肝血管瘤供血动脉栓塞疗效评价

目的 探讨应用超选择性供血动脉栓塞治疗肝血管瘤的疗效。方法 采用Seldinger改良法经皮穿刺股动脉插管，在DSA引导下将导管超选择性插至最接近肝血管瘤的供血动脉，应用平阳霉素和超液态碘化油及明胶海绵为栓塞剂，栓塞治疗巨大型肝血管瘤7例。结果 7例肝血管瘤供血动脉栓塞均获成功，达到瘤内碘油聚集，瘤体血供截流的理想栓塞效果。无明显不良反应，未出现严重并发症。栓塞治疗后临床症状得到缓解，随访复查瘤体逐渐缩小，未见肿瘤复发。结论 采用供血动脉栓塞治疗肝血管瘤是一简便、安全、有效的方法，适应症广，应成为首选治疗方案。     

颌面部血管畸形的新疗法

由山东省临沂市肿瘤医院头颈外科承担的科研项目“供瘤动脉栓塞并瘤内硬化剂治疗颌面部大型血管畸形的研究”，是采用超选择性供瘤动脉栓塞，瘤体内多点注射硬化剂等方法治疗口腔颌面部蔓状血管瘤和大型海绵状血管瘤的。该课题于1993年通过技术鉴定，1995年获山东省科技进步二等奖。目前已治疗患者110余例，其中大部分是由各地转来经手术治疗复发或经其它治疗无效的患者。该方法创伤小，失血量少，痛苦轻，疗效确切，今年这项成果已被山东省卫生厅列为重点推广项目。颌面部血管畸形的新疗法@刘勇     

颈静脉球瘤的栓塞治疗

目的评价介入栓塞治疗对颈静脉球瘤的作用。方法3例经手术病理证实的颈静脉球瘤患者,采用Seldinger技术先行超选择性插管造影明确病变部位及其供血动脉,接着灌注聚乙烯醇颗粒(PVA颗粒)适量。栓塞后一周行手术切除。结果3例患者的肿瘤供血动脉均被栓塞,肿瘤染色消失。栓塞后行手术切除,均完全切除且出血量少。栓塞后随访观察,患者的临床症状均减轻或消失。结论颈静脉球瘤的栓塞治疗对于减少术中出血和抑制肿瘤生长有积极的作用,术前栓塞加外科手术切除是治疗颈静脉球瘤的一种行之有效的方法。     

肝脏海绵状血管瘤的双重供血及外科处理

13年来,住院治疗的68倒成人肝脏海绵状血管瘤病人,男31例,女37例.年龄36~67岁,平均43岁.肿瘤直径3.5~29cm.手术包括单纯肿瘤切除,肝脏楔形切除,肝叶切除,肝动脉TH胶栓塞或99.8%酒精注射.TH胶异位栓塞致死1例.肝动脉和门静脉造影显示:肝脏海绵状血管瘤系肝动脉和门静脉双重供血.肝动脉栓塞,硬化疗法和结扎的适应证;有症状的巨大海绵状血管瘤,手术切除困难或有较大的手术危险性者.     

肝动脉栓塞、硬化治疗肝血管瘤

目的评价肝动脉栓塞,硬化治疗肝血管瘤的临床价值.方法采用Seldinger法行选择性肝动脉栓塞,硬化技术治疗肝血管瘤,其配伍方案:平阳霉素+超液化碘油+鱼肝油酸钠,随访1～7年.结果应用该方法治疗肝血管瘤患者22例,所有瘤灶均明显缩小及纤维化.结论从本组结果显示选择性肝动脉栓塞、硬化技术是肝血管瘤,尤其是多发性或巨大肝血管瘤的理想治疗方法.     

经肝动脉栓塞治疗肝海绵状血管瘤(附26例)

目的:观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性.方法:对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应.结果:26例患者介入治疗成功率100%,肿瘤完全消失者6例,瘤体缩小＞50%者17例,瘤体缩小不足50%者2例,瘤体无变化者 1例,无瘤体进展者;总有效率为95.1%;所有患者未出现严重并发症.结论:经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法.     

平阳霉素碘油乳剂超选择动脉栓塞治疗肝血管瘤的观察

为了探讨平阳霉素碘油乳剂超选择栓塞化疗治疗肝血管瘤(HCH)的临床疗效和治疗体会,对23例HCH患者采用平阳霉素碘油乳剂超选择性动脉插管动脉栓塞治疗,观察治疗前和治疗后6、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症.23例患者在术后6和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘油聚积征象.术前血管瘤直径为(8.1±2.2)cm,术后6个月血管瘤直径为(5.4±1.3)cm,术后12个月血管瘤直径为(3.4±1.2)cm.治疗前有临床症状者治疗后缓解或消失,术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生.初步研究结果提示,超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大HCH是一种疗效肯定、相对安全较为理想的治疗方法.     

平阳霉素碘油乳剂栓塞治疗肝血管瘤的疗效分析

目的探讨平阳霉素碘油乳剂栓塞治疗肝血管瘤的临床疗效。方法对86例肝血管瘤患者行栓塞治疗,行股动脉穿刺,超选择性插管肝血管瘤供血动脉,注入平阳霉素碘油乳剂。结果所有患者在术后3、6和12个月复查CT,见瘤体内碘油沉积良好,瘤体明显缩小,碘油聚集征象明确。83例患者瘤体缩小约80.0%～90.0%,另3例患者瘤体缩小约40.0%～50.0%。86例患者的临床症状完全缓解率为100%。术后均未出现胆囊坏死、肝脓肿、肝坏死等严重并发症。结论平阳霉素碘油乳剂经肝动脉栓塞治疗肝血管瘤疗效肯定,并发症少,成功率高,是一种较为理想的治疗方法。     

术前辅助动脉栓塞联合肿瘤切除治疗复杂颈动脉体瘤的临床疗效

目的:观察术前辅助动脉栓塞联合动脉切除复杂颈动脉体瘤的临床疗效。方法:选择我院复杂动脉体瘤患者38例，均先进行载瘤动脉的血管栓塞术，阻断颈动脉体瘤血供，随后进行肿瘤切除，记录临床资料、手术参数及并发症情况。结果:38例肿瘤Shamblin I型2例，Shamblin II型32，Shamblin III型 4例；患者均完成术前肿瘤栓塞手术，手术成功率100%，均完全栓塞载瘤血管。术后72 h内完成肿瘤切除，平均手术时间（106.85±36.26）min，术中出血（156.52±61.72）ml，围手术期无输血病例发生。术后切口血肿发生率2.63%（1/38），暂时性神经损伤发生率7.89%(3/38)，术后卒中/死亡发生率0，术后总并发症发生率13.16%(5/38)，术后病理提示肿瘤恶性率5.26%(2/38)，其余均为良性病变。结果:结果证实术前栓塞有助于肿瘤的完整切除，是保障手术安全进行的辅助治疗手段。     

经动脉栓塞治疗巨大肝血管瘤效果分析

目的评价经动脉栓塞治疗巨大肝血管瘤的疗效。方法53例患者共行78次动脉内栓塞治疗，所用栓塞剂为平阳霉素 超液化碘化油乳剂。结果每次治疗后4～6周CT复查，所有病灶均有不同程度缩小，其中21例缩小达50％。结论经肝动脉栓塞治疗巨大血管瘤是一种行之有效的方法。     

胸部巨大肿瘤切除术前介入栓塞的临床应用

为了探讨胸部巨大肿瘤切除术前介入栓塞的临床应用价值,对7例经胸部CT确诊的胸部巨大肿瘤患者行手术前介入栓塞治疗。栓塞术后第2天行肿瘤切除术。造影可见参与肿瘤供血动脉均为多支,增粗、迂曲,远端分支增多、杂乱。7例患者均顺利切除肿瘤,无介入栓塞及外科手术相关并发症发生,手术中平均出血量较以往未行术前栓塞者明显减少,手术时间也明显缩短。初步治疗体会,对胸部巨大肿瘤切除术前栓塞肿瘤供血动脉可明显减少术中出血、缩短手术时间、减少并发症发生,是一种安全有效的治疗方法。     

脊柱骨巨细胞瘤的诊断与治疗进展

脊柱骨巨细胞瘤（giant cell tumor of bone,GCTB）较为少见,诊断依靠临床、影像和病理三结合原则。脊柱GCTB的治疗难度较大,目前还没有基于循证医学的治疗流程和共识,因而具有很强的挑战性。手术仍然是脊柱GCTB治疗的首选方法,术前选择性动脉栓塞、完整切除肿瘤及术后辅助使用地诺单抗（denosumab）是目前推荐的综合治疗方法。整块切除是脊柱GCTB的理想治疗方式,但手术方法的选择需要遵循个体化原则,根据不同的部位制定不同的手术方案。地诺赛麦对于手术无法完全切除、复发及转移性GCTB的治疗具有一定的优势,术前使用能够有效降低GCTB外科分期,并为整块切除手术创造条件,具有广泛的应用前景。     

Radiology of Peripheral Arteriovenous Malformations*

Radiologic investigations have proved useful in the evaluation of 26 patients with peripheral arteriovenous malformations which are classified as: hemangioma, congenital arteriovenous fistula and venous malformation. Plain film findings of a soft-tissue mass are common in most patients except in the congenital arteriovenous fistula. Calcification in soft-tissue is noted mostly in hemangiomas and venous malformations. The angiographic findings are characteristic. Hemangiomas reveal slightly dilated small vessels arranged in a fine plexiform network, associated with small collections of contrast. Dilated veins, varicosities or clusters of rounded collections of contrast are seen. Congenital arteriovenous malformations show dilated feeding arteries, rapid arteriovenous shunting and dilated draining veins. Venous malformations have normal arteriograms. Venous stenosis with enlarged veins is seen in phleban-giomas; saccular dilatation of veins is noted in venous angiomas or phlebangiomatosis. Characteristic findings of the venous phase of arteriograms and phlebograms are very helpful in differentiating hemangiomas from soft tissue neoplasm.     

Giant serous microcystic adenoma of the pancreas safely resected after preoperative arterial embolization

Serous microcystic adenomas are rare and account for 1-2% of all exocrine pancreatic tumors and 25% of all pancreatic cystic neoplasms. Recently, with advances in imaging techniques, these adenomas have been identified at an increasing frequency. A 63-year-old woman visited her doctor in 1999 due to a gastric deformity detected by upper gastrointestinal endoscopy. An abdominal computed tomography scan revealed a cystic lesion measuring 6.0 cm in diameter, resulting in a diagnosis of serous microcystic adenoma of the pancreatic head. During follow-up, the tumor increased steadily in size, measuring 6.0 cm in diameter in 1999 and 13.0 cm in 2008, while remaining asymptomatic throughout this period of time. The risk of malignant transformation appears to be low even over the long-term. However, some cases of malignant transformation to serous cystadenocarcinoma have recently been reported. In this case, assessment of the relationship between the tumor and adjacent vascular structures, such as massive drainage vein development on the surface or tumor flow into the portal and superior mesenteric veins and the celiac and superior mesenteric arteries, was critical for determining tumor resectability. The risk of massive intra-operative hemorrhage was felt to be considerable, given the extent of the veins on the surface of the tumor, as well as the size and location of the primary pancreatic mass. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed. Tumor resection with pancreaticoduodenectomy was performed without a blood transfusion, with an estimated blood loss of 570 ml. The final pathology confirmed the diagnosis of serous microcystic adenoma. The patient is currently alive and disease-free. Preoperative partial embolization of the tumor feeding arteries and intra-operative resection of the right gastric and inferior pancreatoduodenal arteries, allowed the tumor blood supply to be arrested without preoperative tumor necrosis. Subsequently, intraoperative blood loss was reduced. Preoperative partial embolization of the feeding arteries is useful for the resection of hypervascular large tumors of the pancreas.     

Intensive multimodality therapy including paclitaxel and reduced-intensity allogeneic hematopoietic stem cell transplantation in the treatment of adrenal cancer with multiple metastases

Adrenocortical carcinoma is a rare malignancy in adolescents and young adults. The prognosis of unresectable/metastatic adrenocortical carcinoma remains very poor because the rarity of the tumor has made it difficult to establish treatment guidelines, and diagnosis and the resultant treatment can be greatly delayed. We treated a 24-year-old woman who was diagnosed with adrenocortical carcinoma of the right adrenal gland which extended to the inferior vena cava. Although she underwent surgical resection of the extensive tumor as the primary treatment, the disease recurred in the lung and liver as multiple metastases shortly after surgery. She received intensive multimodality therapy, including chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP regimen), embolization of the feeding arteries, and proton irradiation for the liver mass. Finally, she underwent reduced-intensity allogeneic hematopoietic stem cell transplantation from an HLA 1-locus-mismatched sibling donor. A prolonged survival of 39 months after the onset of the disease was achieved. Although this experience is limited, we suggest that TIP chemotherapy was effective for adrenocortical carcinoma, and a graft-versus-tumor effect after reduced-intensity stem cell transplantation may have contributed to the prolonged survival.     

骶尾部肿瘤手术治疗的中远期评价

目的 评价骶尾部肿瘤手术治疗的中远期效果.方法 回顾分析1993年4月至2010年2月收治的47例骶尾部肿瘤患者,其中包括脊索瘤13例,囊肿6例,骨巨细胞瘤4例,脂肪瘤3例,皮脂腺瘤3例,软骨肉瘤3例,恶性源性肿瘤3例,转移癌3例,纤维瘤2例,畸胎瘤2例,神经纤维瘤、纤维脂肪错构瘤、神经节细胞瘤、良性间叶瘤、低度恶性纤维母细胞瘤、孤立性纤维瘤、恶性神经鞘瘤各1例.术前主要临床症状：骶尾区疼痛37例,臀部及大腿麻痛33例,大小便障碍5例,双侧下肢肿胀、难以入睡1例.术前行选择性瘤血管栓塞术15例.6例行前后路联合手术,41例行后路手术.良性肿瘤全部为瘤外切除,恶性肿瘤为瘤内切除.结果 术中出血量500～5000ml,平均3000ml,术前行选择性瘤血管栓塞者术中平均出血量为1300ml.13例失访,余34例患者获得随访2-11年,平均随访时间6.4年.8例脊索瘤术后均反复出现局部复发,最快者为术后1个月复发,因其他脏器发生转移而死亡;4例骨巨细胞瘤3例失访,1例随访3年下肢功能、感觉活动良好,无大小便障碍.3例软骨肉瘤术后1例出现复发后死亡,2例无瘤生存;2例转移性癌和3例恶性源性肿瘤术后均死亡.全部良性肿瘤预后较好.结论 骶尾部肿瘤发病率较低,起病隐匿、症状轻微者占多数.术前行选择性瘤血管栓塞能够有效降低术中出血的风险.良性肿瘤可进行边缘完整的切除,预后良好;而单纯手术治疗对骶尾部恶性肿瘤来讲,复发率高,预后差,采用全骶骨切除或手术联合放化疗可望降低术后复发率,改善预后.     

巨块型肺癌的外科治疗及预后因素分析

目的探讨巨块型肺癌的外科治疗及影响预后的因素。方法回顾性分析上海市肺科医院1992年8月至2005年8月经手术治疗的137例巨块型肺癌患者的临床及病理资料,其中根治性手术122例,姑息性手术15例。122例根治性手术中,肺叶切除63例,全肺切除48例,其他手术方式11例。分别对患者性别、肿瘤大小、p-TNM分期、局部淋巴结N分期、原发肿瘤T分期、组织学类型、手术方式和手术性质等因素进行预后分析。Kaplan-Meier计算生存率,Log rank法进行生存率显著性检验,应用Cox比例风险回归模型进行单因素和多因素分析。结果全组1、3、5年生存率分别为76.0%、49.2%和40.1%。单因素分析显示,患者性别(P=0.001)、p-TNM分期(P=0.001)、N分期(P=0.042)、T分期(P=0.006)、手术性质(P=0.026)是影响患者预后的因素。多因素分析则显示,p-TNM分期(P=0.001)是影响患者预后的独立因素。结论p-TNM分期是影响巨块型肺癌患者预后的主要因素。对巨块型肺癌患者,应严格控制手术适应证的选择,争取根治性手术,以获得较高的生存率。     

射频消融联合动脉栓塞治疗肝脏巨大血管瘤的疗效分析(英文)

目的:对射频消融(RFA)联合动脉栓塞(TAE)治疗巨大肝血管瘤的疗效进行回顾性分析。方法:对2004年至2008年应用RFA联合TAE模式治疗的27例巨大肝血管瘤患者进行回顾性分析,共纳入31个瘤体,直径6cm-18.5cm。所有患者首先给予TAE治疗(一次或多次),在包块明显缩小后,进而给予RFA治疗。随访时间为12-64月(最后一次RFA治疗后,中位时间38个月)。所有患者均根据增强CT结果评价疗效。结果:本组患者无严重并发症以及死亡发生。RFA治疗3个月后,21例患者的症状减轻或消失(77.8%)。并且第一次增强CT示瘤体明显缩小,其中完全坏死率为71.0%(22/31)。对于9个提示血流存在的病灶,再次行RFA治疗。至随访结束,10/31(32.3%)已回缩瘤体显示增强信号,其中5个瘤体直径增大。结论:TAE+RFA是治疗巨大肝血管瘤的一种安全有效的模式。     

Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization

We report herein the case of 64-year-old man with gastrointestinal stromal tumor (GIST), who was treated by partial resection of the duodenum after preoperative transarterial embolization. He presented to our hospital with a history of tarry stools, dizziness, and severe anemia (hemoglobin, 7.5 g/dl). Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the second portion of the duodenum. The presence of the tumor was subsequently confirmed by double-contrast gastrointestinal radiography and abdominal computed tomography. Super-selective angiography showed tumor staining fed from the anterior and posterior superior pancreaticoduodenal arteries, and the inferior pancreaticoduodenal artery. Two weeks after transarterial embolization through these vessels, the tumor size was found to have shrunk to 40% of its original size. Partial resection of the duodenum was performed and absence of tumor cells at the surgical margin was confirmed by intraoperative frozen-section examination. Histopathological examination revealed that the duodenal submucosal tumor consisted of spindle cells, and immunohistochemical analysis revealed positive tumor staining for c-kit protein, CD34 and α-smooth muscle actin (SMA), and negative staining for desmin and S-100; the positivity rate for MIB-1 staining was 2.2%. Based on these findings, the tumor was diagnosed as a GIST of low-grade malignancy, classified as the muscular type. It is considered that preoperative treatment of duodenal GISTs, such as transarterial embolization, may be useful for reducing the extent of resection, from pancreaticoduodenenctomy to a partial resection.