骶骨肿瘤术前超选择性动脉灌注化疗栓塞的疗效

目的:评估骶骨肿瘤术前超选择性动脉灌注化疗栓塞的疗效。方法:将22例行术前超选择性动脉灌注化疗栓塞(栓塞组)和16例未行化疗栓塞(对照组)骶骨肿瘤患者手术中失血量、输血量、术后引流量、手术时长、并发症发生率、住院天数及总费用、术后1年内复发率进行对比分析。结果:栓塞组平均术中出血量、输血量、术后引流量、手术时间均优于对照组(P<0.05);栓塞组住院天数、住院费用与对照组差异无统计学意义(P>0.05);术后骶神经损伤等并发症的发生率差异无统计学意义(P>0.05);栓塞组的术后1年复发率明显低于对照组(P<0.05);术后组织病理学证实:栓塞组肿瘤组织均有不同程度坏死、变性、液化、假包膜形成。结论:骶骨肿瘤术前超选择动脉灌注化疗栓塞在不增加医疗费用的情况下有利于手术切除、减少术中出血、缩短手术时间、延长存活时间。     

The curative effect of preoperative superselective arterial chemoembolization for sacrum tumor

目的:评估骶骨肿瘤术前超选择性动脉灌注化疗栓塞的疗效.方法:将22例行术前超选择性动脉灌注化疗栓塞(栓塞组)和16例未行化疗栓塞(对照组)骶骨肿瘤患者手术中失血量、输血量、术后引流量、手术时长、并发症发生率、住院天数及总费用、术后1年内复发率进行对比分析.结果:栓塞组平均术中出血量、输血量、术后引流量、手术时间均优于对照组(P＜0.05);栓塞组住院天数、住院费用与对照组差异无统计学意义(P＞0.05);术后骶神经损伤等并发症的发生率差异无统计学意义(P＞0.05);栓塞组的术后1年复发率明显低于对照组(P＜0.05);术后组织病理学证实:栓塞组肿瘤组织均有不同程度坏死、变性、液化、假包膜形成.结论:骶骨肿瘤术前超选择动脉灌注化疗栓塞在不增加医疗费用的情况下有利于手术切除、减少术中出血、缩短手术时间、延长存活时间.     

局部化疗栓塞术为主的肌骨肿瘤的综合介入治疗(附52例报告)

目的：探讨碘油化疗栓塞术治疗肌骨恶性肿瘤的临床价值,强调肌骨肿瘤综合介入治疗的重要性。方法：对52例肌骨肿瘤患者行以碘油局部化疗栓塞术为主的多种介入方法的综合治疗,全部病例分为手术组22例和非手术组30例,介入方法包括术前局部动脉灌注化疗术、局部动脉栓塞术、腹主动脉球囊阻断术、碘油局部化疗栓塞术及局部射频治疗等。结果：手术组术前动脉栓塞及球囊阻断术后手术出血量明显减少。非手术组碘油化疗栓塞术后患者局部疼痛减轻,肿块缩小,生存期延长,未出现皮肤坏死、溃疡或感染等严重并发症。结论：对不能手术的肌骨恶性肿瘤病变应进行以姑息性碘油化疗栓塞术为主的综合介入治疗。碘油局部化疗栓塞治疗安全可靠,疗效好,具有较大的临床应用价值。     

直肠癌的介入治疗

目的　评价直肠癌的选择性动脉灌注化疗和栓塞的临床价值。方法　采用Seldinger技术对 3 0例原发性直肠癌患者行超选择性插管 ,灌注抗癌药物后用明胶海绵栓塞 ;化疗栓塞后 7d内手术。结果　化疗栓塞后患者临床症状明显缓解 ,有 2 5例达到根治性切除 ,且术中出血明显减少。结论　直肠癌的导管灌注化疗及栓塞可缓解临床症状 ,提高手术切除率     

介入热灌注化疗栓塞治疗肝脏恶性肿瘤疗效分析

目的探讨介入热灌注化疗栓塞术治疗肝脏恶性肿瘤的疗效。方法对31例肝脏肿瘤患者先经导管缓慢推注小剂量5-Fu,再用中等剂量丝裂霉素与顺铂或卡铂联合经动脉灌注行热化疗(使进入体内温度达到43～48℃),并用阿霉素或表阿霉素与超液态碘油按5∶1的比例混合,栓塞肿瘤供血血管。结果介入热化疗栓塞术后,患者临床症状迅速缓解,碘油均匀弥散并延长充填时间。31例中完全缓解3例,部分缓解11例,轻度缓解8例,无效9例,总缓解率为71%。结论介入热化疗栓塞术是治疗肝脏恶性肿瘤的一种重要方法之一。     

急诊介入治疗妇产科继发性出血的临床价值

目的 探讨急诊介入栓塞治疗妇产科继发性出血的临床价值.方法 20例严重妇产科继发出血患者,选择性插管双侧髂内动脉、子宫动脉进行急诊介入栓塞治疗,栓塞物质为明胶海绵颗粒、真丝线段/颗粒或弹簧圈.对于9例恶性肿瘤,同时经微导管进行局部灌注化疗.所有病例术后追踪观察3～36个月.结果 介入栓塞治疗对继发出血的控制情况: 临床治愈16例,占80%;有效3例, 占15%;1例无效,占5%.19例患者保留了子宫,1例介入治疗无效患者后进行子宫切除术.经过3～36个月随访,11例育龄期女性均恢复正常月经周期.无严重与栓塞相关并发症发生. 结论 急诊介入治疗是改善严重妇产科出血性疾病预后的首选方法.     

术前介入化疗及栓塞对贲门癌的治疗价值

目的 探讨术前经胃左动脉灌注化疗药物及栓塞对贲门癌的治疗价值。方法 将入选病例随机分成两组:①试验组(介入化疗栓塞+手术组)30例;②对照组(单纯手术组)30例。试验组采用Seldinger穿刺插管技术将导管插至胃左动脉,采用FAM或FAD方案进行区域性灌注化疗并以明胶海绵颗粒栓塞,栓塞后7～10d行贲门癌根治术,对手术所见、病理表现及生存状况进行对照研究。结果 试验组手术所见病灶缩小(占83％),肿瘤轻度水肿,缺血,术中出血量少,手术易切除。按病理所见分为4级:0级:无效(0例);Ⅰ级:轻度有效(2例);Ⅱ级:中度有效(25例)Ⅲ级:显效(3例)。两组比较差异有显著性(P<0.01)。生存期试验组术后1、2、3年生存率分别为90.0％、80.0％和60.0％,较对照组1、2、3年生存率76.7％、66.7％和46.7％明显延长(P<0.05)。结论 术前介入化疗及栓塞能使肿瘤缩小,肿瘤显著坏死,可减少术后复发及转移,提高生存期。     

介入栓塞治疗在骨与软组织肿瘤中的应用

目的 探讨介入在骨和软组织肿瘤临床治疗中的价值.方法 对28例经病理证实的骨与软组织肿瘤患者行选择性血管造影、动脉内灌注化疗和(或)栓塞治疗;观察治疗后临床、病理改变.结果 动脉灌注化疗和(或)栓塞治疗后23例疼痛缓解或消失;19例软组织消肿,肿瘤缩小;22例在介入治疗后1周内又接受手术治疗并经病理检查,显示瘤细胞不同程度变性、坏死、液化,以并用栓塞治疗者更为显著.肢体肿瘤患者66.4%(10/15)行保肢手术.结论 介入治疗是骨与软组织肿瘤的有效治疗方法,值得在临床上推广使用.     

少血供转移性肝肿瘤滋养动脉超选择性化疗栓塞的疗效观察

目的评价少血供肝转移性肿瘤超选择性滋养动脉插管并完全性栓塞治疗的临床疗效。方法在DSA的引导下,对75例少血供肝转移性肿瘤病灶滋养动脉超选择性插管并完全性化疗栓塞。结果75例共202个被栓塞病灶在术后2～3月CT复查,189个病灶被碘油完全性充填、11个病灶大部被碘油充填、2个病灶碘油充填欠佳。159个病灶明显缩小、41个病灶部分缩小、2个病灶缩小不明显。术后6、12、24、36月及3～5年生存率分别为100%(75/75)、85.3%(64/75)、55%(41/75)、42.7%(32/75)、20%(15/75)。结论高度选择性滋养动脉插管并完全性化疗栓塞是一种对转移性肝肿瘤治疗的有效方法。     

Yashiro导管在骨盆肿瘤化疗栓塞中的临床应用

目的探讨Yash iro导管在骨盆肿瘤化疗栓塞中的临床应用价值。方法对23例骨盆肿瘤患者中11例Cobra导管不能完成同侧髂内动脉和骶正中动脉插管的患者采用Yash iro导管进行超选择插管,找出肿瘤的所有供血动脉,然后根据血供进行超选择性灌注化疗,并用明胶海绵随机对其中11例患者进行所有肿瘤供血动脉的选择性栓塞;对其中12例患者除进行肿瘤供血动脉的选择性栓塞外,还对双侧髂内动脉主干进行栓塞,栓塞后24~48 h由同一组医生切除肿瘤。结果Yash iro导管能明显缩短同侧髂内动脉和骶正中动脉的插管时间,所有病例均成功地完成靶血管的超选择插管;手术中易剥离,出血少,术野清楚,缩短了手术时间;术后随访6~18个月,未见肿瘤复发和转移。结论Yash iro导管能提高骨盆肿瘤介入治疗的效率,利于肿瘤彻底切除,减少肿瘤复发或转移,是一种安全有效的术前辅助性治疗方法。     

Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors

BACKGROUND AND PURPOSE: High-dose intraarterial chemotherapy with repeated one-shot infusion may be useful for treating head and neck tumors. We evaluated the efficacy of superselective continuous arterial infusion chemotherapy administered via a coaxial catheter system and compared the results with those of subselective catheterization for treatment of oral cavity tumors. METHODS: Forty-nine consecutive patients with tumors of the oral cavity (clinical stage I, 12 cases; stage II, 19 cases; stage III, six cases; stage IV, 12 cases) were treated by arterial infusion chemotherapy. After a guiding catheter was advanced into the superficial temporal artery, superselective catheterization was performed using a coaxial system microcatheter. Superselective catheterization was accomplished in 34 cases, and was unsuccessful in 15, owing to difficulties in performing catheterization or to multiple feeding arteries. In the latter cases, the tip of the catheter was placed near the origin of the feeding arteries (subselective catheterization). RESULTS: Thirty (88%) of 34 patients had a complete response to superselective arterial infusion chemotherapy and two (6%) had a partial response. Twelve (80%) of 15 patients had a complete response to subselective arterial infusion chemotherapy and three (20%) had a partial response. Local recurrence was more frequent after subselective treatment (13%) than after superselective (6%) treatment. CONCLUSION: Superselective continuous arterial infusion chemotherapy may be suitable for local control of oral cavity tumors, with a low rate of recurrence.     

头颈部肿瘤的血管内栓塞与化学治疗

目的 探讨头颈部肿瘤选择性动脉内治疗技术及价值。方法 对１９例颅内外肿瘤进行了２２次选择性动脉栓塞或化疗,其中区域性化疗１３例次,血管内栓塞１２例。结果 所有病人治疗后症状均有不同程度的好转,且栓后肿瘤染色部分或全部消失、供血动脉闭塞;未出现严重并发症。再行病变切除时发病变退缩、术中失血少,病理显示病灶及周边血管栓塞和血栓性脉管炎。结论 血管内介入治疗是头颈部肿瘤一种安全有效的辅助性疗法。     

经动脉介入栓塞治疗胰头癌临床观察(附13例报告)

目的 探讨介入动脉栓塞治疗中晚期胰头癌的疗效.方法对13例胰头癌患者进行胰十二指肠动脉造影后,超选入肿瘤供血动脉灌注健择1000 mg,然后用健择200 mg和10 ml碘化油混悬液进行栓塞,4周后行CT扫描评价疗效.结果所有患者临床症状明显减轻,肿块明显缩小.结论 动脉栓塞治疗胰头癌有较好的疗效,是目前临床治疗胰头癌的可行有效方法之一.     

头颈部副神经节瘤的术前栓塞治疗

目的：分析头颈部副神经节瘤的ＤＳＡ表现及评价术前栓塞的作用。材料与方法，８例患者均行双侧颈总动脉及椎动脉ＤＳＡ检查，而后行患侧超选择性插管，以明胶海绵颗粒或真丝段作为栓塞材料。结果：５例颈静脉球瘤，２例颈动脉体瘤及１例迷走神经体瘤的动脉期均显示主要由颈外动脉的分支供血，如咽升动脉，耳后动脉，枕动脉等，颈静球瘤如侵犯后颅凹，颈内动脉或椎动脉的分支也可参与供血，实质期，肿瘤呈分叶状，不均匀染色，静脉期     

骶髂骨肿瘤切除术前介入栓塞价值

目的 评估骶、髂骨肿瘤术前经导管超选择性动脉栓塞的价值和作用.方法对15 例骶、髂骨肿瘤用明胶海绵颗粒行超选择性动脉栓塞,栓塞后1～3 d行手术切除.疾病包括:骨巨细胞瘤5 例、动脉瘤样骨囊肿2例、转移瘤2 例、软骨肉瘤4例、脊索瘤3例.结果本组15 例栓塞后造影均显示肿瘤染色范围均较术前减少80 %以上.术中失血500～2600 ml 之间,平均为1100 ml .所有肿瘤均被顺利切除.结论 骶、髂骨肿瘤手术治疗前超选择性动脉栓塞能安全有效地减少术中出血, 提高肿瘤手术治疗效果并降低手术的风险.     

超选择性颈外动脉分支栓塞术在头颈部疾病中的应用

目的探讨超选择性颈外动脉分支栓塞术在头颈部疾病中的应用。方法对41例头颈部疾病患者进行DSA检查,行超选择性颈外动脉分支栓塞治疗。结果12例鼻出血栓塞后即刻无活动性出血,随访6～12个月未再复发;7例鼻咽纤维血管瘤栓塞后手术出血量明显减少;1例外伤动脉出血栓塞后即刻止血,无复发;14例血管畸形栓塞后随访6～12个月,明显好转3例,好转6例,无变化5例;7例头颈部恶性肿瘤姑息性治疗后存活时间2年以上者3例。结论超选择性颈外动脉栓塞术治疗头颈部疾病安全、有效。     

微导管脑动脉超选灌注BCNU与ACNU治疗脑恶性肿瘤临床研究

目的：本文报告了28例脑恶性肿瘤应用不同化学药物和方法．延长病人生存期．改善生存质量以及并发症防治。材料与方法：将28例脑恶性肿瘤病人随机分二组，施行微导管脑动脉超选灌注化学药物BCNU与ACNU．每次剂量分别为100～200mg／m2和2～3mg／kg。结果：近期疗效，应用BCNU组有效率85．1％；应用ACNU组有效率100％。三年生存率：BCNU组42．8％；ACNU组64．3％，并发症；ACNU组明显低于BCNU组。结论；采用微导管脑动脉超选灌注化学药物治疗脑恶性肿瘤方法，疗效优于静脉及其它给药方法。药物ACNU疗效高于BCNU，并且药物ACNU的毒副作用小并发症少。     

A newly developed double lumen microballoon catheter with a side hole: initial experience of intraarterial infusion chemotherapy and/or embolization

Purpose

To introduce a newly developed double lumen microballoon catheter with a side hole for intraarterial infusion chemotherapy and/or embolization.

Methods and materials

Seven patients with malignant tumors, for whom superselective catheterization was considered difficult or had failed, underwent intraarterial infusion chemotherapy and/or embolization with the 3.3-Fr microballoon catheter. The catheter has a double lumen and a side hole to facilitate infusion from the proximal end of the balloon. The balloon was placed on the distal side of the target artery branching site. Inflation of the balloon and occlusion of the main lumen with the tip of the occlusion device allowed for intraarterial infusion chemotherapy and/or embolization of the target artery via the side hole.

Results

Successful intraarterial infusion chemotherapy and/or embolization with the microballoon catheter was performed in all patients with no complications.

Conclusions

The newly developed microballoon catheter achieves intraarterial infusion chemotherapy and/or embolization without the need for superselective catheterization.     

Selective intra-arterial cytostatic injections in malignant head and neck tumors

Summary Regional intra-arterial drug administration has been advocated in order to reduce the risks of systemic complications in conjunction with systemic tumor chemotherapy. We have been using superselective angiographic techniques to administer the antitumor drug mitomycin C directly into the feeding arteries of the tumor in 15 patients with advanced malignant head and neck tumors. No complications were observed. In five patients the tumor decreased significantly in size, in four patients, tumor cell necrosis was found. A marked decrease in pain was reported by nine of the 15 patients.     

Intraarterial chemotherapy of head and neck tumors

Forty-one patients with advanced recurrent or untreated and neck tumors were treated with intraarterial short-term (1-1 1/2 hr) infusion of cisplatin into the external carotid artery, achieving an immediate tumor response rate of 29.3%. Tumor extent within or beyond the territory of a single external carotid artery was the only significant factor identified affecting the tumor response rate (57.1% vs. 14.8%). Treatment with intraarterial chemotherapy using superselective catheterization before irradiation or surgery is beneficial in some patients.