三氧化二砷持续区域肝动脉灌注治疗肝癌的临床研究

目的 探讨三氧化二砷(As2O3)注射液单药连续区域动脉灌注化疗原发性肝癌的临床疗效.方法 55例手术不能切除的非晚期原发性肝癌患者,随机分为两组:(1)As2O3治疗组26例:患者采用经股动脉肝动脉碘油栓塞后埋置皮下化疗泵,予以连续区域灌注As2O3化疗,20 mg/d,每天1次,共7 d,间隔4周重复,共5疗程.(2)对照组29例:采用经股动脉肝动脉栓塞化疗(TACE),2次TACE15例,3次TACE14例.结果 As2O3治疗组总有效率为34.6%(9/26)、肿瘤复发率为15.4%(4/26)、1年生存率为80.7%(21/26);TACE组分别是31.0%(9/29)、37.9%(11/29)、51.7%(15/29).统计学分析表明,两组的总有效率差异无统计学意义,P＞0.05;肿瘤复发率和1年生存率差异有统计学意义,P＜0.05.As2O3治疗组较对照组不良反应轻微,未见不可逆不良反应.结论 经股动脉肝动脉碘油栓塞后埋置皮下化疗泵予以连续区域灌注As2O3化疗用于治疗原发性肝癌不良反应轻微、疗效确切,具有一定的临床应用前景.     

腹腔干动脉狭窄患者肝癌的TACE治疗结果分析

目的研究腹腔干动脉狭窄后肝癌患者经侧枝循环行导管肝动脉化疗栓塞（TACE）治疗的方法和疗效。方法对11例腹腔干动脉狭窄后肝癌患者应用RH、Cobra配合微导管技术进行治疗。结果 2例经腹腔干插管至肝段水平行化疗栓塞。7例经肠系膜上动脉插管至肝段水平,并行化疗及栓塞治疗,插管成功率为77.8%（7/9）;4～6周复查,CT显示肿瘤缩小,碘油沉积致密。2例插管至肝固有动脉行灌注化疗。结论腹腔干动脉狭窄后肝脏可形成丰富的侧枝循环,其中肠系膜上动脉供血尤为常见,应用RH、Cobra导管配合微导管技术,多能顺利插管至肝段水平对肝癌行TACE治疗。     

肝动脉灌注术治疗原发性肝癌的护理体会

肝动脉灌注术是经股动脉插管,选择性插入肝癌供血动脉,进行栓塞和灌注化疗药物,栓塞主要的肿瘤血管,阻断肿瘤血供,使肿瘤缺血坏死,并灌注化疗药物杀死肿瘤细胞[1]。肝动脉灌注术治疗晚期原发性肝癌,据文献报道,生存期可达12个月~3年,不失为一种较有效的保守治疗手段。我科自2011年12月~2014年2月为24例原发性肝癌患者进行肝动脉灌注术,经股动脉插管至肝动脉,选择性将药物注入肿瘤区域,治疗效果尚理想。 CT片示癌肿组只明显缩小,预后尚好,明显地延长了患者生存期,1例患者生存期已达5年。现将护理体会报告如下。     

三维适形放疗联合肝动脉化疗栓塞治疗原发性肝癌临床研究

目的评价肝动脉化疗栓塞结合三维适形放射治疗对原发性肝癌的疗效。方法将68例原发性肝癌患者分为两组，对照组32例，仅给予肝动脉化疗栓塞；观察组36例，先行肝动脉化疗栓塞后给予三维适形放射治疗，观察疗效及生存率。结果治疗后3个月肿瘤局部控制率观察组为86．1％（31／36），对照组为62．5％（20／32），1、2、3年生存率观察组分别为86．1％，52．8％，22．2％，对照组分别为65．6％、46．9％、18．8％。结论肝动脉化疗栓塞结合三维适形放射治疗是治疗原发性肝癌的有效无创治疗手段。     

灌注式热化疗联合微球在原发性肝癌介入治疗中的价值

目的:观察灌注式热化疗联合微球在原发性肝癌经导管肝动脉化学栓塞（TACE）治疗中的应用价值。 方法:采用便利抽样法选取90例原发性肝癌患者为对象,按照随机数表法分为两组,各45例,其中观察组以化疗药物＋65°热碘油＋微球序贯行TACE治疗,对照组以化疗药物＋常温碘油化疗药乳化合剂＋微球序贯行TACE治疗,术中均灌注化疗替加氟750 mg/m2＋奥沙利铂60 mg/m2。以每4周为1周期,均予以2~6个周期的化疗灌注栓塞治疗。对比两组近期疗效,观察治疗前及治疗4周时血液指标变化情况,包括甲胎蛋白（AFP）及肝肾功能指标丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、尿素氮（BUN）、肌酐（CREA）、白蛋白（ALB）、总胆红素（TBIL）,并分析毒副反应发生率及远期随访结果。 结果:观察组总缓解率ORR为84.44%、对照组为64.44%,差异有统计学意义（P<0.05）。两组治疗4周后,观察组AFP水平显著低于治疗前（P<0.05）,ALT、AST、BUN、CREA水平较治疗前无统计学意义（P>0.05）,对照组上述指标较治疗前均无统计学意义（P>0.05）;观察组治疗4周后AFP水平显著低于对照组（P<0.05）,其他指标较对照组无统计学意义（P>0.05）。观察组毒副反应发生率为22.22%、2年远期生存率为88.89%;对照组依次为20.00%、71.11%,2年远期生存率差异有统计学意义（P<0.05）。 结论:以灌注式热化疗联合微球对原发性肝癌患者行TACE术治疗,近远期疗效显著,毒副反应发生率低。     

亚临床肝性脑病患者躯体感觉事件相关电位研究

目的：观察原发性肝癌患者躯体感觉事件相关电位（ERP）的变化规律，探讨ERP在肝性脑病中的临床意义。方法：对48例原发性肝癌病人在肝动脉化疗栓塞（TACE）术前、后进行躯体ERP检测，并以50名健康人作对照。结果：在肝动脉化疗栓塞后及部分合并亚临床肝性脑病（SHE）患者中N2、P3波的潜伏期延长，P3波幅降低，与对照组比较有显著差异。结论：躯体感觉ERP可作为诊断大脑智能障碍的一种客观指标，有助于亚临床肝性脑病患者的脑功能判断。     

89例巨块型原发性肝癌介入化疗栓塞治疗体会

目的 探索巨块型原发性肝癌介入栓塞治疗的疗效.方法 89例巨块型原发性肝癌患者,经皮股动脉穿刺插管至肝动脉,化疗栓塞治疗肝癌;碘油用量为20～50ml.再注入明胶海绵颗粒栓塞治疗.发现肝外肿瘤供血动脉,超选择插管化疗栓塞后,注入适量明胶海绵栓塞治疗.结果 本组病例中首次DSA造影发现11例存在肝外动脉供血;64例出现肝外供血动脉共计67支.术后甲胎球蛋白下降均>50%.术后4～6周复查CT,肿瘤最大直径缩小3.5～5.9cm.1、2、3年累计生存率分别为73.8%、48.3%和28.5%.结论 巨块型原发性肝癌大剂量碘油栓塞联合肝外肿瘤供血动脉介入治疗,对于提高巨块型原发性肝癌的介入疗效具有重要意义.     

肝动脉化疗栓塞联合血管内皮抑素治疗肝癌的试验及临床应用研究

目的了解经肝动脉化疗栓塞术（TACE）联合血管内皮抑素（Endostar）治疗兔VX2肝癌模型和临床原发性肝癌（HCC）患者后,肿瘤微血管密度（MVD）、血管内皮生长因子（VEGF）及CT灌注参数（BF、BV、PS）的变化情况。方法 60例兔VX2肝癌模型均分为三组,单纯TACE治疗组、联合治疗组（TACE联合Endostar）、对照组。40例经病理证实的HCC患者均分为两组,单纯TACE治疗组和联合治疗组（TACE联合Endostar）。分析各组实验动物或病例在治疗前后病理免疫组化（VEGF、MVD）和CT灌注扫描（BF、BV、PS）的改变。结果治疗前,三组兔VX2肝癌模型、两组HCC患者在BF、BV、PS和VEGF、MVD方面差异均无统计学意义。治疗后,联合治疗组（兔VX2肝癌模型、HCC患者）的VEGF、MVD均较单纯TACE组降低,BF、BV、PS均较单纯TACE组升高,差异均存在统计学意义。结论 TACE联合Endostar可以有效抑制兔VX2肝癌模型和临床HCCTACE术后的新生血管的形成,降低肿瘤复发或转移的几率,提高治疗效果。     

射频消融联合经导管肝动脉化疗栓塞术治疗原发性肝癌

目的探讨经导管肝动脉化疗栓塞术(TACE)联合射频消融对原发性肝癌的治疗效果。方法将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共80例,按住院号数的单、双数分成两组:对照组(TACE组)42例,综合治疗组(TACE 射频消融组)38例。对照组只给予TACE治疗,综合治疗组先行TACE后2~3周再予联合射频消融治疗。两组患者行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予相应处理。结果TACE组治疗42例患者,1、2、3年生存率分别为72%、55%和21%,中位生存期1.78年;综合治疗组38例患者1、2、3年生存率分别为89%、78%和53%,中位生存期2.31年。综合治疗组的生存率及生存期均显著高于TACE组(P<0.05)。综合治疗组的综合介入治疗效果与死亡风险率呈显著的负相关(OR=0.570,P<0.05)。结论TACE联合射频消融对原发性肝癌的治疗可显著提高原发性肝癌的生存率,延长生存期。     

射频消融联合经导管肝动脉化疗栓塞术治疗原发性肝癌

目的 探讨经导管肝动脉化疗栓塞术(TACE)联合射频消融对原发性肝癌的治疗效果.方法 将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共80例,按住院号数的单、双数分成两组:对照组(TACE组)42例,综合治疗组(TACE+射频消融组)38例.对照组只给予TACE治疗,综合治疗组先行TACE后2～3周再予联合射频消融治疗.两组患者行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予相应处理.结果 TACE组治疗42例患者,1、2、3年生存率分别为72%、55%和21%,中位生存期1.78年;综合治疗组38例患者1、2、3年生存率分别为89%、78%和53%,中位生存期2.31年.综合治疗组的生存率及生存期均显著高于TACE组(P＜0.05).综合治疗组的综合介入治疗效果与死亡风险率呈显著的负相关(OR=0.570,P＜0.05).结论 TACE联合射频消融对原发性肝癌的治疗可显著提高原发性肝癌的生存率,延长生存期.     

肝裂的定位与肝段的划分

目的：精确定位肝裂与肝段,为肝脏病变的诊断和治疗提供解剖学依据。方法：用过氯乙烯分色灌注肝静脉和门静脉。固定灌注后的肝脏,再用雕刻法移去肝组织,保留肝静脉和门静脉,并对其进行详细地解剖学观察。结果：3条肝静脉的位置可精确定位3条肝裂。门静脉左、右支可精确定位1条段间裂。肝裂和段问裂将肝脏分成5叶8段。结论：肝裂和段间裂确定了肝叶和肝段的精确定位与划分,对肝脏病变的诊断和治疗非常重要。     

Surgical aspects of hepatic segmentation based on hepatic venographies

Summary Hepatic venographies were performed selectively in 42 patients with hepatocarcinoma. The findings were evaluated from anterior and lateral views. Thirty-nine right hepatic v. could be identified and the existence of one branch as the first ramification was found in 36 cases (92.3%). The first branches of the right hepatic v. could be classified into veins (V7) running from segment VII and those (V8) running from segment VIII. A V7 was identified in 26 cases (72.8%) and a V8 was identified in 10 cases (27.8%). The vena hepatica dorsalis [6] (V8) running from Segment VIII was recognised in 10 cases. The middle and left hepatic v. Were identified in 31 cases and 33 cases respectively. Two main types of middle vein (one with no Principal branching and the other with a branching) were found in 11 cases (37.9%) and 12 cases (41.4%) respectively. The first branch of the middle hepatic v. (V8) running from segment VIII was identified in 10 cases (32.3%). These results indicate that anatomical consideration of the hepatic v. in each patient is necessary when performing hepatic resection.

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Aspects chirurgicaux de la segmentation des veines hépatiques basés sur la veinographie hépatique

Résumé Les veinographies hépatiques ont été réalisées de façon sélective sur 42 malades porteurs d'hépatocarcinomes. Les documents ont été sélectionnés sur des clichés antéro-postérieurs et latéraux. Trente-neuf veines hépatiques droites ont pu être identifiées et la première branche de ramification de cette veine a été visualisée sur 36 cas (92,3 %). Les premières branches de la v. hépatique droite ont pu être classées en veines du segment VII et en veines du segment VIII. Les veines du segment-VII ont été retrouvées dans 26 cas (72,8 %) et les veines du segment-VIII dans 10 cas (27,8 %). La v. hépatique dorsale (Elias), qui chemine dans le segment VIII, a été identifiée dans 10 cas. Les v. hépatiques moyennes et gauches ont été identifiées respectivement dans 31 cas et 33 cas. Deux principaux types de veines moyennes, l'une sans branche importante l'autre avec nombreuses branches, ont été retrouvés respectivement dans 11 cas (37,9 %) et 12 cas (41,4 %). La première branche de la v. hépatique moyenne en provenance du segment VIII a été visualisée dans 10 cas (32,3 %). Ces résultats montrent bien que la reconnaissance du type anatomique des v. hépatiques chez chaque malade est nécessaire lorsque l'on envisage une résection hépatique.

     

Glucagon inhibition of hepatic arterial responses to hepatic nerve stimulation

The hepatic arterial vascular bed of the chloaralose-urethan-anesthetized dog was perfused with blood from a cannulated femoral artery. Hepatic arterial blood flow and perfusion pressure were measured. The hepatic periarterial postganglionic sympathetic nerves were stimulated supramaximally at 0.1, 0.5, 1, 2, 5, 10, and 20 Hz; this caused frequency-dependent rises in the calculated hepatic arterial vascular resistance at all frequencies above the threshold of 0.1 or 0.5 Hz. Glucagon was infused intra-arterially in dosese from 0.25 to 10 microgram/min; glucagon antagonized both the vasoconstrictor effects of hepatic nerve stimulation and of intra-arterial injections of norepinephrine. The degree of antagonism of these responses was significantly correlated with the calculated hepatic arterial glucagon concentration. It is possible that glucagon released physiologically in stress and hypoglycemia may protect the hepatic arterial vasculature from the effects of increased sympathetic discharge.     

A dynamic and static study of hepatic arterioles and hepatic sphincters

The purpose of this investigation was to demonstrate the cytology of the sphincters of hepatic sinusoids, to elucidate further the pathway by which arterial blood is distributed to the sinusoids, and to study the hormonal and local regulation of arterial and portal venous blood flow through the sinusoids. The sphincters were found to consist of reticulo-endothelial cells and were the primary site for the regulation of blood flow through the sinusoids. By contracting independently or in unison the flow of blood was regulated through individual sinusoids, through sinusoids supplying a portion of a lobule, or through sinusoids supplying a whole lobule. When the sphincter cells contracted, their nuclear region bulged into the lumen, thereby occluding it. Hepatic arterioles were found to wind around adjacent portal venules with an average curvature of 42° and communicated with sinusoids via arterio-sinus twigs. No structural arterio-portal anastomoses were observed; however, functional “arterioportal anastomoses” were formed by short twigs which terminated in sinusoids near their origins. No branches were found to terminate near central venules. The data suggest that the local regulation of blood flow through the hepatic sinusoids is mediated by vasodilator metabolites (adenosine and/or potassium) released from hypoxic hepatic cells as a result of the rapid glycogenolysis that accompanies hepatic cellular hypoxia.     

Regulation of hepatic growth

The liver is a conditional renewal system, which in the adult organism undergoes minimal cell production and/or cell renewal. However, a reduction in liver cell mass, because of either actual cell loss or cell atrophy, evokes a rapid regenerative response tailored to replace the lost tissue. Synthesis of DNA begins as early as 15 h after a two-thirds hepatectomy, and the fact that all the remaining hepatocytes enter DNA synthesis within the next 48 h does indicate they are all potentially proliferative, and it is unlikely that a distinct stem cell compartment exists. The temporal sequelae of events can be best explained by the semisynchronous passage of cells from G0 into the proliferative cycle (see Fig. 2) where they undergo one or more rounds of cell division before decycling back into the proliferatively quiescent G0 state. The age of the animal and its nutritional and hormonal status are all important modifiers of the response, but none of them is critical to the regenerative process. Experiments involving the administration of sera or the transfer of blood between animals strongly favor the existence of humoral regulatory factors; the liver is apparently capable of producing both inhibitory and stimulatory molecules that act by negative and positive feedback mechanisms, respectively, to control tissue homeostasis, whereas other organs, notably the pancreas, are important sources of facilitatory molecules. A chemical mechanism of self inhibition is a very intellectually appealing hypothesis, but at present there is no consistent message as to the identity of the inhibitory molecule, although most studies suggest the target site for its action is the G1-S transition. Unless the whole field is one of multilateral analysis of an artifact, then endogenous growth inhibitors do exist, but the problem now is one of biochemical isolation and characterization. The field compares rather badly with the many success stories in recent years in which new hormones and peptides have been speedily isolated and purified. A reduction in liver size appears to be associated with a decrease in the concentration of an hepatic growth inhibitor and the production and/or unmasking of a stimulatory factor(s) that is also of hepatic origin. Once again, there is little information about the biochemical nature of the principle and much less on its mode of action. We all assume that such stimulators, and for that matter inhibitors as well, act on "restriction points" or "mitosis operons" and so on.(ABSTRACT TRUNCATED AT 400 WORDS)