肝癌术后预防性肝动脉化疗栓塞对延缓复发的意义

[目的]了解预防性肝动脉化疗栓塞术(TACE)在延缓肝癌手术后复发方面的作用.[方法]对823例行根治性切除并经病理证实为肝细胞癌患者进行随访分析.其中126例患者手术后行预防性TACE,将可能影响原发性肝癌术后复发的观察指标包括性别、年龄、术前AFP、有无癌栓、手术切缘、手术前肿瘤是否破裂、肿瘤大小、肿瘤有无子灶、肿瘤包膜情况、手术后有无行预防性TACE等,用Cox模型分析各因素与复发时间之间的关系.所有数据经SAS6.12和SPSS统计软件处理分析.[结果]年龄小、有癌栓、手术前肿瘤有破裂、肿瘤体积大和肿瘤周围有子灶等因素使肝癌手术后复发时间提前,保证较大手术切缘距离和手术后行预防性TACE可延缓肝癌手术后复发.预防性TACE可明显降低肝癌患者术后2年的复发率.[结论]对有早期复发病理学征象的肝癌患者行预防性TACE治疗可能延缓术后肿瘤复发.     

经导管肝动脉化疗栓塞在晚期肝癌治疗中的价值

目的　评价经导管肝动脉化疗栓塞在晚期肝癌治疗中的价值。方法　文中对１２ 例肝癌经股动脉行肝动脉化疗栓塞。结果　半年生存率３３％ ,达到了改善病人生活质量、延长生存时间的目的。结论　对于晚期肝癌病人,只要一般情况尚可,应积极治疗,但治疗方案要个体化,这样才能在取得较好疗效的同时又不致产生过多的负效应。     

肝动脉化疗栓塞术后胸腺法新联合索拉菲尼治疗中晚期肝癌的疗效分析

目的:探讨中晚期肝细胞型肝癌患者肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后索拉菲尼联合胸腺法新的疗效分析.方法:回顾性研究第四军医大学附属唐都医院54例中晚期原发性肝癌患者,所有患者均为乙型肝炎表面抗原阳性,并均接受了TACE手术治疗.在手术治疗后三天,开始口服索拉菲尼,以及皮下注射胸腺法新,观察患者的肝功能,计算治疗的有效率以及患者的生存时间.结果:观察组患者的总体有效率82.8%,显著高于对照组的56%,差异有统计学意义(P=0.032);观察组平均生存时间为13.8个月,对照组为10.2个月,可认为观察组生存时间长于对照组(P=0.021);治疗前两组AST、ALT以及白蛋白无明显差异(P>0.05);治疗3个月后与治疗前相比,两组的AST和ALT均得到改善(P<0.05),并且观察组白蛋白提高(P<0.001).结论:胸腺法新、索拉菲尼联合TACE的治疗方法可以有效的改善肝炎病毒所致的原发性肝癌的预后,提高患者的生存期,值得临床推广.     

Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma: clinical efficacy and factors influencing outcomes

BACKGROUND.

The role of transcatheter arterial chemoembolization (TACE) or transcatheter arterial chemoinfusion (TACI) for unresectable intrahepatic cholangiocarcinoma (ICC) has recently been questioned. The aim of the study was to evaluate the clinical efficacy of TACE or TACI in patients with unresectable ICC and to identify prognostic factors associated with clinical success.

METHODS.

From 1997 to 2007, 49 patients with unresectable ICC were treated with TACE (n = 124) or transcatheter arterial chemoinfusion (TACI) (n = 96). Tumor response was evaluated based on computed tomography scans obtained 1 month to 3 months after TACE or TACI. Factors associated with clinical success were evaluated using multivariate logistic regression analysis. Factors associated with the survival period were evaluated using multivariate Cox regression analysis.

RESULTS.

After treatment, 27 (55%) of the patients showed radiographic response. Multivariate analysis confirmed that tumor vascularity (odds ratio [OR], 31.2; P = .002) was the only independent factor associated with radiographic response. The median and mean survival periods in our study patients were 12 and 24 months. Multivariate Cox regression analyses showed that tumor size (OR, 2.64; P = .048), tumor vascularity (OR, 13.5; P < .001), and the Child‐Pugh class (OR, 3.65; P = .014) were the independent factors associated with the length of the survival period.

CONCLUSIONS.

Hepatic intra‐arterial chemotherapy is well tolerated and may be effective to prolong survival of patients with unresectable ICC. Tumor vascularity is significantly associated with radiographic response. Large tumor size, tumor hypovascularity, and Child‐Pugh class B were poor prognostic factors for determining the patient survival period. Cancer 2008. © 2008 American Cancer Society.     

Radiotherapy combined with transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma - a prospective clinical trial

Objective： This study evaluated the therapeutic effect of external beam radiotherapy （RT） combined with transcatheter arterial chemoembolization （TACE） on the patients with unresectable hepatocellular carcinoma （HCC）. Methods： From June 1994 to April 2002, 114 patients with unresectable HCC were nonrandomized prospectively stepped into our study. All patients received TACE as initial therapy, except 54 also received combination therapy with external beam therapy. Survival failure patterns were analyzed and compared between the two groups. Results： Overall survival rates in the patients in the radiotherapy group were 65%, 47%, 38% at 1,2, 3 years, respectively, improved over the non-radiotherapy group rates of 54%, 36.5%, 18% at 1, 2, 3 years, respectively. There was significant difference between two groups （P 〈 0.05）. The survival rates correlated with tumor size, number of tumors, and portal vein embolus. Conclusion： TACE combined with RT is a more effective treatment than TACE alone in patients with unresectable HCC.     

Pulmonary embolism after transcatheter arterial chemoembolization

Metastatic hepatic tumours can be treated with hepatic transcatheter arterial chemoembolization (TACE). Common complications associated with TACE include hepatic insufficiency, fever, and pain. However, pulmonary embolism is rarely documented as a fatal adverse effect. We report a case of pulmonary embolism following TACE in a renal cell carcinoma patient with liver metastases. Total recovery is noted after the effective treatment.     

外照射配合肝动脉栓塞治疗不能手术切除的原发性肝癌的临床研究

Objective: This study evaluated the therapeutic effect of external beam radiotherapy(RT)combined with transcatheter arterial chemoembolization(TACE)on the patients with unresectable hepatocellular carcinoma(HCC).Methods: From June 1994 to April 2002, 114 patients with unresectable HCC were nonrandomized prospectively stepped into our study.All patients received TACE as initial therapy, except 54 also received combination therapy with external beam therapy.Survival failure patterns were analyzed and compared between the two groups.Results: Overall survival rates in the patients in the radiotherapy group were 65%, 47%, 38% at 1, 2, 3 years, respectively, improved over the non-radiotherapy group rates of 54%, 36.5%, 18% at 1, 2, 3 years, respectively.There was significant difference between two groups(P＜0.05).The survival rates correlated with tumor size, number of tumors, and portal vein embolus.Conclusion: TACE combined with RT is a more effective treatment than TACE alone in patients with unresectable HCC.     

肝动脉化疗栓塞术治疗中晚期肝癌120例疗效分析

目的 观察经导管肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的疗效、毒副反应.方法 采用 Seldinger技术,经股动脉穿剌,选择性肝动脉插管灌注化疗药物联合碘油栓塞或加用明胶海绵治疗中晚期原发性肝癌患者120例,共行 280次介入治疗.结果 全组120例患者中,完全缓解60.0%(72/120),部分缓解31.7%(38/120),稳定8.3%(10 /120),12个月以上生存率达63.3%(76/120).结论 TACE治疗中晚期原发性肝癌疗效确切,能够显著延长患者的生存期,提高其生存质量.     

原发性肝癌病人肝动脉化疗栓塞术治疗的护理

目的探讨肝癌病人肝动脉化疗栓塞术治疗的护理方法。方法观察42例原发性肝癌病人肝动脉化疗栓塞术治疗前后病情的变化，并在治疗前后给予相应的护理。结果经过治疗和精心护理，本组病人治疗顺利，无严重不良反应和并发症，病人病情得到明显改善。结论有效的术前及术后护理可以消除病人紧张心理，预防和减少并发症，提高治疗的效果。     

肝动脉栓塞化疗联合放疗治疗原发性肝癌的疗效分析

目的:分析肝动脉栓塞化疗（TACE）联合放射治疗对不能手术的原发性肝癌的疗效与不良反应。方法:2010年1月至2012年12月TACE联合放疗治疗25例原发性肝癌患者（治疗组）,单纯TACE 治疗原发性肝癌27例（对照组）。TACE选择肝脏肿瘤供血血管,注入氟尿苷500-1000mg和/或顺铂40-60mg,吡柔比星20-40mg+碘化油5-20ml混悬剂,大肝癌合用明胶海绵1/3条,剪成碎末栓塞血管。研究组TACE 1-2次后2-3周,行三维适形放疗,总剂量DT 30-60Gy/15-30f,1.8-2Gy/(f·d),5次/周。结果:治疗组25例共计TACE术60次,平均2.4（1-6）次,完成总剂量DT 30-60Gy/15-30f,2例患者的远处转移灶同时放疗;对照组27例共计TACE术83次,平均3.07（1-8）次。52名患者均可评价疗效。治疗组与对照组的有效率为88.0%和25.9%,中位生存时间为22和5个月,平均生存时间为(14.62±1.86)和(7.47±1.29)个月,组间差异非常显著（P=0.0024）。6、12、18、24个月生存率有显著性差异（P<0.05）。52例患者栓塞化疗并发症有呕吐8例,腹痛16例,发热18例,3例出现Ⅳ度白细胞抑制,无肝肾功能损害,放疗期间未观察到毒副反应。结论:TACE联合放射治疗较单纯TACE对晚期原发性肝癌疗效好,毒副反应未增加。     

肝动脉化疗栓塞术联合支持治疗伴HBV感染的中晚期原发性肝癌

[目的]探讨肝动脉化疗栓塞术（TACE）联合支持治疗对伴有乙肝病毒（HBV）感染的中晚期原发性肝癌（PLC）的疗效。[方法]入组伴有HBV感染的中晚期PLC 52例,分为支持治疗组和TACE组,其中支持治疗组给予支持治疗和抗病毒治疗,TACE组在支持治疗和抗病毒治疗的同时给予TACE治疗。治疗结束后分别评价两组的疗效和不良反应。[结果]支持治疗组和TACE组术后1年血清HBV DNA转阴率分别为45.0%和46.9%,差异无统计学意义（P〉0.05）。两组有效率分别为30.0%、59.4%,疾病控制率分别为55.0%、87.5%,差异均有统计学意义（P〈0.05）;1年生存率分别为40.0%、75.0%,2年生存率分别为5.0%、37.5%,差异均有统计学意义（P〈0.05）;中位生存期分别为10个月和19个月;生活质量改善率分别为80.0%和84.4%（P〉0.05）。支持治疗组无明显不良反应出现,TACE组主要不良反应为恶心呕吐和骨髓抑制,但均为Ⅰ～Ⅱ度。[结论]TACE联合支持治疗应用于伴有HBV感染的中晚期PLC患者疗效较好,且不良反应可耐受。     

TACE联合三氧化二砷治疗原发性肝癌的临床研究

目的:探讨三氧化二砷(As2O3)联合经导管肝动脉化疗栓塞术(TACE)对中晚期原发性肝癌的治疗效果.方法: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53例,28例和25例分别采用TACE联合As2O3和单纯TACE治疗,分别评价近期疗效、远期疗效、AFP变化、毒副反应和生活质量.结果:试验组与对照组疾病控制率分别为64.3％和52.0％,P=0.365.两组1年生存率分别为67.86％和40.00％,P=0.042,1年半生存率分别为57.14％和28.00％,P=0.033.AFP变化分别为28.57％和24.00％,P =0.706;两组毒副反应基本可以耐受,生活质量有一定改善.结论:As2 O3联合TACE治疗原发性肝癌能提高一年及一年半生存率,不良反应较小.     

平消胶囊联合肝动脉栓塞化疗治疗中晚期肝癌60例的临床分析

目的 评价平消胶囊联合介入栓塞化疗治疗中晚期肝癌的临床疗效.方法 选择60例中晚期肝癌患者随机分成两组,治疗组30例用平消胶囊联合肝动脉栓塞化疗术,对照组30例单用介入栓塞化疗术.结果 治疗组和对照组近期有效率分别为66.7%和56.7%,治疗前后生活质量改善率分别为73.3%和53.3%,两组比较有统计学意义(P<0.05).结论 平消胶囊联合肝动脉栓塞化疗术治疗中晚期肝癌可以提高近期有效率,改善生存质量.     

平消胶囊联合肝动脉栓塞化疗治疗中晚期肝癌60例的临床分析

目的：评价平消胶囊联合介入栓塞化疗治疗中晚期肝癌的临床疗效。方法：选择60例中晚期肝癌患者随机分成两组,治疗组30例用平消胶囊联合肝动脉栓塞化疗术,对照组30例单用介入栓塞化疗术。结果：治疗组和对照组近期有效率分别为66.7%和56.7%,治疗前后生活质量改善率分别为73.3%和53.3%,两组比较有统计学意义（P〈0.05）。结论：平消胶囊联合肝动脉栓塞化疗术治疗中晚期肝癌可以提高近期有效率,改善生存质量。     

MRI对肝动脉栓塞化疗治疗肝癌近期疗效随访的价值

[目的]评估MRI对经肝动脉栓塞化疗（transcatheter arterial chemoembolization,TACE）治疗肝癌近期疗效随访的价值。[方法]回顾性分析肝癌手术切除后复发22例患者（36个病灶）经TACE治疗后的MRI表现。[结果]MRI可正确判断22例患者（36个病灶）肝癌在TACE治疗后的近期疗效。随访1年,肿瘤完全凝固坏死32个,残留癌灶4个,2例患者在TACE治疗后1～3个月出现复发。[结论]MRI能准确评估TACE治疗肝癌的近期疗效。     

立体定向适形放疗联合TACE治疗原发性肝癌的疗效观察

目的：评价立体定向适形放疗联合经肝动脉栓塞化疗治疗原发性肝癌的临床疗效。方法：将62例中晚期肝癌患者分为R＋T组（32例）与R组（30例）,R＋T组行立体定向适形放疗联合经导管肝动脉化疗栓塞术治疗,R组行单纯立体定向适形放疗,观察近期疗效与不良反应。结果：R＋T组有效24例,有效率75．0％,R组有效15例,有效率50．0％,两者比较差异具有显著性,不良反应比较无显著性差异。结论：新型立体定向放疗联合TACE是治疗中晚期肝癌的有效手段。     

肝动脉栓塞化疗和经皮乙酸消融双介入治疗巨块型肝癌的临床价值及应用研究

Objective： To study the efficacy of transcatheter arterial chemoembolization （TACE） combined with percutaneous acetic acid injection （PAI） on massive hepatocellular carcinoma （MHCC）. Methods： TACE was performed in 57 patients with MHCC, which were randomly divided into group A （n = 28） and group B （n = 29）. Patients in the group A received conventional TACE for the first time and then received low dose TACE （10 mg mitomycin C） for the repeated treatment, Re-examined CT scans after TACE for a week. Based on filled status of Lipiodol in the Lesions, PAl was underwent in the area of rarefaction or defect filled by Lipiodol. Patients in the group B received conventional TACE. Then The survival rate and masses variation and hepatic function and a-FP and side effects were observed. Results： The 1-, 2- and 3-year survival rate after TACE were 96.4%, 78.6% and 32.1% for group A, and 65.5%, 48.3% and 20.7% for group B. Masses diminution were found in all patients in group A, while 20 cases were found in group B, unchanged in 5 cases and enlarged in 4 cases. Conclusion： The efficacy of TACE combined with PAl are significantly better than that of TACE only, low dose TACE produces less hepatic damage and less side effect.     

艾迪注射液联合肝动脉灌注栓塞治疗原发性肝癌108例临床观察

目的:评价中药艾迪注射液联合肝动脉灌注栓塞治疗法治疗肝癌的疗效。方法:108例原发性肝癌患者随机分为治疗组和对照组,每组各54例。治疗组采用艾迪注射液60ml+0.9%氯化钠溶液500ml静脉点滴,d1-d21;静滴同时进行肝动脉灌注栓塞治疗,药物为羟基喜树碱(HCPT)10mg,氟尿嘧啶(5-FU)500mg,碘化油10ml,按Seldinger’s技术要求,将药物注入肝脏肿瘤供养血管并行栓塞,28d为1周期。对照组54例单用肝动脉灌注栓塞治疗方案,同治疗组,2个周期后评价。结果:治疗组和对照组的有效率分别为80.4%和63.4%,中位生存期分别为8.34个月和8.21个月,6个月生存率分别为89.1%和84.8%,12个月生存率分别为63.4%和47.8%,24个月生存率分别为28.3%和17.4%。全组初治者6个月生存率83.1%,12个月生存率46.2%,24个月生存率18.5%,复治者则分别为96.2%,77.8%,33.3%。AFP疗后下降者治疗组29例有效率为69.4%,对照组21例,有效率为54.5%。结论:艾迪注射液能提高肝动脉灌注栓塞治疗疗效,改善生存质量,延长生存期。     

肝移植术后肝癌的介入治疗

目的：观察介入化疗栓塞在肝移植（LT）后肝细胞性肝癌（HCC）复发治疗中的作用。方法：15例原发性HCC肝移植后肿瘤复发且失去外科手术机会的患者接受1次或多次介入化疗栓塞（TACE）治疗。通过影像学资料判定治疗效果,观察患者生存率。结果：15例中2例（13.33%）肿瘤完全消退,10例患者（66.67%）肿瘤体积缩小≥50%。随访期间有11例（73.33%）出现了肝内或肝外新发病灶。移植后1、2和3年生存率分别为86.3%、57.5%和48.5%;复发后0.5、1、1.5、2年生存率分别为70.2%、55.7%、47.2%和38.8%,未出现严重并发症。结论：介入化疗栓塞是肝移植后肝癌复发且失去手术机会的患者可以选择的一种有效、安全的治疗手段,可一定程度地控制肿瘤生长。     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

Objective:To study the efficacy and safety of hepatic arterial infusion of Endostatin(YH-16,Endostar),combined with transcatheter arterial chemoembolization(TACE) on advanced hepatocellular carcinoma.Methods:Thirty patients with advanced hepatocellular carcinoma were enrolled in the study.The patients received hepatic arterial infusion of Endostar combined with TACE.The efficacy was evaluated strictly after 1-2 cycles according to RECIST criteria and the value of AFP;quality of life(QOL) was evaluated according to Karnofsky scores.Adverse effects were evaluated too.Results:29 cases' efficacy was evaluated among the total 30 cases.The KPS were significantly increased after the treatment(80.39 ± 8.37 vs 73.93 ± 9.22,P = 0.002).Compared with control group,the objective response rate(CR and PR) and the rate of AFP negative changed were significantly higher(P = 0.021,P = 0.046).The adverse effects were not obvious.Conclusion:The QOL and preliminary efficiency of patients of advanced hepatocellular carcinoma may be improved by hepatic arterial infusion of Endostar combined with TACE,the rate of AFP negative changed were significantly higher too,and there are little of adverse effects.It is worthy to clinical generalization and further clinical observation.