体外化疗药敏试验系统联合流式细胞仪在胃肠肿瘤化疗中的应用

目的：探讨体外化疗药敏试验系统（ATP－TCA系统）联合流式细胞仪（FCM）在胃肠肿瘤化疗中的应用。方法：取36例胃癌、结直肠癌的手术标本行ATP－TCA试验和FCM P170检测，并分析两结果之间的关系。结果：ATP－TCA的可评估率为88．1％，10种化疗药物的敏感率分别为：氟尿嘧啶15．6％，顺铂18．8％，足叶乙甙21．9％，草酸铂25．0％，丝裂霉素31．3％，表阿霉素37．5％，诺消灵40．6％，开普拓43．8％，健择53．1％，泰素56．3％，P170检测阳性率为43．8％，丝裂霉素，表阿霉素，诺消灵的敏感率在P170阴性表达时高，开普拓，健择，泰素在P170阳性和阴性表达时的敏感率均高，且差异无显性意义（P＞0．05），结论：ATP－TCA法联合FCM可较好地用于胃肠肿瘤的化疗药物的筛选，开普拓，健择，泰素可用于P170阳性表达的患。     

ATP-生物荧光法在消化系恶性实体肿瘤体外药物敏感性的应用

目的探讨ATP-生物荧光法（ATP—TCA系统）在消化道恶性实体肿瘤体外药物敏感性试验中的应用。方法取肝癌、胃癌、直肠癌、结肠癌共39例患者的手术标本，应用ATP—TCA系统方法做药物敏感性试验。结果ATP—TCA的可评估率为92．31％；6种试验用化疗药物的敏感率分别为：丝裂霉素12．50％，紫杉醇23．33％，顺铂30．77％，羟喜树碱42.31％，5-氟尿嘧啶51．85％，表阿霉素61．54％。结论ATP-生物荧光法可用于消化道恶性实体肿瘤化疗药物的筛选。     

ATP—TCA技术指导浅表性膀胱癌术后灌注化疗的临床应用

目的：探讨生物荧光体外肿瘤药敏检测技术（ATP—TCA）在浅表性膀胱癌肿瘤细胞药敏试验中的应用,探讨该技术在指导膀胱癌个体化治疗上的应用价值。方法：对40例浅表性膀胱癌标本进行肿瘤细胞分离,原代培养,应用ATP—TCA技术检测肿瘤标本对五种常用化疗药物的敏感率和耐药率。试验组术后选用最敏感的化疗药物对患者常规行膀胱灌注化疗,对照组选择丝裂霉素进行术后常规化疗。术后随访2年,评价两组膀胱癌复发情况。结果：40例标本中,吡柔比星（THP）、羟基喜树碱（HCPT）、丝裂霉素（MMC）、表柔比星（EPI）、吉西他滨（GEM）的敏感率分别为75．0％、10．0％、5．0％、37．5％、10．0％,肿瘤细胞对五种化疗药物的敏感率和耐药率差异有统计学意义（P〈0．01）。膀胱肿瘤对化疗药物的敏感性存在个体差异。术后随访2年,药敏组膀胱癌复发率为17．5％（7／40）,对照组膀胱癌复发率为37．5％（15／40）。两组肿瘤复发率差异有统计学意义（P〈0．05）。结论：应用ATP—TCA技术检测出的药敏结果能够反映个体对化疗药物的敏感性,可以作为选择灌注化疗用药的理论基础,指导临床用药进行个体化治疗。同时,应用ATP—TCA技术指导临床膀胱癌术后灌注化疗,可显著降低浅表性膀胱癌患者术后复发率,提高临床疗效。     

ATP-TCA模拟希罗达在消化道恶性肿瘤化疗中的应用效果

目的试图通过体外化疗药物敏感试验系统（ATP-TCA系统）模拟希罗达在消化道恶性实体肿瘤的应用效果。方法取肝癌、胰腺癌、胃癌、结肠癌、直肠癌共18例的手术、活检和穿刺标本应用体外药敏试验ATP-TCA法,其中应用20倍的氟尿嘧啶模拟希罗达。结果ATP-TCA的可评估率为100％;10种化疗药物的敏感率分别为：诺消灵5．88％,足叶乙甙11．76％,顺铂17．65％,,丝裂霉素23．53％,表阿霉素23．53％,草酸铂27．78％,开普拓38．89％。健择47．06％,泰素52．94％,20倍氟尿嘧啶（相当于希罗达）72．22％。结论希罗达可能适宜用于消化道恶性实体肿瘤化疗。     

原发性肝癌化疗药物敏感性检测的临床价值

目的 探讨三磷酸腺苷生物荧光法(ATP-TCA)评估原发性肝癌药物敏感性和指导术后介入化疗的临床价值。方法 以ATP-TCA法在体外分别检测了19例原发性肝癌细胞对6种化疗药物的耐药率和敏感率。结果 5FU、DDP等常用化疗药物的耐药率在78％以上，泰素、羟基喜树碱和丝裂霉素对肝癌的敏感率分别为89．67％、64．39％和47．11％。结论 ATP-TCA法用于检测原发性肝癌化疗药物敏感性稳定可靠，可作为指导肝癌术后序贯性化疗的药物筛选手段。     

ATP生物荧光肿瘤药敏检测技术在胰腺癌中的应用

目的探讨ATP肿瘤化疗药敏实验（ATP tumor chemosensitivity assay，ATP—TCA）对胰腺癌化疗药敏测定并指导临床个性化治疗的可行性。方法2003年～2006年，采用ATP—TCA法对40例胰腺癌进行药敏检测。结果对胰腺癌未发现强敏感药物和部分敏感药物，轻度敏感的药物有：吉西他滨（GEM），氟尿嘧啶（5-FU），紫杉醇（PTX），奥沙利铂（OXA）；耐药的药物有：卡铂（DDP），表柔比星（EPI），长春瑞滨（NVB），丝裂霉素（MMC），拓扑替康（TPT），卡莫司汀（BCNU），多西他赛（TXT）。结论ATP—TCA法对胰腺癌进行药敏检测是可行的，但尚未发现胰腺癌强敏感和部分敏感的药物；ATP—TCA法指导胰腺癌个体化治疗的临床疗效有待进一步观察。     

原发性肝癌对化疗药物敏感性的研究

目的 研究化疗药物对原发性肝癌细胞的敏感性。方法 应用ＭＴＴ法及流式细胞仪,选择１７种化疗药物对２０例经手术切除的原发性肝癌标本进行化疗药物２性的检测。结果 对原发性肝癌细胞平均抑制率大于５０％的化疗药物为异环磷酰胺、氟脲嘧啶、ＶＭ－２６（威猛）、ＴＡＡ（泰素）、环磷酰胺及ＤＤＰ（顺铂）。结论 根据联合化疗的原则,对于原发性肝癌患者选用的化疗方案为：以氟脲嘧啶为主、配合顺铂等其他一种或二种敏感的化     

原发性肝癌多药耐药基因的表达与化疗敏感预测的相关性研究

目的探讨原发性肝癌多药耐药基因的表达与化疗敏感预测的相关性。方法取64例肝癌切除组织行ATP-TCA法肿瘤体外药敏试验。以RT—PCR法半定量检测肝癌多药耐药基因表达情况，分析多药耐药基因的表达与化疗敏感预测的相关性。结果1．原发性肝癌5种耐药基因的表达率分别为：MDR190、63％、MRP96．88％、GST-π96．88％、LRP90.63％、TOPOⅡ96.88％，各耐药基因的表达率间无显著相关。2，多药耐药基因MDR1、MRP、GST-Ⅱ、LRP、TOPOⅡ的表达量在肝癌组织分别为1．17±0．47、1．59±0．33、1．18±0．48、1．03±0．48、1．00±0．31．在癌旁组织分别为1．11±0．38，1．32±0．44，1．04±0．42．0．96±0．32，1．19±0．28，除TOPOⅡ外，癌旁组耐药基因mRNA表达量低于肝癌组的表达量，两者间的差别无显著性（P〉0．05）。3．多药耐药基因的表达与疗效的关系显示：在有效组中MDR1、MRP、GST-ⅡLRPmRNA的表达量低于无效组，且在MDR1、MRP、LRP存在显著差别（P〈0．05）。TOPOⅡmRNA的表达量有效组高于无效组，但差异无显著性（P〉0．05）。4．ATP—TCA法肿瘤体外药敏试验临床敏感预测准确率为77．27％（17／22），对抗药性的预测准确率为100％（2／2）；临床符合率为79．17％。5．MDR1的表达量与MIT、VP-16、EPI、TAX的IC。值正相关；MRP的表达量与MIT、VP-16、EPI的IC50值正相关；GST-π的表达量与5．FU、CDDP、OXA、GEM的IC50值正相关；LRP的表达量与5-FU、CDDP、OXA、EPI、GEM的IC50值正相关；TOPOⅡ的表达量与CPT的IC50值正相关。6．多药耐药基因预测化疗的准确率为72．70％。结论在肝癌存在实现化疗敏感预测基因化的可行性．可通过监测多药耐药基因的表达来预测化疗的效果．选择相关的化疗药物。     

姑息性切除治疗中晚期肝癌

目的：评价姑息切除在中晚期肝癌治疗中的作用。方法：将1996年3月－2000年1月收治的98例（术中证实不能行根治性切除者）中晚期肝癌患者行癌肿大部分切除加肝动脉置管埋泵化疗等综合治疗49例治疗组,行肝动脉置管埋泵化疗等综合治疗49例（对照组）,结果：治疗组及对照组的AFP下降率分别为60．0％和31．7％（P＜0．05）;（0．5,1,3年的生存率分别为85．7％（42／49）,60．5％（23／28）,45．4％（10／22）和67．3％（33／49）,32．5％（13／40）,10％（2／20）,（P＜0．05）。结论：癌肿姑息切除有助于提高中晚期肝癌患者的生存时间和生命质量。     

DLC-1和MMP-2、MMP-9在肝癌组织中的表达及意义

目的：研究肝癌缺失基因1（DLC－1）和MMP－2、MMP－9在肝癌组织中的表达及其与临床病理分期的关系，为探讨对肝癌发生、发展及转移的分子机制提供依据。方法：采用免疫组化ABC法检测50例肝癌和26例肝脏良性病变肝血管瘤及其周围正常组织中DLC-1和MMP－2、MMP－9的表达情况，结合临床病理资料分析二者在肝癌中表达的意义。结果：DLC－1在原发性肝癌、肝血管瘤组织和周围正常组织中的表达率分别为31．2％，72．1％和81．7％（P〈O．01），MMP－2在3组中的表达率为77．1％，33．3％和26．7％（P〈O．05），MMP－9的表达率为74．3％，29，5％和23．7％（P〈O．05）。DLC－1和MMP－2、MMP－9在原发性肝癌组织中的表达呈明显负相关（Kappa值为－0．459，－O．523），DLC－1和MMP－2、MMP-9与肝癌的发生、分期和淋巴结转移关系密切（P〈0.01）。结论：DLC－1低表达或无表达和MMP－2、MMP－9高表达与肝癌的发生发展转移有关，DLC－1和MMP－2、MMP－9在影响肝癌发生、发展、转移方面存在－定的协同效应，DLC－1有可能成为肝癌早诊和预后判断的候选标志物。     

体外药敏试验ATP-TCA与流式细胞仪在肝癌化疗中的应用

目的 探讨体外化疗药敏试验系统（ATP-TCA系统）联合流式细胞仪（FCM）在肝癌化疗中的应用及其结果之间的关系。方法 取24例肝癌切除，活检或穿刺组织行体外药敏试验和流式细胞仪P170检测，并分析二者间的关系。结果 ATP-TCA的可评估率为91.67%;10种化疗药物的敏感率分别为：氟尿嘧啶5.00%，诺消灵5.00%，顺铂14.26%，足叶乙甙19.05%，草酸铂19.05%,丝裂霉素23.81%，表阿霉素28.57%，开普拓45.46%，健择47.62%，泰素63.64%；P170检测阳性率为57.14%；丝裂霉素，表阿霉素的敏感率在P170阴性表达时高，开普拓健择，泰素的敏感率高且在P170阳性表达和阴性表达时无显著差异。结论 ATP-TCA法联合FCM可较好用于肝癌化疗药物的筛选；丝裂霉素，表阿霉素可用于P170阴性表达的病人，开普拓，健择，泰素可用于P170阳性表达的病人。     

XAGE-1b mRNA在肝癌、肝硬化、良性肝病患者和健康人血液中的表达

目的探讨原发性肝癌、肝硬化、良性肝病患者和健康人血液中XAGE-1b mRNA表达的差异及意义.方法采集125例原发性肝癌患者、23例肝硬化患者、34例良性肝病患者、41例健康志愿者静脉血,实时荧光定量PCR检测其中XAGE-1b mRNA的表达.结果原发性肝癌患者、肝硬化患者、良性肝病患者、健康人血液中XAGE-1b mRNA的表达量分别为3.72(0.93,10.2)×10-5、0(0,0.56)×10-5、0(0,0)×10-5、0(0,0)×10-5.原发性肝癌患者表达量显著高于肝硬化、良性肝病患者和健康人,肝硬化患者表达量高于良性肝病患者和健康人,良性肝病患者与健康人的表达量差异无统计学意义.以8.385×10-7为最佳临界值,XAGE-1b mRNA诊断原发性肝癌的敏感性为80.0%,特异性为89.8%,阳性预测值90.9%,阴性预测值77.9%.肝癌患者的阳性率为80.0%,肝硬化患者的阳性率为30.4%.结论XAGE-1b mRNA可作为一种肿瘤标志物诊断原发性肝癌,并有利于肝癌、肝硬化、良性肝病的鉴别.     

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目的 探讨体外化疗药物敏感试验系统（ATP-TGA系统）在消化道恶性实体肿瘤的应用及体会。方法 取肝癌，胃癌，结肠癌，直肠癌共42例的手术，活检和穿刺标本应用体外药敏试验ATP-TCA法。结果 ATP-TCA的可评估率为88.10%,10种化疗药物的敏感率分别为：氟脲嘧啶11.11%，顺铂13.89%。足叶乙甙19.44%，草酸铂22.22%。诺消灵25.00%。丝裂霉素27.78%，表阿霉素38.89%。开普拓44.45%。健择52.78%。泰素62.16%。结论 ATP-TCA法可用于消化系恶性实体肿瘤化疗中的化疗药物的筛选。     

Treatment of cancer of the liver. Twenty years'' experience with infusion and resection in 414 patients.

The factors influencing survival for patients with cancer of the liver were studied by reviewing the records of 414 patients operated on in a private oncology practice. Approximately half (47%) had colorectal metastasis; 17% had metastatic breast carcinoma, 14% had malignant hepatoma, 5% had metastatic melanoma, and the remainder had a variety of primary cancers. Eighty-two per cent of all patients had advanced liver disease when first diagnosed. One quarter of the patients had some type of resection; the remainder had abdominal exploration plus insertion of an infusion catheter into the hepatic artery. The postoperative mortality rate after liver resection for 108 patients was 6.5%. After resection, the most important prognostic factor influencing survival was the presence or absence of extrahepatic metastases. When possible, resection was by far the best treatment available, and the best results were seen in patients who had resection of a solitary lesion. For advanced disease, when resection was not possible, intra-arterial chemotherapy, primarily with 5-fluorouracil (5-FU), was associated with response rates of 36% for colorectal cancer, 45% for breast cancer, 13% for hepatocellular cancer, 12% for melanoma, and 14% for metastases from other primary sites. The patients who responded to infusion lived longer than those who did not respond. For example, at 18 months, 26% of the responders with colorectal cancer were alive, as were 50% of the responders with breast cancer and 40% of the responders with hepatocellular cancer. In contrast, at 18 months, there were no survivors among the nonresponders with colorectal, breast, or hepatocellular cancer. For those patients treated solely by infusion chemotherapy, the extent of disease in the liver was the most reliable factor in predicting the length of survival. However, very few patients treated in this manner lived longer than 3 years.     

The time interval between primary colorectal carcinoma resection to occurrence of liver metastases is the most important factor for hepatic resection. Analysis of total course following primary resection of colorectal cancer

The lack of any other effective treatment for colorectal liver metastases makes hepatic resection a primary treatment consideration. Between January 1980 and December 1996, 36 patients with metachronous liver metastases who underwent hepatic resection were reviewed. The age, sex, site of primary lesion, stage, size and number of hepatic metastases, and time interval between primary colorectal carcinoma resection to occurrence of liver metastases (disease-free interval, DFI) were documented. DFI was 569 days on average. Complete removal of primary colorectal cancer and metastatic liver tumour with histologically negative resection margins was accomplished in all cases. The 5 year survival rate following the first operation for primary colorectal cancer was 43.1%. The length of DFI influenced, independently, patients' prognoses based upon not only univariate but also multivariate survival analysis (P<0.01). We conclude that the DFI is the independent prognostic factor for metachronous liver metastases after curative resection of primary tumour.     

明胶海绵微粒栓塞治疗肝转移癌

目的评价采用明胶海绵微粒(GSPs)进行TACE治疗肝转移癌的临床疗效。方法回顾性分析36例接受350~560μm明胶海绵微粒TACE治疗的肝转移癌患者的临床资料,评价疗效、肝功能损伤、不良反应及生存率。结果中位随访时间15个月,肿瘤均有不同程度坏死及缩小;完全缓解2例、部分缓解27例、稳定5例、进展2例,客观反应率80.55%(29/36);术后7天肝功能基本恢复至术前水平,无严重并发症发生;6个月生存率91.67%(33/36)、12个月生存率83.33%(30/36)。结论采用GSPs进行TACE治疗肝转移癌近期疗效良好。     

Rationale for the combination of cryoablation with surgical resection of hepatic tumors

Only 5% to 10% of metastatic and primary liver tumors are amenable to surgical resection. Hepatic cryoablation has increased the number of patients who are suitable for curative treatment. The aim of this study was to evaluate survival and intrahepatic recurrence in patients treated with cryoablation and resection. From June 1994 to July 1999, thirty-eight surgically unresectable patients underwent a total of 42 cryoablative procedures for 65 malignant hepatic lesions. Twenty patients underwent cryoablation alone, and 18 patients were treated with a combination of resection and cryoablation, with a minimum of 18 months’ follow-up. The 38 patients had the following malignancies: primary hepatocellular carcinoma (n = 8) and metastases from colorectal cancer (n = 21), neuroendocrine tumors (n = 3), ovarian cancer (n = 3), leiomyosarcoma (n = 1), testicular cancer (n = 1), and endometrial cancer (n = 1). Patients were evaluated preoperatively with spiral CT scans and intraoperatively with ultrasound examinations for lesion location and cryoprobe guidance. Local recurrence was detected by CT. Major complications included bleeding in three patients and acute renal failure, transient liver insufficiency, and postoperative pneumonia in one patient each. Two patients (5%) died during the early postoperative interval; mean hospital stay was 7.1 days. Median follow-up was 28 months (range 18 to 51 months). Overall survival according to Kaplan-Meier analysis was 82%, 65%, and 54% at 12, 24, and 48 months, respectively. Forty-eight-month survival was not significantly different between those patients undergoing cryoablation alone (64%) and those treated with a combination of resection and cryoablation (42 %). Diseasefree survival at 45 months was 36% for patients undergoing cryoablation plus resection compared to 25% for those undergoing cryoablation alone. Local recurrences were detected at five cryosurgical sites, for a rate of 12% overall (5 of 42), 11% (2 of 18) for patients in the cryoablation plus resection group, and 12% (3 of 24) for those in the cryoablation alone group. For patients with colorectal metastases, survival was 70% at 30 months compared to 33% for hepatocellular cancer and 66% for other types of tumors. Patients with tumors larger than 5 cm or numbering more than three did not have significantly decreased survival. Cryoablation of hepatic tumors is a safe and effective treatment for some patients not amenable to resection. The combination of cryoablation and resection results in survival comparable to that achieved with cryoablation alone. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 21–24, 2000.     

腹腔镜辅助射频消融术治疗特殊部位肝癌的研究

目的:探讨腹腔镜辅助射频消融术治疗特殊部位肝癌的可行性、安全性及优势,并评估其疗效.方法:为35例肝癌患者、42枚特殊部位肝肿瘤行腹腔镜辅助射频消融术(laparoscopic radiofrequency ablation,LRFA).其中原发性肝癌29例,转移性肝癌6例.32例曾行介入栓塞治疗.单发肿瘤30例,直径...