立体适形放疗联合介入治疗肝癌肾上腺转移

[目的]探讨肝癌肾上腺转移放射治疗联合介入治疗的效果和患者的耐受情况。[方法]41例经细胞学或组织学证实的肝癌肾上腺转移患者,行TACE治疗2次,1个月后再行立体适形放疗。观察肿瘤的变化及评价病人的毒副反应。[结果]2例CR,34例（82.9%）PR。5例肾上腺肿瘤体积没有明显的变化。中位生存期为12.5个月。所有病例未出现严重的毒副反应,可以耐受治疗。[结论]立体适形放射治疗联合介入治疗肝癌肾上腺转移,治疗效果明显。     

经皮射频消融治疗胆囊旁肝肿瘤

[目的]探讨冷循环超能射频肿瘤治疗系统经皮治疗胆囊旁肝肿瘤的可行性和有效性。[方法]在超声引导下,采用冷循环电极对11例胆囊旁肝肿瘤病人15个肿瘤结节进行经皮射频消融治疗。[结果]11例病人中,9例术后出现腹痛,持续时间2~17天(7.5±4.2天);5例术后发热,体温≥38.5℃;2例术后白细胞>10.0×109/L,2例术后AFP和1例术后CEA降至正常范围。术后CT或超声证实,9例病人肿瘤完全毁损,其中3例病人在随访期间局部复发。[结论]冷循环超能射频肿瘤治疗系统治疗胆囊旁肿瘤是安全和有效的。     

肾上腺髓性脂肪瘤15例报告

目的;探讨肾上腺髓性脂肪瘤的临床表现、诊治方法。方法：对15例病例;临床资料进行回顾性分析。结果：13例无典型的症状和体征，1例有高血压，术后血压恢复正常，1例有向心性肥胖，术后有所改善。14例术前B超、CT确诊，1例诊为肾上腺肿瘤。所有患者的肿瘤均手术切除，术后无复发及转移。结论：肾上腺髓性脂肪瘤B超、CT多可确诊，手术是该病的主要治疗方法。     

单侧肾上腺皮质结节增生性原发性醛固酮增多症27例诊断治疗

[目的]探讨单侧肾上腺皮质结节增生性原发性醛固酮增多症的临床特点,提高诊治水平。[方法]对27例经手术及病理学确诊的单侧肾上腺皮质结节增生性原发性醛固酮增多症患者的资料进行回顾性分析。[结果]术后随访20例患者,18例患者术后6个月内血压恢复正常;2例6个月后血压控制不理想,其中1例需2种以上降压药物联合降压。[结论]部分单侧肾上腺皮质结节增生性原发性醛固酮增多症的定性诊断需要反复检测血浆醛固酮及肾素等,CT及肾上腺静脉采血是其术前分型定侧诊断的重要手段。     

后腹腔镜下肾上腺肿瘤切除21例

[目的]探讨后腹腔镜下肾上腺肿瘤切除于术的疗效和安全性。[方法]后腹腔镜下肾上腺肿瘤切除手术治疗21例。[结果]21例均完成手术,手术时间60-190min．术中出血量约50～200ml。术后住院天数平均5．1d,切口愈合良好。[结论]后腹腔镜肾上腺肿瘤切除手术不仅能够避免对腹腔内脏器的扰动、损伤,同时具有创伤小、康复快、安全、住院时间短等优点。     

后腹腔镜手术治疗17例肾上腺偶发瘤分析

[目的]探讨后腹腔镜手术治疗肾上腺偶发瘤的疗效和安全性。[方法]2005年10月至2010年3月应用后腹腔镜手术切除肾上腺偶发瘤17例。用自制的气囊扩张后腹腔,腰部3个Trocar穿刺入路,超声刀将肿瘤切除,用自制的标本袋取出肿瘤。[结果]17例手术全部成功,手术平均时间90min,平均出血量70ml,术后平均住院7d。无严重并发症发生。[结论]后腹腔镜手术治疗肾上腺偶发瘤是安全、有效的,具有手术创伤小、并发症少及患者恢复快等优点。     

肾上腺髓性脂肪瘤15例报告

探讨肾上腺髓性脂肪瘤的临床表现，诊治方法。方法：对１５例病例临床资料进行回顾性分析。结果：１３例无典型的症状和体征１，例有高血压，术后血压恢复正常，１例有向心性肥胖，术后有所改善。１４例术前Ｂ超，ＣＴ确诊，１例诊为肾上腺肿瘤。所有患者的肿瘤均手术切除，术后无复发及转移。结论：肾上腺髓性脂肪瘤Ｂ超，ＣＴ多可确诊，手术是该病的主要治疗方法。     

γ刀治疗垂体腺瘤232例临床分析

[目的]探讨立体定向γ刀对垂体腺瘤的疗效。[方法]对232例垂体腺瘤患者实施立体定向γ刀治疗，肿瘤直径3mm～67mm（平均21mm）；肿瘤周边剂量8Gy～30Gy，平均29.6Gy。[结果]176例随访3～36个月（平均22个月），临床症状改善132例（75%），激素水平恢复正常或下降79例（88%），肿瘤缩小87例（60%）。[结论]γ刀是一种简便安全治疗垂体腺瘤的有效方法。     

四肢骨巨细胞瘤局部灭活方法的评价

正骨巨细胞瘤(giant cell tumor,GCT)是一种具有局部侵袭性的良性骨肿瘤,主要治疗方法是手术治疗。刮除、瘤壁灭活和自体骨、异体骨或骨水泥填充是目前GCT治疗最常用的方法 [1-6]。早期报道的单纯刮除手术术后的复发率比较高,从25%~50%不等[7-12]。瘤腔周围的微小病灶残留是肿瘤复发的主要因素,因此,为了降低GCT刮除局部复发率,各种针对瘤腔周围微小病灶的辅助措施逐渐发展起来。多数研究表明,刮除术后残腔处理可以有效降低术后复发率[6-7,13]。广泛切除可以降低肿瘤的局部复发率[14-16],但是其一方面增加了手术后的并发症[17-18],另一     

肾上腺囊肿的外科治疗24例分析

[目的]探讨肾上腺囊肿外科治疗方法。[方法]回顾性分析24例肾上腺囊肿患者（腹腔镜组10例．开放手术组14例）外科手术情况。[结果]10例腹腔镜手术中3例完整剥离囊肿．7例行腹腔镜肾上腺部分切除术．平均住院日6．20±0．79d：14例开放手术中4例行肾上腺全切,10例行肾上腺部分切除术．平均住院日8．85±1．03d。两组平均住院日差异比较有统计学意义（t=6．849．P=0．001）。腹腔镜组均成功保留患侧肾上腺正常实质．[结论]对于多数肾上腺囊肿病例．肾上腺部分切除术是可行的：行腹腔镜保留肾上腺部分正常实质的切除手术治疗肾上腺囊肿有微创的优点有其应用价值．     

肝动脉栓塞化疗和经皮乙酸消融双介入治疗巨块型肝癌的临床价值及应用研究

Objective： To study the efficacy of transcatheter arterial chemoembolization （TACE） combined with percutaneous acetic acid injection （PAI） on massive hepatocellular carcinoma （MHCC）. Methods： TACE was performed in 57 patients with MHCC, which were randomly divided into group A （n = 28） and group B （n = 29）. Patients in the group A received conventional TACE for the first time and then received low dose TACE （10 mg mitomycin C） for the repeated treatment, Re-examined CT scans after TACE for a week. Based on filled status of Lipiodol in the Lesions, PAl was underwent in the area of rarefaction or defect filled by Lipiodol. Patients in the group B received conventional TACE. Then The survival rate and masses variation and hepatic function and a-FP and side effects were observed. Results： The 1-, 2- and 3-year survival rate after TACE were 96.4%, 78.6% and 32.1% for group A, and 65.5%, 48.3% and 20.7% for group B. Masses diminution were found in all patients in group A, while 20 cases were found in group B, unchanged in 5 cases and enlarged in 4 cases. Conclusion： The efficacy of TACE combined with PAl are significantly better than that of TACE only, low dose TACE produces less hepatic damage and less side effect.     

Sequential transarterial chemoembolization and percutaneous acetic acid injection therapy versus repeated percutaneous acetic acid injection for unresectable hepatocellular carcinoma: a prospective study.

BACKGROUND: Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective treatments for hepatocellular carcinoma (HCC). We have conducted a prospective study to compare the efficacy of sequential TACE and PAI (TACE-PAI) versus repeated PAI therapy for HCC. PATIENTS AND METHODS: A total of 108 HCC patients with tumor size 相似文献   

Radioactive Seed Implantation and Lobaplatin Chemotherapy Are Safe and Effective in Treating Patients with Advanced Lung Cancer

Objecive: To investigate the clinical safety and efficacy of CT-guided 125iodine (125I) seed implantationcombined with percutaneous intra-tumor injection of chemotherapy emulsion of lobaplatin and lipiodol intreating patients with advanced lung cancer. Materials and Methods: Patients with advanced lung cancer andtreated with spiral CT-guided 125I seed implantation combined with percutaneous intra-tumor injection ofchemotherapy emulsion of lobaplatin and lipiodol were recruited. Results: Of the 36 patients, there were 40nidi in total. The contrast-enhanced CT evaluation was conducted 60 d after treatment. Response evaluationsuggested that 4 patients achieved complete remission (CR), 24 partial remission (PR), 4 stable disease (SD)and 4 progression disease (PD), with a total response rate of 77.8% (28/36). Conclusions: CT-guided 125I seedimplantation combined with percutaneous intra-tumor injection of chemotherapy emulsion of lobaplatin andlipiodol are safe and effective in treating patients with advanced lung cancer.     

Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study.

BACKGROUND: Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective locoregional therapies for hepatocellular carcinoma (HCC). This study aimed to investigate whether HCC patients who had initial complete response to these treatments had a subsequent lower risk of intrahepatic metastasis. PATIENTS AND METHODS: A total of 152 patients who underwent locoregional therapy (94 received PAI and 58 received both TACE and PAI) for HCC (tumor size < or =5 cm) were prospectively evaluated. RESULTS: In all, 60 (39%) patients had a complete tumor necrosis after treatment. The cumulative incidence of the development of intrahepatic metastasis was lower for patients with complete remission (P = 0.005) and for patients with smaller (< or =3 cm) tumor size (P = 0.083). Cox multivariate survival analysis showed that absence of complete remission [relative risk (RR) 2.7; 95% confidence interval (CI) 1.4-5.3; P = 0.003] was the only independent factor that predicted the occurrence of intrahepatic metastasis. Patients with complete remission had a significantly better long-term survival than those without (P = 0.002), and the occurrence of intrahepatic metastasis over time independently predicted a decreased survival (RR 3.2; 95% CI 2.0-6.1; P = 0.019). CONCLUSIONS: Induction of complete tumor necrosis in HCC patients undergoing locoregional therapy may decrease the risk of intrahepatic metastasis and improve survival.     

Population-based matching comparison between radiofrequency ablation and percutaneous ethanol or acetic acid injection for hepatocellular carcinoma

BackgroundLoco-regional therapies are evolving for hepatocellular carcinoma (HCC) treatment. Radiofrequency ablation (RFA) has changed the landscape in treating HCC; however, percutaneous ethanol or acetic acid injection (PEI/PAI) remains a widely used and easily performed technique by experienced clinicians. Nevertheless, the effectiveness of RFA compared to that of PEI/PAI remains unclear.MethodsRecords of 73,136 patients with newly diagnosed HCC between 2007 and 2013 were drawn from the Taiwan Cancer Registry. The primary outcome measures were the overall survival and local recurrence-free survival. Propensity score matching (PSM) was performed to compare the effectiveness of RFA and PEI. Median follow-up time was 61.6 months (36–120 months).ResultsAfter PSM, 4496 patients diagnosed with stage I-III HCC, who were initially treated with RFA (3372 patients) or PEI/PAI (1124 patients), were assessed. Compared to PEI/PAI, patients treated with RFA had better 5- and 9-year overall survival, cancer-specific survival, disease-free survival, and local recurrence-free survival. Median overall survival and recurrence-free survival of patients treated with RFA vs PEI/PAI were 61.5 vs 41.9 months and 72.1 vs 45.2 months, respectively. Multivariate Cox model analysis revealed that, except for patients with high cell grade or advanced stage, RFA resulted in better overall survival (HR: 0.74, 95% CI 0.68–0.81, P < 0.001) and local recurrence-free survival (HR: 0.69, 95% CI 0.63–0.75, P < 0.001) than PEI/PAI.ConclusionsRFA provides advantages over conventional PEI/PAI for HCC. Considering technological advances in instruments, loco-regional therapies for HCC can be employed in carefully selected patients.     

免疫检查点抑制剂致原发性肾上腺功能减退的报道并文献分析

目的:探讨免疫检查点抑制剂致原发性肾上腺功能不全的临床特征。方法:报道1例信迪利单抗致原发性肾上腺功能减退的诊治过程，并通过文献检索的方法收集免疫检查点抑制剂致原发性肾上腺功能减退的病例报告。回顾性分析患者的性别、年龄、原患疾病、用药情况、临床症状、发生时间、治疗方法等。结果:纳入分析的患者共30例。PAI的中位发生时间为18周。主要临床表现为乏力、厌食、恶心、呕吐。其中伴有低血压12例，伴有低血糖5例，伴有体重下降3例，皮肤色素沉着加深1例。实验室检查发现20例出现了低钠血症，其中7例不仅出现低钠血症还伴随高钾血症。25例进行糖皮质激素替代治疗，5例进行糖皮质激素联合盐皮质激素替代治疗。结论:免疫检查点抑制剂相关原发性肾上腺功能减退的临床表现不典型，临床医生需提高警惕，及时诊断及治疗，避免出现肾上腺危象，危及生命。     

Destructive effect of percutaneous hydrochloric acid injection therapy for liver cancer--a preliminary experimental and clinical study

OBJECTIVES: To evaluate the tissue coagulation and anticancer effects of hydrochloric acid compared with ethanol and acetic acid. To assess the in situ destructive effects and safety of CT mediated percutaneous hydrochloric acid injection therapy (PHAIT). METHODS: IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines in vitro were determined. Coagulated necrotic area of hydrochloric acid was observed in vitro and in vivo using pig liver. The coagulated effects of 6 mol/l hydrochloric acid solution (HAS6) on pig liver and muscle were compared with 50% acetic acid and anhydrous alcohol. Thirty patients with 38 lesions of liver cancer were treated by the CT mediated intratumor injection of HAS6. The in situ destructive rate, CT evaluation, PET, histopathology, survival and side effects were observed. RESULTS: The IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines were as similar as approximately 0.05-0.07% in concentration. Coagulated area of liver tissue by 1 ml of 1.5-12 mol/l hydrochloric acid was 18.3-53.4 mm in diameter. The globular hoariness coagulation area with a clear-cut borderline separated from normal tissue was produced. The 6.0 mol/l hydrochloric acid shows a larger coagulation dimension with a clear boundary, 15 times of anhydrous alcohol and 5 times of 50% acetic acid. No toxicities in the routine local injection dosages were found. Clinically, the patients received 73 sessions of PHAIT; CT scan shows a low density area with gas that did not enhance by CT scan shown 24 hrs later. A good necrosis and destruction rate of cancer was obtained by PET, biopsy and AFP measurement. One year, 2-year and 3-year survival rates were 100, 90 and 85%, respectively. Nine cases survived more than 3 years, and 2 cases for more than 4 years. No change in the heart, liver and kidney functions were found. Main side effects were slight pain, lower fever, etc. CONCLUSIONS: The 6 mol/l hydrochloric acid is an effective endogenetic protein coagulator; the cancer tissue coagulated effect of HAS6 was superior to 50% acetic acid and anhydrous alcohol. CT mediated percutaneous hydrochloric acid injection therapy showed good destructive effects; it would be used as a new minimum invasive treatment for percutaneous treatment of liver cancer, instead of acetic acid and anhydrous alcohol with its safety, controllability and no poisonous effects.     

经皮肺抽吸活检对晚期癌症病人合并肺部疑难病变的诊断价值

目的:探讨经皮肺穿吸活检对晚期癌症患者合并肺实质疑难病变的诊断价值.方法:对51例晚期肺外恶性肿瘤合并肺部实质性病变且诊断有疑难的患者,行经皮肺穿刺抽吸活检术,抽吸物联合进行病理细胞学检查、细菌学培养、抗酸染色检查以明确诊断.结果:51例肺抽吸组织病理学诊断为炎症19例(37.25％)、恶性肿瘤14例(27.45％)、真菌感染8例(15.69％)、结核4例(7.84％)、纤维组织增生3例(5.88％)、无阳性发现3例(5.88％),总阳性率为94.12％ (48/51).病原学检查共检出抗酸染色阳性2例、培养出细菌13例、真菌10例,阳性率分别为3.92％ (2/51)、25.49％(13/51)和19.61％(10/51).结论:经皮肺穿刺抽吸活检术,对抽吸物联合进行病理细胞学、细菌学检查具有较高的检出阳性率,对晚期癌症合并肺部疑难病变患者具有较高的诊断价值.     

CT引导下经胸穿刺活检对胸部病变的诊断价值

目的 探讨CT引导下经胸穿刺活检对胸部病变的诊断价值。方法 CT引导下对215例胸部病变行经胸穿刺活检取材，行细胞和组织学检查。结果 215例经手术和临床随诊证实恶性肿瘤182例，其中穿刺证实为恶性肿瘤168例，恶性肿瘤确诊率为92．3％(168／182)。假阴性14例，假阴性率为7．7％(14／182)。元假阳性。诊断良性病变33例，良性病变确诊率为81．9％(27／33)，总确诊率为90．7％。术后发现少量气胸14例，痰中带血8例，其发生率分别为6．5％和3．7％，均未做特别处理。结论 CT引导下经胸穿刺活检术是一种安全有效、准确性高、并发症少的检查方法，对胸部病变具有较高的诊断价值。     

Percutaneous injection of a low-concentration alkaline solution targeting hepatocellular carcinoma

We developed a percutaneous low-concentration alkali injection therapy (PLAIT) targeting hepatocellular carcinoma (HCC), and compared the necrotic areas in the livers of rats that had received PLAIT [an alkaline solution of sodium hydroxide (NaOH)] with those that had received percutaneous ethanol injection therapy (PEIT) and percutaneous acetic acid injection therapy (PAIT). The necrotic area increased with increasing concentrations of NaOH solution. The survival rate of rats was 100% up to a concentration of 4 N; however, the rate dropped below 80% with concentrations over 5 N. Also, at a concentration of 2 N, the necrotic area increased with increasing quantities from 0.01 ml to 0.1 ml. PLAIT using 0.05 ml of 2 N NaOH was 1.56 times more effective than PEIT using 0.05 ml of 99.5% ethanol, and 63.33% less effective than PAIT using 0.05 ml of 50% acetic acid. However, the survival rate after PAIT was 50%, while that after PLAIT was 100%. Histopathological observation of normal rat livers after injection of 2 N NaOH at a volume of 0.05 ml showed that the tissue necrosis spread radially from the site immediately after injection by PLAIT, but necroses were not found in other organs. We conclude that PLAIT has promise as a new form of local therapy for HCC.