大肠癌肝转移介入治疗的临床研究

目的：评价介入治疗大肠癌肝转移的疗效和影响疗效的因素。方法：对80例大肠癌肝转移介入治疗后得到随访患者的生存期和预后因素进行统计分析。结果：0．5,1,2和3年累积生存率分别为100％,75．8％,31．5％和10．8％。单因素分析显示,有意义的预后因素是患者年龄、肿瘤占据率（与全肝比值）、病灶血供丰富与否和碘油沉积情况、原发病灶是否切除以及治疗后病灶大小差别;多因素分析为病灶血供情况和治疗后病灶大小差别。结论：经肝动脉介入治疗是大肠癌肝转移的有效治疗方法。血供较丰富的转移性肿瘤和原发病灶切除是决定疗效的关键。     

介入治疗大肠癌肝转移72例体会

目的：探讨介入化疗和栓塞治疗大肠癌肝转移的临床应用价值，分析肝脏转移肿瘤的DSA表现。方法：对72例大肠癌肝转移病人采用选择性肝动脉插管灌注化疗药物和碘化油栓塞为主的综合治疗。结果：CR＋PR68％（49／62），6个月、1年、2年和3年生存率分别为95．3％、78．9％、43．3％和16．7％。结论：采用介入化疗栓塞是治疗大肠癌盱转移的一种安全有效的治疗方法。     

胃肠道间质瘤肝转移介入治疗疗效分析

目的观察经肝动脉化疗栓塞(TACE)治疗胃肠道间质瘤(GIST)肝转移的临床疗效。方法对4例胃肠道间质瘤肝转移患者共19个病灶,病灶直径2～5cm,经肝动脉灌注FuDR、CDDP、EPI-ADM,用超液化碘油和明胶海绵作动脉栓塞,每例平均2～4次。结果DSA显示GIST肝转移灶动脉血供丰富,染色明显,经TACE治疗后,肝转移灶未见缩小,碘油较快被清除,4例患者无CR或PR,2例改服伊马替尼有效。结论有限的病例显示TACE治疗胃肠道间质瘤肝转移未见明显疗效。     

大肠癌肝转移的介入治疗

目的：探讨采用介入化疗并栓塞方法治疗大肠癌肝转移的疗效,并发症及生存期。材料与方法：治疗组３８例采用介入法肝动脉栓塞化疗,对照组２４例采用常规全身静脉化疗。结果：介入栓塞化疗组ＣＲ＋ＰＲ为８４．２％,全身静脉化疗组ＣＲ＋ＰＲ为３７．５％,两组比较,介入栓塞化疗组３８例中６、１２和２４个月的生存率分别为９４．７％、６４．５％和４１．７％,而单纯静脉人 组２４例中６、１２和２４个月的生存率分别为５９．     

大肠癌肝转移的介入治疗

目的 探讨采用介篱化疗并栓塞方法治疗大肠癌肝转移的疗效、并发症及生存期。方法 治疗组３８例采用介入法肝动脉栓塞化疗,对照组２４例采用常规全身静脉化。结果 介入栓经疗组ＣＲ＋ＰＲ为８４．２％,全身静脉化疗组ＣＲ＋ＰＲ为３７．５％,两组比较Ｐ〈０．０１,介入栓塞化疗组３８例中６、１２和２４个月的生存率分别为９４．７％、６４．５％、４１．７％,而单纯静沦疗组２４例中６、１２和２４个月的生存率分别为５８．     

鼻咽癌肝转移的综合介入治疗

目的对46例鼻咽癌肝转移患者行包括射频消融治疗(RFA)、化疗栓塞(TACE)等为主的综合介入治疗,研究其近期局部治疗效果和不良反应。方法鼻咽癌肝转移患者共46例,其中富血供型17例,病灶总数32个;乏血供型29例,病灶总数61个,分别进行以TACE和RFA为主的综合介入治疗。结果治疗结束后经CT评价均表现为近期有效,无严重并发症。结论综合介入治疗对鼻咽癌肝转移患者创伤微小,安全有效。     

肝转移瘤介入治疗的疗效评价

目的：评价经动脉化疗和栓塞治疗肝脏转移瘤的临床效果。方法：65例多种来源的肝脏转移瘤，经一次或多次肝动脉灌注化疗和／或栓塞，并视条件积极处理存在的原发，观察病例术后肿瘤缩小情况，统计病例的生存时间，结果：有效率为63.1%，半年、一年生存率和中位生存期分别是72.3%、44.8%和10.2个月。结论：介入治疗肝转移瘤效果显著。     

肝转移性肿瘤介入治疗体会

目的 分析肝转移性肿瘤DSA表现、介入治疗方法及其临床疗效的价值。方法 对98例肝转移性肿瘤患者均行超选择插管治疗共245次，所用化疗药物为5-Fu，MMC，ADM，CDDP，联合化疗方案加超液化碘化油和明胶海绵栓塞。结果 近期疗效以CT检查和生化检查作为评价标准，总有效率为100％，平均生存期为21．6个月，本组0，5、1、2、3a生存率分别为97．4％，73．3％，46．9％和22．4％。结论 经肝动脉超选择介入治疗是肝转移肿瘤的较好方法，不但能减少副反应和并发症的发生，而且可以提高近期疗效。     

凝血因子Ⅶ在大肠癌中的表达及其在肿瘤肝转移中的意义

 目的 研究大肠癌组织中FⅦ的表达情况,探讨FⅦ表达量和大肠癌、肿瘤肝转移的相关性.方法 以北京大学第一医院新近(2006年1月至2007年6月间)手术切除的大肠癌肿瘤标本和同一病例的大肠正常黏膜取材,共30例.通过免疫组织化学方法 检测FⅦ在大肠癌组织当中的合成情况.通过Western-Blot方法 检测FⅦ在其中18例不同Dukes分期的大肠癌组织当中合成量的差异.结果 免疫组织化学法发现在大肠癌组织当中有FⅦ高表达(17/30),Western-Blot蛋白质印迹法证明在不同Dukes分期的大肠癌肿瘤组织中的FⅦ表达存在差异,从B期到D期,表达量逐渐提高,尤其是D期与其他各期存在明显差异.结论 大肠癌组织中存在异源性的活性凝血因子Ⅶ蛋白的合成;大肠癌组织中的FⅦ表达量和肿瘤的Dukes分期密切相关,可能具有促进大肠癌肿瘤的侵袭和转移能力.     

大肠癌肝转移的射频消融治疗

目的研究大肠癌肝转移射频消融(RFA)治疗近期局部疗效和不良反应。方法大肠癌肝转移患者32例,病灶总数71个,其中直径小于4.0 cm的病灶41个,4.1~5.0 cm者14个,5.1~6.0 cm者9个,大于6.1 cm者7个。经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果不同大小瘤灶经消融治疗后达到完全坏死者分别为41个(41/41),13个(13/14),4个(4/9),2个(2/7)。无严重不良反应和并发症。结论RFA安全可靠,不良反应小,是治疗大肠癌肝转移的有效方法之一。     

进展期胃癌综合治疗临床观察(附36例)

通过对３６例进展期胃癌介入（栓塞）化疗＋放疗＋中药综合治疗，总有效率达９１．７％，半年、一年、二年生存率分别为９７．２％、５５．５％、３３．３％，说明充分利用介入化疗与放疗之间的相加增敏作用，配合中药可明显提高抗肿瘤能力，降低副作用，显著改善病人的生存质量，提高生存率。综合治疗优于任何单项治疗，是治疗胃癌的最有效方法。并对综合治疗的基础、适应症进行了探讨。     

选择性动脉化疗药物灌注及栓塞治疗结肠直肠癌肝转移

目的：探讨选择性动脉２化疗药物灌注及栓塞治疗结直肠癌肝转移的价值。材料与方法：对２７例失去手术机会的结直肠癌肝转移患者,采用经股动脉穿刺,选择性肝动脉插管灌注化疗药物（ＡＤＭ,ＣＢＰ,ＦＵＤＲ）,并用ＡＤＭ及磺化油乳化后栓塞肝动脉。结果：在第１疗程结束后,１９例患者肝内肿瘤有缩小,２５例ＣＥＡ降低,２３例上腹疼痛减轻或消失。１、２、３年生存率辊７０．４％、５１．９％、２２．２％。结论：经肝动脉化疗     

Hepatic Arterial Infusion Chemotherapy Using Fluorouracil Followed by Systemic Therapy Using Oxaliplatin Plus Fluorouracil and Leucovorin for Patients with Unresectable Liver Metastases from Colorectal Cancer

The purpose of this study was to assess retrospectively the sequential treatment of hepatic arterial infusion (HAI) chemotherapy followed by systemic therapy using oxaliplatin plus 5-flourouracil (5-FU) and leucovorin, namely, FOLFOX, for patients with liver metastases from colorectal cancer. We reviewed 20 patients with unresectable liver metastases from colorectal cancer. Patients were initially treated with HAI chemotherapy until disease progression (5-fluorouracil, 1000 mg/m² intra-arterial infusion, weekly) and then with FOLFOX thereafter (FOLFOX4, n = 13; modified FOLFOX6, n = 7). Adverse events, tumor response, and time to progression for each therapy were evaluated retrospectively, and overall survival was estimated. Toxicity of HAI chemotherapy was generally mild. Of 20 patients, adverse events leading to treatment discontinuation occurred in only 1 patient (5%) during initial therapy using HAI chemotherapy, while 9 patients (45%) exhibited adverse events during subsequent FOLFOX therapy. For HAI chemotherapy and FOLFOX, objective response rates were 85.0% and 35.0%, respectively, and median time to progression was 11.6 and 5.1 months, respectively. Median overall survival was 30.1 months. In conclusion, the sequence of HAI chemotherapy followed by FOLFOX is a promising treatment strategy for the long-term use of active chemotherapeutic agents, leading to a superior tumor response and fewer toxic effects in patients with unresectable liver metastases from colorectal cancer.     

支气管肺癌介入治疗的临床研究

目的：探讨经皮支气管动脉灌注化疗和灌注化疗栓塞治疗中晚期肺癌的临床效果。资料与方法：对57例肺癌患者施行了经皮支气管动脉灌注化疗或灌注化疗栓塞术。采用改良式Seldinger技术，行选择性和超选择性支气管动脉插管。经导管注入超液化碘油（3－10ml）和吡柔比星（10mg）的混悬液，然后注入另外2种化疗药物，咳血患者最后用明胶海绵颗粒适量栓塞肿瘤周围小血管，支气管动脉主干保持通畅。结果：40例为富血管型（70．18％），17例（29．82％）为乏血管型。现存15例中，半年生存率100％，1年生存率80．00％。死亡33例，中位生存期14．75个月，半年生存率96．97％，1年生存率73．33％，2年生存率33．81％，3年生存率9．09％。结论：经皮支气管动脉灌注化疗栓塞，三明治方法是治疗中晚期肺癌的最有效方法之一。可以确切延长中位生存期，提高患者生存质量。长期疗效需要大量随机增加病例及长期随访，不断提高肺癌介入治疗的临床效果。     

Retrospective Review of Efficacy of Radiofrequency Ablation for Treatment of Colorectal Cancer Liver Metastases From a Canadian Perspective

Purpose

A retrospective single-center review of ultrasound-guided radiofrequency ablation (RFA) treatment of colorectal cancer liver metastases was performed. This study reviews the primary and secondary technical effectiveness, overall survival of patients, recurrence-free survival, tumour-free survival, rates of local recurrence, and postprocedural RFA complications. Technical effectiveness and rates of complication with respect to tumour location and size were evaluated. Our results were compared with similar studies from Europe and North America.

Methods

A total of 63 patients (109 tumours) treated with RFA between February 2004 and December 2009 were reviewed. Average and median follow-up time was 19.4 and 16.5 months, respectively (range, 1–54 months). Data from patient charts, pathology, and Picture Archiving and Communication System was integrated into an Excel database. Statistical Analysis Software was used for statistical analysis.

Results

Primary and secondary technical effectiveness of percutaneous and intraoperative RFA were 90.8% and 92.7%, respectively. Average (SE) tumour-free survival was 14.4 ± 1.4 months (range, 1–43 months), and average (SE) recurrence-free survival was 33.5 ± 2.3 months (range, 2–50 months). Local recurrence was seen in 31.2% of treated tumours (range, 2–50 months) (34/109). Overall survival was 89.4% at 1 year, 70.0% at 2 years, and 38.1% at 3 years, with an average (SE) overall survival of 37.0 ± 2.8 months. There were 14 postprocedural complications. There was no statistically significant difference in technical effectiveness for small tumours (1–2 cm) vs intermediate ones (3–5 cm). There was no difference in technical effectiveness for peripheral vs parenchymal tumours.

Conclusions

This study demonstrated good-quality outcomes for RFA treatment of colorectal cancer liver metastases from a Canadian perspective and compared favorably with published studies.     

Radiofrequency Ablation of Colorectal Liver Metastases: Small Size Favorably Predicts Technique Effectiveness and Survival

The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases (MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine nonresectable MTS (0.5–8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during surgery. The technique was “simple” or “combined” with vascular occlusion. The mean follow-up time was 24.2 months. Complications, technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions ≤3 cm versus 33.3% of lesions >3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%, and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS ≤3 cm and 23.2 in those with at least one lesion >3 cm (p = 0.006). We conclude that “simple” RFA is safe and successful for MTS ≤3 cm, contributing to prolong survival when patients can be completely treated. Presented at CIRSE 2006.     

结直肠癌合并肝脏转移的介入治疗

目的 探讨结直肠癌合并肝脏转移经导管动脉灌注及栓塞治疗的价值. 资料与方法 35例结直肠癌合并肝脏转移患者,行结直肠肿瘤供血动脉插管灌注化疗和/或栓塞术,同时对肝脏转移瘤行动脉插管灌注化疗栓塞术.其中介入治疗后1～3个月23例患者行结直肠肿瘤外科手术切除,6例肝脏单发转移癌行外科手术切除.结果 所有病例术后1～3个月随访复查CT,结直肠肿块显效11例,有效22例,无效2例;肝脏转移灶显效20例,有效12例,无效3例.23例外科手术切除肿瘤顺利,术中出血300～1500 ml,术后病理提示肿瘤坏死明显,可见纤维组织增生和炎性细胞浸润.6例肝脏转移瘤外科切除,术后病理提示1例未见癌细胞,其余5例可见少量癌细胞,坏死明显.结论 经导管动脉灌注及栓塞治疗结直肠癌合并肝脏转移疗效显著,值得推广.     

钆塞酸二钠增强MRI在结直肠癌肝转移系统治疗疗效评价中的价值

目的 探讨肝细胞特异性对比剂钆塞酸二钠(Gd-EOB-DTPA)在评价结直肠癌肝转移系统治疗疗效中的价值.方法 回顾性分析系统治疗后经手术切除的48例结直肠癌患者的83个肝转移瘤,所有患者术前行Gd-EOB-DTPA增强MRI检查.判断动脉期强化特征(环形强化/非环形强化)、肝胆期强化特征(靶样强化/非靶样强化),测量...     

晚期食管癌介入治疗的疗效探讨

本文对２７例不能手术的晚期食管癌患者，采用支气管动脉、胃左动脉灌注，鳞癌以ＤＭＶＣ方案，腺癌以ＦＡＭ方案为主的化疗药物。取得了一定的近期疗效，达到了提高生存质量，延长生命之目的，笔者重点对其介入治疗的适应证及理论依据进行了讨论。     

直肠癌的介入治疗

目的　评价直肠癌的选择性动脉灌注化疗和栓塞的临床价值。方法　采用Seldinger技术对 3 0例原发性直肠癌患者行超选择性插管 ,灌注抗癌药物后用明胶海绵栓塞 ;化疗栓塞后 7d内手术。结果　化疗栓塞后患者临床症状明显缓解 ,有 2 5例达到根治性切除 ,且术中出血明显减少。结论　直肠癌的导管灌注化疗及栓塞可缓解临床症状 ,提高手术切除率