肝外动脉供血在TACE治疗原发性肝癌临床意义的探讨

目的:探讨肝癌肝外动脉在介入治疗原发性肝癌中的意义.方法:回顾性分析2009-03-2010-08山东省肿瘤医院200例原发性肝癌患者的DSA资料.所有患者行常规腹腔动脉造影及肝外动脉探查,并对其行超选择性插管及化疗栓塞治疗(TACE).结果:200例患者共接受257次TACE治疗,36例患者存在47条肝外动脉参入肿瘤供血,主要来自膈下动脉(10例),肋间动脉(4例),内乳动脉(1例),网膜动脉(3例),胃十二指肠动脉(8例),肠系膜上动脉的分支(10例).33例患者肝外动脉均行超选择性插管和化疗栓塞治疗,其余3例患者肝外动脉困未能成功超选择性插管而经皮射频消融治疗后CR.结论:肝外动脉的存在直接影响肝癌治疗的疗效,对肝外动脉供血支超选择性栓塞治疗,对提高TACE的疗效具有十分重要的意义.     

膈下动脉栓塞术在原发性肝癌和肝转移癌介入治疗中的疗效评价

目的 探讨膈下动脉对肝癌患者肿瘤的供血及通过该血管行化疗栓塞术在肝癌治疗中的价值.方法 收集收治的有膈下动脉供血肿瘤的肝癌病例19例,所有病例均行肝动脉及膈下动脉造影,均行肝动脉化疗栓塞术及参与肿瘤供血的膈下动脉行化疗栓塞术治疗.结果 19例患者中,17例原发性肝癌及乳腺癌肝转移患者肝内病灶碘化油沉积良好,术后随访4～24个月,所有患者临床症状、体征均明显改善,71.4%的患者AFP值降至正常值范围,1年和2年生存率分别为52.6%和21.1%.结论 在肝癌肿瘤的侧支供血管中,膈下动脉是主要的侧支动脉之一,行肝癌介入治疗时,膈下动脉与肝动脉同时进行化疗栓塞治疗对肿瘤的治疗有重要意义.     

原发性肝癌肝外侧支血供动脉的特点和介入治疗分析

目的：分析原发性肝癌患者肝外侧支血供动脉的发生情况及其对介入栓塞治疗的影响。方法选取行经导管肝动脉化疗栓塞术的350例原发性肝癌患者,分析原发性肝癌患者肝外侧支血供的发生率、发生部位、介入栓塞治疗效果及肝外侧支供血动脉的发现时机等。结果350例患者中发生肝外侧支血供73例,占20.86%,其中肝外侧支动脉85条,主要以右膈下动脉、胃十二指肠及网膜动脉为主,分别占41.18%和18.82%。经1次介入治疗,肝外侧支血供动脉的发现率为6.86%,经多次介入治疗其发现率为14.00%,随着介入治疗次数的增多,肝外侧支血供动脉的发现率升高,差异有统计学意义（P﹤0.05）。肝外侧支血供动脉中插管成功率为90.59%（77/85）,手术结束1周后,甲胎蛋白（AFP）值下降者占87.67%（64/73）。结论原发性肝癌肝外侧支血供动脉发生率较高,且分布复杂,对肝外侧支血供动脉进行介入栓塞治疗,有利于提高介入治疗疗效。     

肝动脉化疗栓塞与肝动脉化疗栓塞联合无水乙醇注射治疗原发性肝癌疗效比较

目的:比较肝动脉化疗栓塞(TACE)与肝动脉化疗栓塞联合无水乙醇注射(PEI)治疗原发性肝癌的治疗效果.方法:52例患者接受TACE治疗,58例患者接受TACE联合PEI治疗,比较两组患者1、2、3年的存活率.结果:TACE联合PEI治疗组2、3年的存活率分别为34.48%,15.51%.显著高于TACE组2、3年的存活率15.38%,1.9%.结论:肝动脉化疗栓塞联合无水乙醇注射治疗较单用肝动脉化疗栓塞治疗能延长原发性肝癌患者存活期.     

肝癌的肝外动脉供血及其介入治疗

目的 探讨肝癌的肝外动脉供血规律、插管技术及介入治疗。方法 分析62例肝癌患者78条肝外动脉供血特征,对肝外动脉供血支行超选择插管,并同时进行肝动脉系统及肝外动脉供血支的双动脉化疗栓塞术。结果 肝外动脉供血占肝癌患者的43．1％,肝外动脉供血与肿瘤部位、大小密切相关;RH、Cobra、SP管配合使用,肝外动脉供血支插管成功率为71．8％。治疗后1个月复查,CT显示肿瘤缩小,碘油沉积致密完全。结论 肝癌有丰富的肝外动脉供血,对具有肝外动脉供血的肝癌患者采取双动脉内化疗栓塞是可行、必要和有效的。     

彩色多普勒超声血流动力学特征对鉴别诊断原发性和转移性肝癌的价值

目的 探讨彩色多普勒超声通过血流动力学特征对原发性肝癌和转移性肝癌的鉴别价值.方法 选取60例确诊为原发性肝癌和60例转移性肝癌患者,所有患者行彩色多普勒超声检查,对比分析两者血流动力学特征的异同.结果 原发性肝癌的血流动力学参数的肝动脉直径、肝动脉峰值、门静脉流速以及肝动脉最小流速均与转移性肝癌存在明显差异,具有统计学意义(P＜0.05);但2组患者的肝动脉血流阻力指数差异不具统计学意义(P＞0.05).原发性肝癌内部血流信号检出率为88.3％,周边血流信号检出率为100.0％;转移性肝癌内部血流信号检出率为48.3％,周边血流信号检出率为70.0％,2组差异具有统计学意义(P＜0.05).原发性肝癌血流特点为高速高阻型,转移性肝癌则为低速高阻型.结论 彩色多普勒超声通过血流动力学参数对原发性肝癌和转移性肝癌鉴别特异性较好,具重要临床使用价值.     

原发性肝癌肝外侧支动脉供血的诊断及介入治疗

目的:探讨肝癌侧支供血的影像学类型和介入治疗方法。方法:分析165例肝癌患者的数字减影血管造影(DSA)表现,并与多层螺旋CT对照。分析侧支供血类型,并相应行栓塞治疗。结果:165例肝癌侧支供血的患者DSA检查共发现侧支206条,其中右膈下动脉107条,左膈下动脉31条,右肋间动脉19条,胃十二指肠动脉13条,胃左动脉7条,右肾上腺动脉18条,胸廓内动脉11条。术前多层螺旋CT检查发现157条肝外侧支供血动脉,阳性率为76%(157/206)。栓塞侧支动脉后,行CT复查可见肿瘤病灶内碘油沉积较前密实、均匀,其边缘与肿瘤边缘相吻合。结论:肝癌的肝外侧支供血发生率较高,及时发现并进行栓塞治疗,可明显提高对肝癌的治疗效果。     

吉西他滨治疗晚期肝癌疗效观察

目的评价吉西他滨肝动脉栓塞化疗治疗晚期原发性肝癌的临床疗效。方法随机抽取原发性肝癌患者18例为治疗组,采用吉西他滨治疗;随机抽取过去行5-Fu治疗的原发性肝癌患者23例为对照组。分别评价治疗前后两组患者的临床疗效及毒副反应。结果两组患者治疗后,吉西他滨组的临床疗效优于5-Fu组,不良反应轻微。结论吉西他滨肝动脉化疗栓塞治疗原发性肝癌是一种较理想的给药途径。     

经皮射频毁损和肝动脉栓塞化疗联合治疗中晚期原发性肝癌的疗效观察

肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)已广泛用于治疗中、晚期原发性肝癌,并已取得了一定的疗效.但肝癌由肝动脉和门静脉双重供血,单纯肝动脉栓塞化疗不能有效控制肿瘤生长.射频毁损(Radiofrequency Ablation,RFA)治疗肝脏恶性肿瘤,有明确疗效[1].本文回顾性分析我院103例中、晚期原发性肝癌患者行TACE和(或)RFA治疗资料,探讨TACE与RFA联合治疗中、晚期原发性肝癌的疗效.     

经皮经肝门静脉导管药盒植入治疗肝癌4例报告

化疗仍是肝癌综合治疗的 1个重要组成部分 ,其给药途径与方法直接影响疗效。在Ｂ超引导下经皮经肝门静脉穿刺导管药盒植入术 ,安全、简便、费用较低 ,是肝癌化疗的良好途径之一 ,我们应用此技术治疗 4例肝癌患者 ,现报告如下。1　临床资料4例患者均为男性 ,年龄 3 1～ 65岁 ,平均年龄 5 2岁。原发性肝癌 2例 ,其中 1例右半肝癌复发者行左肝外叶肝癌切除术 ,术后行肝动脉化疗栓塞 1年余 ;另 1例为第Ⅴ、Ⅷ段巨块性肝癌 ,行肝动脉化疗栓塞术后原发灶明显缩小 ,但出现新卫星灶 ,最后 1次介入治疗显示栓塞的肝动脉尚未开通。继发性肝癌 2例 ,均…     

肠细膜上动脉供血型肝癌的血管造影分析及介入治疗

目的 研究肠细膜上动脉供血型(即变异肝动脉起源于肠细膜上动脉)肝癌的血管造影表现及插管技术。 方法 回顾分析41例肠细膜上动脉供血型肝癌的DSA及介入治疗资料,统计血管解剖变异的发生率,对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。 结果 350例肝癌中,肠细膜上动脉供血型41例(11.9％),其中副肝右动脉15例(36.5％),替代肝右动脉16例(39.0％),肝总动脉8例(19.5％),腹腔动脉干起源于肠细膜上动脉2例(5％)。31例肠细膜上动脉发出替代或副肝右动脉者,29例(94.0％)腹腔动脉造影表现为肝右动脉细小或缺如,肝右叶出现无血管区。RH导管超选择性插管成功25例(61％),未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。 结论 肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血,熟悉其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。     

晚期肝癌肝脏内外侧支供血及临床意义

目的：探讨肝癌肝脏内、外侧支供血的产生机理。方法：收集TAE治疗资料完整的中晚期肝癌340例，对其血管造影表现进行分析。结果：肝内侧支供血227例：叶间侧支207例，叶内侧支20例；肝外侧支供血78例：胃左肝在动脉共干21例、网膜动脉29例、右IPA13例、左IPA5例、结肠中动脉9例、右肾动脉1例；肝内合并肝外侧支同时供血35例。结论：侧支供血形成的机制与肝脏的解剖及肿瘤生长部位有关。认为了解肿瘤侧支供血的造影表现，对肝癌TAE及手术治疗有重要的临床意义。     

Angiographic findings of extrahepatic branches originating from hepatic artery and its clinical significance

Objective: To observe the presentation and variation of extrahepatic branches originating from hepatic artery by hepatic arteriography.Methods: Hepatic arteriogram of 200 cases with unresectable hepatic primary or metastatic tumors before interventional therapy were retrospectively analyzed. Two interventional radiologists independently reviewed the type, originating artery, distribution and variation of extrahepatic artery.Results: Five types of extrahepatic artery were found, with the most common type of the right gastric artery (n=156, 78%), followed by the cystic artery (n=126, 63%), accessory left gastric artery (n=19, 9.5%), hepatic falciform artery (n=5, 2.5%), and accessory left inferior phrenic artery (n=4, 2%). In 188 cases, there were extrahepatic arteries derived from hepatic proper artery or its branches, and the most frequent originating site was the right hepatic artery (130 extrahepatic branches), followed by the proper hepatic artery (103 branches), left hepatic artery (56 branches) and middle hepatic artery (3 branches). The left hepatic artery was the arising site with the multiple types of extrahepatic branches including all above branches except the cystic artery.Conclusion: Many types of extrahepatic branches usually derive from the hepatic artery or its distal branches, and its originating sites are not constant. It is important to avoid damage of extrahepatic tissue during interventional therapy for liver tumors.     

超选择性动脉灌注化疗栓塞术治疗大肠癌所致机械性肠梗阻的效果分析#br#

目的探讨超选择性动脉灌注化疗栓塞术治疗大肠癌所致机械性肠梗阻的效果及安全性。方法选取2019年1月至12月在右江民族医学院附属医院肿瘤科住院的大肠癌所致机械性梗阻患者26例,均行超选择性动脉灌注化疗栓塞术,分析肠梗阻治疗显效率、显效时间及安全性。结果26例患者均顺利完成超选择性动脉灌注化疗栓塞术治疗,其中经肠系膜上动脉超选择灌注化疗栓塞8例,经肠系膜下动脉超选择灌注化疗栓塞17例,经骶正中动脉超选择灌注化疗栓塞1例;经治疗后,肠梗阻缓解24例,显效率92.3%（24/26）,其中完全缓解20例（76.9%）,部分缓解4例（15.4%）;无效2例（7.7）,其中肠梗阻加重1例,进展为绞窄性肠梗阻1例。肠梗阻缓解的显效时间为11～63 h,平均（30.2±10.4）h。结论经动脉超选择灌注化疗栓塞术治疗大肠癌所致机械性肠梗阻的效果好且安全,患者可接受性强。     

Hepatocellular carcinoma with blood supply from parasitized omental artery: Angiographic appearance and chemoembolization

Objective: To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. Methods: A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. Results: Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor’s oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. Conclusion: Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.     

TACE联合放疗对原发性肝癌合并门静脉癌栓患者生存的影响

  目的  观察TACE联合放疗对原发性肝癌合并门静脉癌栓患者生存的影响。   方法  收集福建省肿瘤医院2005年1月至2010年1月间收治的原发性肝癌合并门静脉癌栓患者52例,分为观察组和对照组:观察组32例,采用肝动脉化疗栓塞联合三维适形放射治疗;对照组20例,单纯采用肝动脉化疗栓塞治疗。观察两组患者的疗效及患者的生存时间和1年生存率,对患者生存质量进行评分。   结果  观察组患者总有效率78.1%,显著优于对照组（45.0%）;观察组患者总生存时间和1年生存率均显著优于对照组;两组不良反应的发生率无显著性差异;治疗后生存质量评分观察组低于对照组,但治疗后3个月生存质量评分观察组显著优于对照组。   结论  TACE联合放疗可显著提高患者的疗效,延长生存时间,提高1年生存率,改善患者生存质量。      

A clinical study of hepatic arterial infusion chemotherapy with low-dose CDDP and 5-FU for liver metastases

We followed patients who underwent hepatic arterial infusion chemotherapy with low-dose CDDP+5-FU for liver metastases from colorectal cancer in the outpatient setting. A catheter was inserted from the femoral artery into the proper hepatic artery using the interventional technique. Two complete response (CR) and seven partial response (PR) were achieved, but later 2 of these patients had lung metastases. We conclude that this therapy may be effective, but control of extrahepatic lesions is necessary for life prolongation.     

A case report of advanced huge hepatocellular carcinoma (H.C.C.) accompanied by tumor embolism to the inferior caval vein (Vv3) that was treated with surgical extended right lobectomy after multimodal therapy

We performed multimodal therapy for a huge hepatocellular carcinoma with tumor embolism (Vv3), for which excision was judged impossible. After treatment, a hepatectomy to the primary lesion was finally carried out and long-term survival was achieved. A 52-years-old man with right lateroabdominal pain had a huge occupied hepatocellular carcinoma that was detected in October 2000. A tumor embolism, which invaded the inferior vena cava, was also seen. The residual liver was judged to have insufficient capacity for a right hepatic lobectomy. A percutaneous transhepatic portal embolism (PTPE) was carried out against the right portal vein to increase in the left lobe capacity. The chemo-radiotherapy (36 Gy to the right hepatic vein and systemic administration of CDDP) and transcatheter arterial chemoembolization were added to the feeding arteries of the hepatic tumor. When a decrease in the postcaval vein tumor embolism was observed, the extended right hepatic lobectomy was performed. The postoperative course was good, and the patient was discharged from the hospital on postoperative day 41. Though lung metastasis and new lesions in left lobe were seen in a recurrence, two years and ten months since the start of the systemic chemotherapy. This case suggested that even if a huge liver cancer with vascular invasion is judged impossible to excise, multimodal therapy with the aim of surgical treatment helps retain the possibility to later chose hepatectomy for the primary lesion and improve prognosis.