible curative treatment for malignant portal vein thrombosis in hepatocellular carcinoma

Postoperative residual hepatocellular carcinoma(HCC) with malignant portal vein thrombosis in a 48-year-old man was cured with transarterial chemoembolization (TACE) for the parenchymalportion and percutaneous ethanol injection (PEI) for the malignantportal vein thrombosis. No evidence of tumor recurrence was noted after18 months of follow-up. The only severe complication in our patient wasbiliary stricture which was treated with an internal stent viaendoscopic retrograde pancreatico-cholangiography (ERCP).     

肝癌合并动静脉瘘的处理方法探讨

目的：研究肝癌介入治疗中对肝癌合并肝动脉肝静脉瘘和肝动脉门静脉瘘的处理方法。方法：对5例肝动脉肝静脉瘘患者（A组）先行在瘘口附近多点，多次的经皮无水酒精注射消融术（PEI）后，再行经导管肝动脉栓塞术（TAE）。对26例肝动脉门静脉瘘者（B组）则将超微导管头端越过瘘口后进行栓塞，再用带毛钢圈或无水乙封闭瘘田，结果：A组动脉脉瘘消失及明显减少40例，无效10例。在消融后TAE碘油沉积良好的38例中，37例PEI在4次以上，B组26例经1－2次治疗后，全部达到中止门静脉分流的目的，表现为TAE碘油沉积良好25例，门静脉压力明显下降，其中腹力减水23例，上消化道出血的2例均于术后1d止血。结论：上述2种方法处理肝癌合并动脉脉瘘后，能令碘油药物更好地在肿瘤内沉积，避免或减少了碘油导致肺梗死或门静脉压力进一步升高的危险性，提高了肝癌介入治疗的效果。     

VX2兔肝门静脉主干癌栓模型建立的实验研究

目的 利用原位种植的方法制备VX2兔肝门静脉主干癌栓动物模型,观察癌栓生长过程中的影像学与病理学特点.方法 新西兰大白兔24只,随机分为实验组(16只)和对照组(8只).实验组通过外科手术方式将VX2瘤块固定于门静脉主干内壁.对照组取自体肌肉组织块以同样方法固定于门静脉主干内壁.术后分别于第7、14、21天和第28天对2组兔进行CT检查.实验组每个观察点随机取3只兔进行DSA检查,随后处死作病理学检查.对照组在每个观察点完成CT检查后随机取1只兔处死做病理检查.剩余兔观察生存时间.结果 实验组16只兔中15只顺利完成手术,接种成功率93.8%,15只兔门静脉主干内均形成癌栓,剩余3只兔平均生存时间为(39.3±2.1) d.CT及DSA检查可显示癌栓影像学特征,病理学检查证实癌栓存在并发现新生肿瘤血管形成.结论 通过原位种植的方法可以成功获得门静脉主干癌栓的动物模型,其影像和病理特征与人原发性肝癌合并的门静脉癌栓相似.     

125I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的近期疗效

目的探讨¹²⁵I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的安全性及近期疗效。 方法15例原发性肝癌伴门静脉主干癌栓患者行门静脉¹²⁵I粒子条植入术,手术操作在超声及DSA引导下进行。术后对肝功能、血常规及凝血功能的变化、癌栓的改变、不良反应进行评价。 结果所有患者均成功植入放射性¹²⁵I粒子条,门静脉主干癌栓的有效率为40.00%(6/15),疾病控制率为86.67%(13/15)。术后2个月复查所有患者的肝功能、血常规、凝血功能与术前比较差异无统计学意义。未出现与粒子条植入相关的严重并发症。 结论植入¹²⁵I粒子条治疗肝癌伴门静脉主干癌栓是安全、可行、有效的。     

经皮脾穿刺门静脉插管技术及临床应用

目的 探讨经皮脾穿刺门静脉插管(PTSPC)技术的可行性.方法 30例门静脉高压症患者接受经PTSPC行食管胃底曲张静脉栓塞术,其中2例同时接受门静脉支架植入术.病例纳入标准:门静脉主干阻塞(癌栓或血栓)和肝硬化严重肝萎缩患者;排除标准:凝血酶原时间(PT)＞20 s的严重凝血功能不良患者.17例患者为原发性肝癌合并门静脉主干癌栓、13例为肝硬化合并严重肝萎缩和(或)小至中量腹水.30例患者术前均有食管胃底静脉曲张破裂出血病史;术前凝血功能正常(PT＜14 s)16例,轻度降低(PT 14～17 s)10例,中度降低(PT 18～20 s)4例;均接受上腹部CT增强检查,并依据CT结果确定脾静脉分支的穿刺位置、方向及深度.术后回顾性分析PTSPC要点、并发症及临床应用价值.结果 30例患者,28例成功应用PTSPC进行门静脉插管;2例插管未成功者均为脾静脉脾内分支细小.发生与PTSPC相关并发症6例(20.0%),均为不同程度血红蛋白浓度下降(15～50 g/L);其中4例需要输血治疗,包括1例腹腔大出血,在术后2 h出现血压严重下降,经输入4个单位红细胞和补充血容量后好转.PTSPC成功的28例均行食管胃底曲张静脉栓塞术,其中2例在栓塞曲张静脉的基础上放置门静脉覆膜支架.28例患者术后中位随访时间6个月(1～42个月),死亡16例,其中14例为肝癌患者在术后1～12个月死亡,2例肝硬化患者分别在术后14、23个月死于肝功能衰竭.随访期间,发生静脉曲张再出血4例,累积再出血率为14.3%.结论 PTSPC是可行的,为经导管门静脉腔内治疗提供了一条新路径,但穿刺部位出血应引起足够重视.     

Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

Objective

To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations.

Materials and Methods

We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 ± 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups.

Results

Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess.

Conclusion

Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.