131Ⅰ标记单克隆抗体导向治疗肝癌的临床研究进展

目的探讨^131碘（^131Ⅰ）标记单克隆抗体导向治疗肝癌的临床治疗效果。方法复习国内、外相关文献并进行综述。结果^131Ⅰ标记单克隆抗体导向治疗在肝癌治疗过程中的合理应用，可以大大提高肝癌的治疗效果，适应证广，不良反应少，对部分原发性肝癌有效。结论^131Ⅰ标记单克隆抗体导向治疗肝癌安全、有效，也可以作为肝脏外科手术的辅助治疗方法，临床应用前景广阔。     

甲状腺功能亢进的介入治疗

甲状腺功能亢进（甲亢）是一种常见的内分泌疾病。传统的治疗方法包括药物、手术及放射性碘（^131I）治疗。甲亢的介入治疗即甲状腺动脉栓寒术，是近年来应用于临床治疗甲亢的新方法。现结合甲亢介入治疗的有关文献做一综述。     

131I-MIBG肾上腺髓质扫描对嗜铬细胞瘤的诊断价值

目的：评价^131I—MIBG肾上腺髓质扫描在嗜铬细胞瘤的诊断价值。方法：16例患者术前均经B超检查及^131I—MIBG肾上腺髓质扫描，10例术前行CT检查。结果：14例患者经^131I—MIBG肾上腺髓质扫描直接提示病灶部位核素浓聚，其中包括6例血压正常或临界正常患者。B超检查提示嗜铬细胞瘤不能排除诊断5例，CT检查提示嗜铬细胞瘤可能4例。本组^131I-MIBG肾上腺髓质扫描敏感性87．5％，特异性100％。结论：^131I-MIBG肾上腺髓质扫描对嗜铬细胞瘤的诊断价值在于其可直接反映可疑肿瘤的嗜铬性质，具有高效、可靠的优点，应作为嗜铬细胞瘤的首选功能性诊断手段。     

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甲状腺癌有4种类型，即乳头状癌(占70％～75％)，滤泡状癌(占15％～20％)，未分化癌(占3％～5％)，髓样癌(占1％～3％)。前2种属分化良好的肿瘤，恶性程度不高，病程缓慢。但这两种肿瘤细胞的膜上有Na-I转运体蛋白(NIS)，在组织内有碘有机化的酶系存在所以可以摄取^131I，虽然其摄碘率低于正常细胞，但正因为可摄碘，所以可用^131I来进行治疗。未分化癌是恶性程度最高，死亡率也最高。它和髓样癌都不摄取^131I，所以不能直接用^131I来治疗。下面分别介绍这4种癌的核素治疗。     

125I粒子植入对荷肝癌裸鼠肿瘤增殖及微血管生成的抑制作用

为探讨^125I粒子植入治疗肝癌的生物学机制，我们利用BEL-7402肝癌细胞株建立肝癌裸鼠模型，在肿瘤组织内植入挖^125I粒子，观察其对肿瘤的抑制效果及对肿瘤细胞增殖和微血管生成的影响。     

^131抗CEA单抗治疗结肠腺癌肝转移裸鼠对CEA水平影响的研究

目的 探索应用^131I标记CEA单抗治疗结肠腺癌肝转移后对荷瘤裸鼠血清、腹水和癌组织中CEA水平的影响。方法 在建立人结肠腺癌裸鼠肝转移后10min（早期治疗组）、10d（中期治疗组）、20d（晚期治疗组）经尾静脉注射^131I标记CEA单抗；并以模型建立后经尾静脉注射^131I标记的正常小鼠IgG作为对照组。于接种癌细胞4周后，采集血、腹水和癌结节，分别检测其CEA含量。结果 早期治疗组的血、腹水和癌结节中CEA水平均明显低于对照组（P＜0．01）；早期治疗组与晚期治疗组则无显著性差异（P＞0．05）。结论 早期应用^131I标记抗CEA单抗能有效地降低荷瘤裸鼠的血清、腹水和癌结节中CEA水平。     

影像学检查对嗜铬细胞瘤定位定性的诊断价值

目的：总结B超、CT、^131I—MIBG及IVU对嗜铬细胞瘤(Pheo)定位、定性诊断的作用。方法：对146例Pheo均行百超、IVU检查，其中140例另行CT检查，42例行^131I-MIBG检查。结果：B超、CT、^131I-MIBG对Pheo的定位诊断符合率依次是94．5％、97．1％和85．7％。IVU有利于术前泌尿系功能与形态以及肾与Pheo之间关系的了解。结论：B超和CT对Pheo定位诊断有很高的准确率^131I—MIBG有利于多发和恶性Pheo转移灶的发现，IVU应作为Pheo术前常规检查。     

肾上腺小病灶的诊断体会——附86例分析

目的探讨超声、CT、MRI、间位碘苄胍(^131I—MIBG)、尿香草扁桃酸(VMA)、血浆皮质醇、血浆醛固酮对肾上腺小病灶的临床诊断价值。方法对86例肾上腺小病灶的术前辅助诊断和术后病理诊断进行对比分析。结果定位诊断符合率：超声86．0％、CT93．1％、MRI95．7％，^131I—MIBG、VMA对儿茶酚胺症的定性诊断正确率分别为91．2％、82．4％，血浆皮质醇对皮质醇症的定性诊断符合率100％，血浆醛固酮对原醛症的定性诊断符合率100％。结论超声、CT、MRI对肾上腺小病灶的定位诊断有较高的价值，VMA、血浆皮质醇、血浆醛固酮分别对儿茶酚胺症、皮质醇症、原醛症定性诊断有较高的意义。^131I—MIBG对儿茶酚胺症有较高的定性与定位意义。     

131I-LPD内辐射治疗原发性肝癌的研究

目的研究131I－LPD选择性内辐射治疗原发性肝癌的吸收剂量及其疗效。方法对8例经手术证实不能切除的肝癌患者经肝动脉反复灌注131I－LPD计算癌组织的吸收剂量，观察其疗效。结果8例平均接受了25次内辐射治疗，放射性活废为（529±127）MBq.131主要聚集在肝癌病灶，癌肝放射性计数比值（T／NT）为2．50～8．50（SD5．60±1．78）。癌组织接受的内辐射吸收剂量为（1792±774）cGY。8例中有5例AFP＞500μg／L，，治疗后转为正常。其中4例因癌肿缩小得以再切除。8例的3年生存率为74％，5年生存率为56％。结论131I－LPD经肝动脉灌注是较理想的内辐射治疗肝癌的方法。     

腺病毒介导钠/碘泵基因靶向治疗胰腺癌

目的观察0．8kb的Mucin1黏蛋白（MUC1）启动子驱动人钠／碘同向转运体（hNIS）基因在胰腺癌细胞靶向表达，评估其吸收碘的能力及结合放射碘治疗胰腺癌的效果。方法采用双质粒脂质体共转染方法获得复制缺陷型腺病毒Ad／MUC1／hNIS。Ad／MUC1／hNIS体外感染细胞，通过免疫荧光染色方法及细胞。I的吸收试验检测hNIS在细胞的靶向表达及吸碘功能。构建鼠Capan-2胰腺癌模型，瘤内注射病毒后，结合^131I治疗，观察对移植瘤生长的抑制作用。结果hNIS仅在MUC1阳性的CAPAN-2和SW1990细胞的胞膜靶向表达，且有高的^125I吸收能力，分别较对照组提高20．5和13倍。Ad／MUC1／hNIS感染的肿瘤结合^131I治疗能抑制肿瘤生长，肿瘤体积减小到原来的83％。结论0．8kb的MUC1启动子能驱动hNIS基因在MUC1阳性的胰腺癌细胞靶向表达，结合^131I治疗后能抑制胰腺癌的生长。     

Resection of hepatocellular carcinoma in noncirrhotic liver: analysis of risk factors for survival

BACKGROUND: The aim of this study was to identify factors predictive of survival after curative resection of hepatocellular carcinoma (HCC) in noncirrhotic liver. STUDY DESIGN: Eighty-four patients underwent resection of HCC in noncirrhotic liver between January 1998 and December 2003. Univariate and multivariable analyses were used to retrospectively identify factors associated with overall survival and disease-free survival when resection was curative for the primary tumor. RESULTS: Overall 1-, 3-, and 5-year survival rates were 77.8%, 55.0%, and 44.4%, respectively, and 84.0%, 62.0%, and 50.0% when resection was curative for the primary tumor. HCC recurred in 27 patients (39.1%). Recurrence was intrahepatic in 14 patients (51.9%), extrahepatic in 3 patients (11.1%), and both intra- and extrahepatic in the remaining 10 patients (37.0%). In multivariable analysis, three independent factors were associated with poorer overall survival and recurrence-free survival, namely multiple tumors, macroscopic vascular invasion, and nonuse of adjuvant iodine-131-iodized oil. CONCLUSIONS: Aggressive operation is an effective treatment for HCC in noncirrhotic patients, whatever the degree of liver fibrosis. Multiple tumors and macroscopic vascular invasion are poor prognostic factors. Postoperative iodine-131-iodized oil injection appears to prevent recurrence and improve overall survival, although this needs to be confirmed in a prospective randomized trial.     

肝癌合并门静脉癌栓形成机制及治疗方法

肝细胞性肝癌是全世界常见的恶性肿瘤之一.近年来,随着影像学的发展,越来越多的肝细胞性肝癌在早期即能被发现,但是,其中11％～42％的肝癌患者已有门静脉侵犯,即门静脉癌栓的形成.门静脉癌栓的形成使肿瘤细胞在肝脏中广泛传播并引起肝功能的进一步恶化.过去常被认为不宜行手术治疗,多采用保守治疗或放弃治疗,大多数患者在数月内死亡,即使有机会行手术切除,术后多辅以经导管肝动脉栓塞化疗术、门静脉支架植入或门静脉化疗等治疗方式,部分患者能更长时间的存活,但由于微小癌栓及微小转移灶术前已存在,术前检查难以发现,手术取栓很难清除干净,容易导致术后肝癌早期复发.随着科学技术的不断进步及对门静脉癌栓形成机制的进一步认识,越来越多的治疗新技术被应用于临床.本文主要就门静脉癌栓形成机制及经典的经导管肝动脉栓塞化疗术和一些新的治疗方法,如螺旋断层放疗、CIK细胞治疗、经导管肝动脉栓塞化疗术联合门静脉支架植入后125I放疗进行综述.     

布加综合征合并肝癌十例

目的 探讨布加综合征合并肝癌病人的临床特征、预后及治疗情况.方法 对10例布加综合征合并肝癌病人的临床资料进行回顾性分析.彩色多普勒超声探查或(和)下腔静脉造影和肝静脉造影确诊布加综合征:Ⅰ a型4例,Ⅱ型3例,Ⅲ a型3例.肝细胞癌由彩色多普勒超声、增强螺旋CT和病理检测诊断;肝癌单发8例,多发2例.8例均成功开腹进行肝癌切除术,3例并行肠系膜上静脉-下腔静脉人工血管反C型分流术(肠-腔分流术);5例开腹手术前2～3 d介入行下腔静脉球囊扩张成形术或(和)(副)肝静脉扩张成形术.2例多发肝癌合并布加综合征病人行介入超选择性肝动脉化疗栓塞术+下腔静脉球囊扩张成形术或(和)(副)肝静脉扩张成形术.结果 1例行肠-腔分流术+肝癌切除术病人术后5 d死于肝衰竭;1例行肠-腔分流术病人术后4 d出现乳糜漏,治疗15 d后好转.随访9例,随访时间为术后半年至5年;2例多发肝癌病人介入术后1年和半年死于肝衰竭;2例病人在术后1年和2年死于肝癌复发转移.结论 布加综合征合并肝癌病人预后不良,在解除布加综合征病人肝脏淤血的状态的同时尽早并尽可能的切除肝癌病灶是目前最有效的治疗方法.     

CT引导下125I放射性粒子植入治疗原发性肝细胞癌伴门静脉癌栓

目的探讨CT引导下125I放射性粒子植入术治疗原发性肝细胞癌（HCC）合并门静脉癌栓（PVTT）的疗效。方法根据放射性粒子植入计划系统（TPS系统）,通过CT引导对47例HCC合并PVTT患者于TACE后植入^125I放射性粒子,癌栓处方剂量100～120 Gy,对比治疗前后癌栓长径、肝功能、AFP的变化。结果完全缓解无,部分缓解29例,总有效率为61.70%（29/47）;术后癌栓长径明显小于术前（P〈0.05）。接受^125I放射性粒子植入治疗后,47例患者1年、2年生存率分别为53.45%、36.75%,平均生存期为（14±2）个月。结论 CT引导下125I放射性粒子植入术治疗HCC伴PVTT可明显提高疗效,创伤小、恢复快、并发症少。     

Selective Radionuclide Localisation in Primary Liver Tumours

The therapeutic potential of ¹³¹I-Lipiodol was investigated in 8 patients with cholangiocarcinoma (CCA) and 15 patients with hepatocellullar carcinoma (HCC). Patients received one or two doses of ¹³¹I-Lipiodol via hepatic arterial injection. The mean total administered activity was 668 (SD 325) MBq in CCA and 953 (SD 477) MBq in HCC. One patient with CCA retained ¹³¹I-Lipiodol. The cumulative radiation dose was 9.6 Gy to tumour, 6.4 Gy to liver and 1.5 Gy to lung. The patient remained asymptomatic with no evidence of tumour 30 months from the start of treatment, whereas the remaining 7 patients exhibited tumour progression. The mean survival in CCA was 11.6 (SD 14.5) months. All 15 patients with HCC retained ¹³¹I with tumour: liver ratios of up to 30:1. The mean cumulative radiation dose was 34.7 (SD 32.4) Gy to tumour, 3.3 (SD 1.5) Gy to liver and 4.4 (SD 2.3) Gy to lung. The mean dose per administered activity was 3.8 (SD 4.1) cGy/MBq. Partial response (reduction in tumour size > 50%) was observed in 6 patients (40%). The mean survival was 7.1 (SD 6.0) months. ¹³¹I-Lipiodol can deliver highly selective internal irradiation to foci of HCC with evidence of objective response and may be the treatment of choice for patients with cirrhosis and a small tumour.     

Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation

Abstract: In December 1997, a prospective study with informed consent was initiated to test a neoadjuvant treatment of transcatheter hepatic arterial chemo-embolization (TACE) and thermal or chemical ablation followed by transcatheter hepatic arterial chemo-infusion (TACI) in patients with hepatocellular carcinoma (HCC) referred for transplantation (OLT) and for resection. Patients were staged with American Liver Tumor Study Group-modified tumour-node-metastasis (TNM) staging classification using serial 3–6 month physical exam, alphafetoprotein (AFP), abdominal enhanced MRI, chest CT and bone scan. Sixty-five patients with HCC, out of 508 patients referred for OLT, were divided into five clinical groups and an incidental HCC patient group ( n  = 8), diagnosed on post-transplant explant pathology. The key focus of study was safety, site of HCC recurrence and tumour free survival. One hundred and thirty three ablation, infusion procedures were performed with an overall 24.8% morbidity, including two septic deaths. There were 13 (21.6%) HCC recurrences in 60 patients having one or more ablative treatments with only 23% hepatic HCC recurrences at 43 months of study. Eighteen HCC patients were listed for OLT (Group 3), with 12 patients transplanted after 29–424 d waiting. Two patients were removed from the OLT list due to HCC metastases, waiting a mean of 145 d. Two patients, post-OLT, had their TNM score upgraded from T₂, T₃ to T₄. No Group 3 post-OLT patient has died or had HCC recurrence at mean follow-up of 27 ± 15 months. No incidental HCC group post-OLT patient has died or had HCC recurrence at mean follow-up of 24 ± 14 months. This neoadjuvant protocol is safe and effective in reducing HCC recurrence prior to and after OLT and resection.     

Preoperative treatment of hepatocellular carcinoma with intra-arterial injection of 131I-labelled lipiodol

BACKGROUND: Recurrence is common after surgery for hepatocellular carcinoma (HCC). METHODS: The efficacy of, and tolerance to, preoperative intra-arterial injection of (131)I-labelled lipiodol was examined in 34 patients with HCC, including 29 with cirrhosis. Twenty-five patients had a single hepatic tumour and the mean(s.d.) tumour size was 5.2(3.7) (range 2-15) cm. The patients received between one and three injections of (131)I-labelled lipiodol (60 mCi per injection) before surgery. Operations included 14 liver transplants, 13 minor hepatectomies, six major hepatectomies and one exploratory laparotomy. RESULTS: There was one complication after lipiodol injection due to acute ischaemia of the small bowel. Three of 34 patients died within 28 days, two after transplantation and one after resection. An objective tumour response (decrease in tumour size) was observed in 19 of 34 patients, and a complete histological response in eight of 34. There was an objective tumour response or major histological necrosis of lesions in 25 of 34 patients. The 5-year survival rate was 48.4(8.0) per cent, 69.0 per cent after transplantation and 36.0 per cent in patients who underwent resection. CONCLUSION: This preoperative method appeared to be well tolerated, and provided promising results in terms of macroscopic and microscopic tumour responses.     

Feasibility of total thyroidectomy in the treatment of thyroid carcinoma: postoperative radioactive iodine evaluation of 140 cases.

The objective of this study was to evaluate our experience with so-called total thyroidectomy. Fifty cases (the retrospective group) had been operated on before the start of the study and had been on thyroid replacement therapy; this was discontinued, thyroid-stimulating hormone was administered, and iodine-131 studies were performed. Ninety cases (the prospective group) were evaluated 3 or more weeks postoperatively with no thyroid hormone having been administered. All patients were given 50 microcuries of iodine-131 and uptake studies were performed 24 hours later. All the patients were evaluated at a time when it was believed that practically all circulating hormone secreted by the thyroid gland before its removal had been metabolized or excreted from the body. If the patients with iodine-131 uptakes only in the region of the pyramidal lobe are considered to have had total thyroidectomy, we find that 85.7% of the patients studied had an uptake of less than 1.5%, and 96.4% had an uptake of less than 2.5%. There is increasing evidence to indicate that total thyroidectomy is the procedure of choice in the treatment of differentiated thyroid carcinoma. The present study indicates that with proper technique, total resection of the thyroid gland is feasible in nearly all cases of thyroid carcinoma.     

Intra-arterial iodine 131-labeled lipiodol as adjuvant therapy after curative liver resection for hepatocellular carcinoma: a phase 2 clinical study

HYPOTHESIS: Intra-arterial lipiodol labeled with iodine 131 ((131)I-lipiodol) can be safely used as adjuvant therapy following curative liver resection for hepatocellular carcinoma (HCC). DESIGN: Phase 2 pilot study. SETTING: Large teaching hospital. PATIENTS: Twenty-eight patients (24 men and 4 women; median age, 61.5 years; range, 33-75 years) were treated from January 1991 to June 1997. The liver was cirrhotic in 7 cases and noncirrhotic in 21 cases. An equal number of 14 patients underwent a major and a minor resection, all with clear margins. Median diameter of solitary tumors or the larger tumor when multiple tumors occurred was 5.5 cm (range, 2.5-29 cm). Tumor encapsulation was present in 12 cases and absent in 16 cases. After informed consent, patients who had no evidence of residual or recurrent tumor on computed tomographic (CT) scan and no sign of liver failure 2 to 3 months after curative resection for HCC were included in the trial. Complete follow-up was obtained (median, 51 months; range, 5-93 months). INTERVENTIONS: A 1110-MBq dose of (131)I-lipiodol was administered into the hepatic artery using the Seldinger technique. Patients were kept in a radio-protected room for 5 days. Postinjection radioactive whole scintiscan was performed at 5 days and an abdominal CT scan at 1 month after the injection. A second injection was performed in 16 patients 2 years later using the same protocol. MAIN OUTCOME MEASURE: Procedure safety. RESULTS: All patients experienced transient fever during the first 12 hours following injection. There were no noted adverse clinical effects or significant alteration in hepatic function due to the procedure or at immediate and late follow-up. The radioactive scan demonstrated an intense liver uptake, which was homogeneous in 19 cases and heterogeneous in 9. Mild detectable thyroid and lung uptake occurred in 50% of cases. No lipiodol liver fixation was observed on the 1-month CT scan. At the time of follow-up, 6 patients had died and 12 had developed recurrences, with 5 of the 6 deaths belonging to the recurrent group. Sixteen patients remained disease free. The median time to detected recurrence was 28 months (range, 12-62 months). Overall survival rates were 86% at 3 years and 65% at 5 years. CONCLUSIONS: This pilot study failed to demonstrate any clinically significant adverse effect of adjuvant therapy by intra-arterial (131)I-lipiodol after curative liver resection for HCC. Long-term survival compares favorably with those undergoing only surgery and suggests a benefit in lowering tumor recurrence. A randomized, multicenter, prospective trial comparing patients treated with intra-arterial (131)I-lipiodol with a nontreated control group seems appropriate.     

肝癌切除术后残肝断面125Ⅰ粒子植入预防肝癌复发

目的 观察肝癌患者肝切除术后残肝断面125Ⅰ粒子植入对肝癌肝内复发的影响.方法 对2003年1月至2007年1月经手术完整切除的肝细胞癌患者85例分为2组.125Ⅰ粒子植入组(43例):肿瘤完整切除后在残肝断面均匀植入125Ⅰ粒子.对照组(42例).所有患者分别于术前1 d和术后7 d、30 d采血,测定转氨酶、胆红素、NK细胞、T细胞亚群、血清中MMP-9及AFP水平.全部患者术后均定期随访复发情况.结果 所有患者术后均顺利恢复,无围手术死亡,无严重并发症.术后两组患者CD3+、CIM+、CD8+和NK细胞及转氨酶、胆红素等指标比较,差异无统计学意义(P＞0.05);125Ⅰ粒子植入组患者AFP、MMP-9明显低于对照组(P＜0.05).125Ⅰ粒子植入组术后0.5年、1年复发率为2.3%、6.9%,与对照组(14.2%、26.1%)相比,差异有统计学意义(P＜0.05).结论 肝癌切除后切125Ⅰ粒子植入能有效地降低AFP、MMP-9水平.术后局部复发率显著下降.