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1.
中晚期肝癌介入治疗包括经血管介入治疗和影像导向经皮穿刺病灶消融。血管介入治疗即经动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)。1975年,Goldstain首先创立了经导管肝动脉栓塞术(TAE)治疗肝脏恶性肿瘤。随后,在Wallace,VP Chuang等人的不懈努力下,创立并发展了TACE,它已经成为中晚期肝癌介入治疗最为经典的方法。 相似文献
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目的观察原发性肝癌采用放射介入治疗的临床疗效。方法选取78例原发性肝癌患者,按照治疗方法不同分为经肝动脉化疗栓塞术(TACE)组36例和TACE+射频消融术(RFA)组42例,比较2组患者的治疗效果。结果 (1)A组CR 7例,PR 12例,总有效率为52.8%;B组CR 14例,PR 18例,总有效率为76.2%。2组患者总有效率比较差异有统计学意义(x2=15.247,P<0.01)。(2)2组患者12、18个月生存率比较差异具有统计学意义(x2=12.417,x2=16.389,P<0.01)。结论采用TACE+RFA联合方法治疗原发性肝癌可达到较理想效果,可显著延长患者生存时间、改善生存质量。 相似文献
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目的探讨肝动脉化疗栓塞术(TACE)与化疗灌注术(TAI)对原发性肝癌切除术后预防性肝动脉介入治疗疗效的影响。方法选取2012年1月至2015年1月期间原发性肝癌切除术后患者40例,采用随机数字表法将其分为两组,各20例,观察组采用TACE治疗,对照组采用TAI治疗,比较两组临床疗效的差异。结果两组临床总缓解率、复发率与住院时间比较差异无统计学意义(P0.05)。观察组无瘤生存期、无进展生存期与总生存期明显长于对照组,P0.05。治疗前,两组PLGF、VEGFR-2水平比较差异无统计学意义(P0.05),治疗后,全部患者上述指标均明显高于治疗前,治疗前后比较差异具有统计学意义(P0.05),观察组上述指标均明显低于对照组P0.05)。治疗前后,两组AST、ALT、TBIL、ALB与PT水平比较差异无统计学意义(P0.05),全部患者治疗前后上述指标水平比较差异无统计学意义(P0.05)。结论 TACE在原发性肝癌切除术后预防性肝动脉介入治疗中的临床疗效更显著,值得临床推广应用。 相似文献
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通过同位素交换反应将131I标记到碘化油分子上,其标记率在95%以上,室温下放置15天及高压灭菌后未见有脱碘现象。γ—照相显示131I—碘化油注入狗的肝动脉后,仅选择性地蓄积于注入的肝叶内,甲状腺、肺等其它部位未见核素蓄积。131I—碘化油在肝内的有效半衰期为4.92±0.66天。每毫升血液放射性为注人量的0.09±0.04%。提示131I—碘化油性能稳定,适宜临床应用。 相似文献
5.
目的比较经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)和肝动脉灌注化疗(transcatheter arterial infusion,TAI)在单发原发性肝癌切除术后辅助性介入治疗中的效果。方法 94例行手术切除的单发原发性肝癌患者根据术后辅助性介入方法不同,分为TACE组(n=49)和TAI组(n=45),同期选取术后均未行预防性介入治疗的30例作为对照组。TAI组采取单纯化疗药物灌注化疗,TACE组采用化疗药物与碘油混悬剂,所有患者随访至2016年9月,比较三组患者术后肿瘤复发情况,利用Kaplan-Meier分析三组患者无复发生存期。结果 TACE组和TAI组患者术后1年复发率分别为14.3%和13.3%,均低于对照组的46.7%,差异有统计学意义(P0.05);TACE组患者术后2年和3年复发率分别为21.4%和30.3%,均低于TAI组和对照组,差异均有统计学意义(P0.05)。对于中位无复发生存期,TACE组34.30个月,TAI组24.71个月,对照组12.90个月,Log-Rank检验显示差异具有统计学意义(χ2=34.228,P0.001)。结论相比于TAI,TACE可有效降低患者术后2年和3年复发率,延长患者无复发生存期,有助于改善患者预后。 相似文献
6.
经肝动脉灌注化疗(HAI)及栓塞治疗(HAE)已被公认为中晚期原发性肝细胞癌(HCC)的首选疗法.文献报道较多,本文着重探讨40岁以下青壮年HCC的特点及介入治疗的有关问题。 相似文献
7.
目的探讨经导管肋间动脉(intercostal artery,ICA)栓塞化疗的安全性。方法对24例经血管造影确认有ICA参与肝癌供血者进行经导管肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)。巨块型15例,结节型9例。术前行CT或MRI平扫及增强扫描,术中行肋间动脉造影,将导管超选择至供血支进行栓塞化疗,并摄肝区碘油平片。观察术后临床经过、相关实验室检查和影像学表现,并与血管造影进行对照分析。结果病灶均位于肝右叶S6、S7段。参与肿瘤供血的ICA侧支均在T8(7.5%,3/40),T9(15.0%,6/40),T10(47.5%,19/40)和T11(30.0%,12/40)椎体水平右侧。22例肋间动脉TACE成功。治疗后复查CT显示87.5%(21/24)肝肿瘤完全被碘油充填,82.6%(19/23)血甲胎蛋白(AFP)下降至正常范围。3例术后肩部疼痛剧烈。1例术中皮肤瘙痒。5例术后出现皮肤红斑。结论ICA参与肝癌供血多见于多次行TACE并且肿块位于肝右叶S6、S7段的患者。肋间动脉TACE安全,但应警惕皮肤损伤并发症。 相似文献
8.
肝癌介入治疗的进展 总被引:9,自引:0,他引:9
贾雨辰 《中国实用外科杂志》1995,15(3):175-178
肝癌介入治疗的进展上海第二军医大学长海医院(200433)贾雨辰80年代后期,对中晚期肝癌广泛地开展了动脉内药物灌注(TAI)或栓塞化疗(TACE),已被公认介入治疗是最有效的保守疗法,取得了较好的成绩,TACE的1、3年生存率在44%~68%和12... 相似文献
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10.
联合应用经股动脉插管肝动脉化疗栓塞术(TAE)和在B超引导下经皮肤肝穿刺瘤内注射无水酒精(PEI)治疗原发性肝癌42例,肿癌面积缩小≥50%26例(61.8%),30%~49%14例(33.3%),<30%或无变化2例(4.9%)。8例经双介入治疗后获Ⅱ期手术切除,占19.0%。半年、1年、2年、3年生存率分别为:92.8%、64.3%、26.2%、7.1%。作者认为:双介入治疗优势互补、疗效增加、是治疗原发性肝癌一种行之有效的方法。 相似文献
11.
A. Y. F. Chung L. L. P. J. Ooi D. Machin S. B. Tan B. K. P. Goh J. S. Wong Y. M. Chen P. C. N. Li M. Gandhi C. H. Thng S. W. K. Yu B. S. Tan R. H. G. Lo A. M. M. Htoo K. H. Tay F. X. Sundram A. S. W. Goh S. P. Chew K. H. Liau P. K. H. Chow K. H. Tay Y. M. Tan P. C. Cheow C. K. Ho K. C. Soo 《World journal of surgery》2013,37(6):1356-1361
Background
The purpose of the present study was to determine whether intrahepatic injection of 131I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC).Methods
From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4–6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan–Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong.Results
The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46–1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51–1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by 131I-lipiodol and hepatic artery dissection during angiography.Conclusions
The randomized trial provides insufficient evidence to recommend the routine use of 131I-lipiodol in these patients. 相似文献12.
131Ⅰ标记单克隆抗体导向治疗肝癌的临床研究进展 总被引:1,自引:0,他引:1
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。 相似文献
13.
131I-LPD内辐射治疗原发性肝癌的研究 总被引:2,自引:0,他引:2
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。 相似文献
14.
Nia Adeniji Vinodhini Arjunan Vijay Prabhakar Zeynep Tulu Neeraja Kambham Aijaz Ahmed Paul Kwo Renumathy Dhanasekaran 《Clinical transplantation》2020,34(12):e14128
Long waiting times due to ongoing organ shortage have led to increased utilization of locoregional therapies (LRTs) to bridge patients with hepatocellular carcinoma (HCC) to liver transplantation (LT). We performed this study to evaluate the impact of LRTs on post-LT outcomes. We conducted a retrospective study of patients who were transplanted for HCC at Stanford University Hospital between 2008 and 2018 (n = 302). We found that receipt of ≥5 LRTs was an independent and significant predictor of poor overall 5-year survival (58.3% vs. 83.3%; HR 2.26, p = .03), poor recurrence-free 5-year survival (51.9% vs. 80.4%; HR 2.12, p = .03), and was associated with higher rates of recurrence (25.0% vs. 7.4%, p = .001). Moreover, recurrent HCC was more likely to be the cause of death (58.3% vs. 41.7%, p = .04) in patients who received ≥5 LRTs. Also, patients who required ≥5 LRTs showed an overall lower rate of radiological complete response (46.9% vs. 97.8%, p = .001) and were more likely to have more advanced pathological stage tumors in the explant (65.6% vs. 29.6%, p < .001). In conclusion, receipt of ≥5 bridging LRTs prior to LT is associated with worse post-transplant clinical outcomes. 相似文献
15.
目的探讨125I粒子与内支架结合治疗食管恶性狭窄的可行性及相关疗效。方法本组16例食管恶性狭窄的患者,临床分级为3~4期,在X线透视下经口腔将125I粒子联合内支架植入到患者食管内狭窄段进行治疗,术后随访并发症及疗效。结果16例患者125I粒子联合内支架植入均顺利释放,释放过程中未出现放射粒子脱落现象;所有患者术后吞咽困难症状消除或明显缓解,无明显并发症。结论125I内照射联合金属内支架治疗食管恶性狭窄,是一种安全、可行和有效的方法。 相似文献
16.
人类基因治疗的背景与肝癌基因治疗的研究概况 总被引:1,自引:0,他引:1
目的 了解人类基因治疗的背景与肝癌基因治疗的研究概况。方法 采用文献复习的方法对人类基因治疗的临床研究历史与发展,以及肝癌基因治疗方面的一些基础研究进展进行综述和分析。结果 基因治疗作为人类某些遗传疾病的替代治疗方法在临床研究中已取得了较好,冲锋枪量在肿瘤的治疗研究中基本上不处于基础研究阶段。在胆癌的基因治疗研究中,所有的病毒载体如逆转录病毒、腺病毒以及腺病毒的相关病毒各有优缺点,逆转录病毒邕有提高滴度,应该更有前景;所有目的基因TK及p53基因等已在体外及动物实验中取得了较好的效果,但在治疗的特异性和安全性方面还存在较大的缺陷。结论 人类基因治疗的前景是乐观的,肝癌的基因治疗研究也取得了一定成果,但距临床应用还有一段距离。 相似文献
17.
人肝癌特异性 HSV-TK/GCV重组腺病毒相关病毒质粒的构建与研究 总被引:1,自引:0,他引:1
目的 构建肝癌特异性HSV—TK/GCV重组腺病毒相关病毒质粒并了解其在细胞内的表达。方法 以腺病毒相关病毒的质粒WAV2作为载体,将TK基因插在甲胎蛋白(AFP)增强子/白蛋白启动子(AFP增强子/ALB启动子)的调控基因的下游,重组成pWAV2/AFP-ALB/HYTK质粒载体。同时构建质粒载体pEGFP-1/AFP—ALB。然后将上述两种不同载体分别转入AFP阳性表达的HepG2细胞株以及阴性表达的7721、SPC和7901细胞株。结果 绿色荧光蛋白只在AFP阳性表达的HepG2细胞株表达,采用PCR技术,以HSV—TK的引物扩增所抽提的总DNA中,只有AFP阳性表达的HepG2细胞株扩增出了710bp的DNA片段。结论 pWAV2/AFP—ALB/HYTK质粒载体在体外实验中具有很好的靶向性。 相似文献
18.
Kawano Y Sasaki A Kai S Endo Y Iwaki K Uchida H Shibata K Ohta M Kitano S 《Annals of surgical oncology》2008,15(6):1670-1676
Background Hepatic resection for hepatocellular carcinoma (HCC) in cirrhotic patients with esophageal varices (EV) is often avoided because
of poor liver function reserve. Outcomes of resection in such cases have not been fully investigated.
Methods We conducted a retrospective study of 134 cirrhotic patients (Child–Pugh class A or B) who underwent hepatic resection for
HCC, comparing short- and long-term outcomes in patients with EV (n = 31) to those in patients without EV (n = 103).
Results Patients with EV had higher tumor differentiation, fewer instances of portal invasion, lower liver function reserve, and more
limited resections than did patients without EV. Of 31 patients with EV, four died of postoperative complication, and nine
of liver failure, seven of HCC, two of ruptured EV, and two of other causes. Median survival time for patients who died of
liver failure was 59 months. Mortality and morbidity rates after hepatic resection did not differ between patients with and
without EV. The 5-year overall survival rate was significantly higher in patients with EV (70.1%) than in those without EV
(47.5%, P = 0.045) but did not differ between patients without portal invasion with and without EV (P = 0.55). Presence of EV was not an independent predictor for survival.
Conclusions Short- and long-term outcomes of hepatic resection in HCC patients with and without EV are similar. Limited hepatic resection
for early-stage tumor is an option for Child–Pugh class A or B patients with EV. 相似文献
19.
The Impact of Pre-Operative Loco-Regional Therapy on Outcome After Liver Transplantation for Hepatocellular Carcinoma 总被引:2,自引:3,他引:2
Francis Y. Yao Milan Kinkhabwala Jeanne M. LaBerge Nathan M. Bass Robert Brown Jr. Robert Kerlan Alan Venook Nancy L. Ascher Jean C. Emond John P. Roberts 《American journal of transplantation》2005,5(4):795-804
No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8% for the 85 patients who received pre-operative loco-regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC. 相似文献
20.
目的研究原发性肝细胞肝癌伴门静脉癌栓接受外放疗患者的疗效和预后因素。方法回顾性分析2000年1月至2009年11月期间在复旦大学附属中山医院放疗科进行外放射治疗的126例原发性肝细胞肝癌伴门静脉癌栓患者的临床资料。采用6MX或15MV光子,针对癌栓(部分包括肝内肿瘤)外照射,剂量30~60 Gy,中位剂量50 Gy,常规分割。生存分析采用单因素及COX回归多因素分析。结果多因素分析显示白蛋白水平、AFP、肝功能Child-Pugh分级、肝内肿瘤控制情况、淋巴结转移情况和放疗方法是独立的预后因素。放疗剂量与生存无显著性相关。结论在肝细胞肝癌患者中,外放疗治疗门静脉癌栓是安全而有效的。但是,姑息性放疗剂量不是肝细胞肝癌合并门静脉癌栓患者的预后因素。 相似文献