在肝癌治疗中吡柔比星碘油乳剂的应用

对62例肝癌患者使用以吡柔比星碘油乳剂动脉栓塞为主的联合化疗方案。其中9例单发巨块型肿瘤伴外周血象降低者单纯使用吡柔比星碘油乳剂栓塞，l例Ⅲ期肝癌、肝功ChildC级患者仅行导管化疗灌注，3例栓塞后手术切除肿瘤。结果显示近期有效率58％。8例出现胃肠道反应。2例较治疗前WBC明显降低。4例治疗后发生心律异常。9例单纯栓塞患者无ECG或外周血象改变。3例术后病理肿瘤细胞完全坏死。以吡柔比星碘油乳剂栓塞为主的方案毒副作用较低。对血象异常而血供较好的巨块型肝癌患者单纯采用吡柔比星碘油乳剂栓塞，疗效满意并避免了多种化疗药的毒副作用。     

经肝动脉灌注化疗并栓塞治疗转移性肝癌的临床疗效

分析了１１８例转移性肝癌经肝动脉插管灌注化疗或并栓塞治疗２２４人次的经验以评价其临床疗效。灌注化疗并碘油乳剂及明胶海绵碎屑栓塞７２例，灌注化疗并碘油乳剂栓塞３２例，单纯灌注化疗１４例。结果显示灌注化疗并碘油乳剂及明胶海绵栓塞者疗效最佳，单纯灌注化疗效果较差。肝内单发转移和多血病变姑息效果最好。本组１，３，５年生存率分别为８６．０％，２５．０％及３．０％。作者认为，经肝动脉插管灌注化疗并栓塞治疗是姑息治疗转移性肝癌的较好方法     

吡柔比星超液化碘油乳剂介入治疗肝癌临床分析

经皮肝动脉栓塞化疗(TACE)是中晚期肝癌非手术治疗的首选方法.最常用的方法是将抗癌药物与超液化碘油制成混悬乳剂经肝动脉注入肿瘤内,起到栓塞化疗的作用.但由于栓塞化疗对肝、肾功能以及白细胞、血小板的损害,使多次重复介入治疗受到不同程度的限制.近5年来,我们采用以THP及MMC超液化碘油乳剂肝动脉栓塞化疗为主的联合化疗方案,对271例肝癌患者进行治疗,取得了较满意的疗效,现报告如下.     

经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效观察

目的探讨经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效和安全性。方法 7例外生型肝癌接受经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,治疗后评价肿瘤反应及毒副反应。结果所有7例患者共顺利完成10次经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,初次术后3个月后评价疗效,其中CR 2例,PR 4例,SD 1例,有效率为85.7%,无严重毒副反应发生。结论应用经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌患者耐受性良好,且有较好的近期疗效,可以作为经动脉灌注化疗栓塞术治疗的补充。     

博莱霉素治疗肝癌TACE的临床应用

目的 评价博莱霉素加常规化疗药物及碘油乳剂在肝动脉化疗栓塞中对原发性肝癌肿瘤的祛血管作用及其副反应。方法 对15例大的原发性肝癌经过常规药物和碘化油肝动脉化疗栓塞后疗效不满意的病例,采用常规化疗药物加博莱霉素及碘化油乳剂行肝动脉化疗栓塞。比较栓塞后肿瘤血管支数的变化,栓塞后一周肝功能及血常规恢复情况。结果 应用博莱霉素治疗前血管减少值24±4.75,应用博莱霉素治疗后血管减少值43±11.89,二者比较统计学显著差异(P=0.001)。应用博莱霉素治疗前后WBC值、肝功能ALT值、BILT值及ALB值比较均无明显统计学差异(P＞0.05)。应用博莱霉素治疗前后发热反应发生率均为73.3%,呕吐反应发生率为53.3%。应用博莱霉素治疗前疼痛发生率为80%,应用博莱霉素治疗后疼痛发生率为60%,统计学无显著性差异。结论 博莱霉素加常规化疗药物及碘油乳剂对原发性肝癌有明显祛血管作用,副反应很小。     

奈达铂联合氟尿嘧啶栓塞治疗中晚期肝癌的临床观察

目的 探讨奈达铂(NDP)联合氟尿嘧啶(5-FU)方案栓塞治疗中晚期肝癌的疗效及安全性.方法 202例中晚期肝癌患者采用NDP联合5-FU方案与超液化碘油乳剂化疗栓塞治疗,具体为:NDP 100mg/m2行肝动脉灌注,5-FU1000mg/m2和超液化碘油5～ 40ml混合成乳剂行肝动脉栓塞.参照WHO抗癌药物毒性分级...     

法玛新超液态碘化油乳剂介入治疗肝癌180例临床观察

目的观察用法玛新超液态碘化油乳剂行肝动脉化疗栓塞治疗中晚期肝癌的疗效及不良反应.方法对180例中晚期肝癌患者使用法玛新碘化油乳剂动脉栓塞(Ⅰ组)为主的联合化疗方案.并与同时期132例阿霉素腆化油乳剂动脉栓塞(Ⅱ组)治疗比较.结果Ⅰ组:近期有效率65.6%(108/180),41例出现胃肠道反应,31例较治疗前白细胞降低.Ⅱ组:近期有效率为34.1%,96例有胃肠道反应,91例白细胞明显降低.结论法玛新超液态碘化油乳剂栓塞为主的介入治疗方案不良反应较少,是中晚期肝癌介入治疗理想而安全的方案.     

59例中晚期肝癌介入治疗的近期疗效观察

目的探讨中晚期肝癌经肝动脉灌注化疗与化疗加栓塞治疗的近期疗效。材料与方法原发性肝癌59例,均为失去手术指证的中晚期肝癌。22例行选择性肝动脉灌注化疗;17例肝动脉化疗加含药碘油检塞治疗;20例肝动脉化疗加合药碘油和明胶海绵栓塞治疗。结果单纯化疗组总有效率为77．3％,1年生存率为13．6％;化疗加含药碘油栓塞治疗组总有效率为88．2％,1年生存率为52．9％;化疗加含药碘油和明胶海绵栓塞组总有效率为95．00％,1年生存率为60．0％。结论肝动脉插管灌注化疗与化疗栓塞治疗是中晚期肝癌行之有效的治疗方法。肝动脉化疗加合药碘油和明胶海绵复合栓塞治疗近期疗效优于肝动脉化疗加合药碘油栓塞治疗和单纯肝动脉灌注化疗。     

表阿霉素、鸦胆子的碘油超液化乳剂介入性治疗286例肝癌

目的　研究表阿霉素与中药抗癌剂鸦胆子油、碘油制成超液化乳剂(简称YLEE)治疗肝癌的临床价值。　方法　1987年12月～1990年12月间治疗的原发性肝癌286例。行肝动脉化疗栓塞共450人次。最短随访时间1年。全部采用Seldinger′s方法,应用超选择肝叶和肝段动脉插管。本组病例按以下分组分析疗效:(1)化疗 单纯碘油表阿霉素乳剂栓塞(HAI HAEⅠ);(2)化疗 YLEE栓塞(HAI YLEE)。　结果　本治疗组10例大肝癌治疗后肿块缩小率达到50%以上,二期切除病理显示:肿瘤区域细胞全部凝固性坏死,边缘有淋巴细胞浸润。286例患者治疗后一年、二年生存率分别为552%和345%(北方代表组为423%和77%;南方代表组为353%和250%)。8例生存3年,3例生存5年,其中1例已生存10年,目前仍在随访中。　结论　利用鸦胆子具有栓塞、抗肿瘤和载体三重作用,与表阿霉素、碘油制成“双载体”、“双弹头”的油包水剂型,具有很好的稳定性,加强了杀伤癌细胞、栓塞末梢血管的作用,为中晚期肝癌患者所接受     

THP-Lp乳化剂为主介入化疗栓塞治疗肝癌的临床研究

目的：评价以ＴＨＰ－Ｌｐ乳化剂进行栓塞的联合化疗治疗肝癌的临床价值。方法：对１１９例肝癌患者进行了５２０例次栓塞化疗治疗，其中单纯碘油（Ｌｐ）栓塞２１４例次，碘油与明胶海绵（ＧＦ）联合栓塞１０９例次，经化疗泵栓塞化疗１７１例次，经动脉栓塞与经皮肝穿刺联合化疗栓塞２６例次。结果：本组患者总有效率（ＣＲ＋ＰＲ）为７４．８％，肝肿瘤缩小５０％以上者占５０％。４种治疗的有效率有显著差异（χ＾２检验Ｐ〈０．     

Efficacy and toxicity of transcatheter arterial chemoembolization with Cisplatin suspended in lipiodol for unresectable hepatocellular carcinoma

In this study we evaluated the efficacy and toxicity of transcatheter arterial chemoembolization (TACE) with Cisplatin (CDDP)-Lipiodol (LIP) suspension in 24 patients with advanced hepatocellular carcinoma (HCC). Eligibility criteria were as follows; unresectable HCC, age <75 years, performance status (PS) 0-2, Child-Pugh A or B and adequate heart and renal function. When TACE was performed, the catheter was placed selectively in feeding arteries of the tumors, and CDDP-LIP suspension (20 mg/mL) was injected followed by gelatin sponge particles. The direct and total effect on tumors were evaluated 3 and 6 months after TACE, respectively. As for a direct effect, complete and partial response rates were 54.2% and 25%, respectively. As for a total effect, complete and partial response rates were 41.7% and 4.1%, respectively. Grade 3/4 drug-related toxicities were as follows: thrombocytopenia (13%), appetite loss (8%) and nausea (4%). These severe side effects disappeared within 10 days after TACE. No renal and hepatic dysfunction was encountered, and no drug-related deaths occurred. TACE with CDDP suspended in LIP may provide some clinical benefits with relatively tolerable toxicities.     

Prognosis for intrahepatic cholangiocarcinoma patients treated with postoperative adjuvant transcatheter hepatic artery chemoembolization

Objective: We used meta-analysis to evaluate the efficacy of transcatheter hepatic arterial chemoembolization (TACE) for the treatment of intrahepatic cholangiocarcinoma (ICC). Methods: We performed the meta-analysis using the R 3.12 software and the quality evaluation of data using the Newcastle-Ottawa Scale. The main outcomes were recorded as 1-year overall survival (OS), 3-year OS, 5-year OS, and hazard ratio (HR) of TACE treatment or non-TACE treatment. The heterogeneity test was performed using the Q-test based on chi-square and I² statistics. Egger's test was used to test the publication bias. The odds ratio or HR and 95% confidence interval (CI) were used to represent the effect index. Results: Nine controlled clinical trials involving 1724 participants were included in this study; patients came mainly from China, Italy, South Korea, and Germany. In the OS meta-analysis, the 1-year and 3-year OS showed significant heterogeneity, but not the 5-year OS. TACE increased the 1-year OS (odds ratio = 2.66, 95% CI: 1.10-6.46) of the patients with ICC, but the 3- and 5-year OS rates were not significantly increased. The results had no publication bias, but the stability was weak. The HR had significant heterogeneity (I² = 0%, P= 0.54). TACE significantly decreased the HR of ICC patients (HR = 0.59, 95% CI: 0.48-0.73). The results had no publication bias, and the stability was good. Conclusions: Treatment with TACE is effective for patients with ICC. Regular updating and further research and analysis still need to be carried out.     

肠外营养醛肝动脉栓塞化疗对肝癌的影响

目的 探讨糖一脂双能源部分肠外营养（PPN）配合肝动脉栓塞化疗（TACE）对肝癌患者肝功能、营养状态及肿瘤生长的影响。方法 58例肝癌患者随机分为含脂组（30例）与对照组（28例）；两组行TACE每月1次，连续3周，同时，按组别每月给予含或不含脂肪乳剂PPN1周、连续3个月；治疗前及治疗后每月测ALT、AST、TB、血清蛋白、AFR与AFU，治疗后每月计算肿瘤生长率。结果 与对照组比较，治疗后含脂组ALT、AST及TB有不同程度下降，血清蛋白有不同程度升高；两组治疗后AFP与AFU变化幅度及每月肿瘤生长率相近。结论 糖一脂双能源PPN可改善肝癌患者肝功能及营养状态。配合TACE治疗，对肿瘤生长并无明显促进作用。     

含亚砷酸化疗方案TACE治疗中晚期肝癌的临床研究

目的：探讨舍亚砷酸（arsenic trioxide，As2O3）联合常规化疗药物脱氧氟尿苷（floxuridine，FuDR）、卡铂（carboplatin，CAP）和吡柔比星（pirarubicin，THP）TACE治疗中晚期肝癌的疗效和不良反应。方法：将86例中晚期肝癌患者随机分成亚砷酸组（41例）和对照组（45例），分别采用As2O3联合常规化疗药物和单纯常规化疗药物方案行肝动脉栓塞化疗（TACE）治疗。结果：As2O3组的客观有效率（CR＋PR）、荻益率（CR＋PR＋SD）、AFP下降率及肝内外转移发生率分别为14．6％、75．6％、84．6％和14．6％；对照组的客观有效率（CR＋PR）、获益率（CR＋PR＋SD）、AFP下降率及肝内外转移发生率分别为8．9％、66．7％、73．5％乖33．3％。两组主要毒副反应为发热、胃肠道反应、血液学及肝脏毒性。As2O3组的肝内外转移发生率显著低于对照组，P〈0．05，而两组的客观有效率、获益率、AFP下降率及不良反应差异均无统计学意义，P〉0．05。结论：与单纯THP、CAP及FUDR化疗方案相比，As2O3联合THP、CAP及FUDR化疗方案TACE治疗中晚期肝癌可显著降低肿瘤的肝内外转移发生率，并有较好的近期疗效而不增加毒副反应。     

Association Between Insulin-like Growth Factor-2 Expressionand Prognosis after Transcatheter Arterial Chemoembolization and Octreotide in Patients with Hepatocellar Carcinoma

Objective: To investigate the association between the change of IGF-2 level in serum after transcatheterarterial chemoembolization (TACE) and hepatocellular carcinoma (HCC) progression, especially in relation tometastasis. Methods: IGF-2 in serum was measured by quantitative sandwich enzyme-linked immunosorbentassaybefore, 3 days and 4 weeks after TACE in 60 patients with HCC. The occurrence of HCC metastasis wasalso evaluated, 3 months after TACE. Results: (1) The average serum level of IGF-2 in the 60 patients withHCC was 136.5 ± 87.3 pg/ml; (2) A tendency for increase was observed with heterogenous uptake of octreotideand portal vein thrombosis. Metastatic foci were found in 37/38 patients in the group with IGF-2 increasing(97.0%), in contrast to 3/22 (13.6%) patients with IGF-2 decrease. Conclusion: The increase of IGF-2 level inserum appears to be associated with the occurrence of metastatic HCC after TACE and chemotherapy.     

介入联合三维适形放疗治疗中晚期肝癌的临床研究

目的:通过单纯介入治疗中晚期肝癌与介入联合三维适形放疗对比,来研究介入联合三维适形放疗治疗中晚期原发肝癌的疗效。方法:2001年3月至2006年5月对确诊的57例中晚期原发肝癌患者,随机分为单纯介入组及介入联合三维适形放疗组。介入组30例,联合组27例。介入组采用经导管动脉化疗及栓塞,经皮股动脉穿管,根据肿瘤部位插管至肝固有动脉或左、右肝动脉。灌注化疗药物包括5-FU、顺铂、丝裂霉素、蒽环类药物等,灌注后使用碘油栓塞,4-6周重复,共3-6次。联合组先TACE治疗2次后再局部三维适形放疗(3D-CRT),一般在第二次介入后一周左右开始放疗。放疗为1次/日,2-2.5GY/次,5次/周,放疗总剂量为Dt52GY-62GY。治疗3个月后影像学复查疗效。结果:介入组CR 0例,PR 20例,NC 8例,PD 2例,CR+PR为有效,有效率为66.7%;联合治疗组CR2例,PR18例,NC6例,PD1例,有效率为74.1%,P=0.049。远期观察:介入组及联合组0.5,1,2年生存率分别为66.7%,53.3%,43.3%;88.9%,70.7%,55.5%(P=0.023)。所有病例均顺利治疗结束,未出现治疗中断退出。结论:介入联合三维适形放疗治疗能提高中晚期原发肝癌疗效,没有明显增加不良反应。     

吡柔比星及拓僖联合应用化疗栓塞治疗原发性肝癌

目的:研究拓僖(HCPT)与吡柔比星(THP)联合用于肝癌TACE治疗的安全性及有效性.方法:302例原发性肝癌患者,肝功能均为A或B,KPS评分≥70分,肿瘤大小21～144mm(平均69mm),分别接受1～5次TACE治疗.结果:随访6～22个月(平均14.2个月),总有效率为61.6%,其中CR 1.3%,PR 60.3%,NC 26.5%,PD11.9%.1年生存率57.3%,2年生存率27.8%.结论:HCPT与THP联合用于肝癌TACE疗效确定,不良反应低,安全可靠.远期疗效尚待进一步观察.     

经导管肝动脉化疗栓塞联合经皮无水乙醇注射治疗肝癌的长期疗效观察

背景与目的肝癌的介入治疗中,经导管肝动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)与经皮无水乙醇注射(percutaneousethanolinjection,PEI)是开展最广泛、效果最显著的两项治疗措施。TACE联合PEI可明显提高肝癌的近效疗效,但远期随访结果报道较少。本研究拟探讨TACE联合PEI治疗肝癌的长期效果及价值。方法675例肿瘤直径为2～15cm(平均9.6cm)、不能切除的原发性肝细胞癌(hepatocellularcarcinoma,HCC)接受介入治疗,其中179例行TACE联合PEI治疗(联合组),496例行单纯TACE治疗(TACE组)。两组中各有10例介入治疗后行Ⅱ期手术切除,标本送病理研究。其他病例随访5～7年以上(平均6.6年),分别统计1、3、5、7年累计生存率。联合组与TACE组两组无论是手术切除病例,还是随访病例,介入治疗前的一般资料均具有可比性。结果病理研究显示,虽然治疗前后肿块缩小程度两组无显著性差异,但联合组肿瘤平均坏死程度[(100.0±0.0)%]及完全坏死率(100%)均显著高于TACE组[分别为(91.5±7.1)%和20%,P<0.05或0.01]。随访结果显示,联合组1、3、5、7年生存率分别为80.5%、58.6%、29.6%和16.5%,TACE组分别为68.5%、27.8%、7.2%和5.2%,统计学处理均有显著性差异(P<0.01)。结论TACE联合PEI是提高HCC远期生存率较好的治疗     

Intraarterial chemotherapy of experimentally metastasized liver carcinoma with anticancer emulsion containing surface-active agent

The w/o Emulsion (w/o) of 0.3% adriamycin (ADR) in the mixture of a water-soluble contrast medium, 60% urografin, and an oily contrast medium, lipiodol, at the ratio of 1 : 4 was combined with 0.5% lecithin. This combination could stabilize the micelles and make the emulsion desirably slow releasing form. ADR emulsion was injected into the hepatic artery of rabbit with metastatic liver carcinoma 7 days after intraportal transplantation of VX2 tumor. The examination at day 5 revealed good accumulation and retention of ADR in tumor. This emulsion was histologically confirmed to be effective in suppressing the growth of metastatic lesion, and it was considered that this ADR emulsion would have a great possibility for clinical application in the treatment of hepatic metastasis of gastrointestinal carcinomas.     

磁共振表观弥散系数对肝癌TACE疗效的预测价值

背景与目的：肝癌患者经导管动脉化疗栓塞(transcatheter arterial chemoembolization，TACE)后早期疗效评价仍是临床难点。该研究旨在探讨表观弥散系数(apparent diffusion coeffcient，ADC)对肝癌患者TACE术后疾病早期进展的预测效能。方法：本研究经伦理委员会批准，所有患者均被充分告知。共入组23例肝癌患者(男性14例，女性9例，年龄21~85岁，平均年龄53.3岁)，所有患者术前及术后1个月分别行MRI检查和弥散加权成像(diffusion-weighted imaging，DWI)检察(b=50、500、1000 mm2/s)。术后3个月行MRI增强扫描检查，根据RECIST 1.1标准，把患者分为进展组和非进展组。采用配对t检验比较进展组、非进展组术前及术后1个月ADC值变化。采用非配对t检验比较进展组与非进展组之间的相关ADC参数。在23例肝癌患者中，采用受试者操作特征曲线(receiver operating characteristic curve，ROC)，确定一个鉴别进展和非进展的ADC变化率(ADC%)阈值。结果：14例肝癌患者出现进展，9例肝癌患者未进展。未进展组术后1个月肿瘤ADC值明显升高，与术前肿瘤ADC值之间差异有统计学意义(P=0.01)。进展组术前、术后1个月肿瘤ADC无明显变化(P=0.221)。进展组与非进展组术前肿瘤ADC、ADC%之间差异均无统计学意义(P>0.05)。肝癌患者中，未进展组肿瘤ADC%显著高于进展组(P=0.029)，用ROC分析ADC%区分进展组与非进展组的能力，以-6.455%为阈值(95%CI：0.643~1.000)，曲线下面积为0.867，此时敏感度为100%，特异度为66.7%。结论：术后1个月肿瘤ADC值仅在未进展组明显增高。对于肝癌患者，ADC%能够有效预测患者经TACE治疗后是否早期发生疾病进展。