Effective segmental chemoembolization of advanced hepatocellular carcinoma with tumor thrombus in the portal vein

Purpose: Evaluate therapeutic results of transcatheter segmental hepatic artery chemo-oily-embolization (segmental TAE) against advanced hepatocellular carcinomas (HCC) accompanied by portal tumor thrombus (PTT). Methods: Segmental TAE was performed in nine patients with hepatic cirrhosis and advanced HCCs accompanied by PTT. Four subsegmental portal branches were obstructed by PTT in three patients, and two were obstructed in the remaining six patients. TAE was performed into the targeted segmental hepatic artery followed by embolization with gelatin sponge particles. Results: In one patient undergoing subsequent resection, a marked anticancer effect on the PTT was demonstrated histologically. In the eight other patients who did not undergo subsequent resection, the cumulative survival rates were 67% at 6 months, 44% at 1 year, and 22% at 2 years. No serious complications were noted. Conclusions: This therapeutic approach is thought to be a useful treatment for HCC with PTT, because it reinforces anticancer effects and can be performed more safely than conventional transcatheter arterial embolization.     

重视介入性肺减容术的研究

介入性肺减容术是在外科切除肺减容术和内镜下非外科切除肺减容术的基础上发展起来的。它是一项X线导引下的经导管治疗技术,在靶肺叶经支气管行博来霉素(或无水乙醇)碘油乳剂栓塞的同时并对其近端支气管用骨水泥封堵,可获得稳定的肺纤维化和肺减容,即所谓的功能性肺叶切除。虽然此项介入治疗技术目前仍处于动物实验阶段,但已经显露出其临床应用潜力和广阔的前景。     

四氧化三铁微粒与碘化油混悬液栓塞兔肾动脉的实验研究

目的　探讨四氧化三铁(Fe3O4)微粒与碘化油(Lp)混悬液(suspension from magnetic microspheres with lipi odol, S Fe3O4 Lp)对兔肾动脉的栓塞和导向作用机制。方法　测定工业工艺制备粒径为 50~250μm 5 种规格的 Fe3O4微粒在Lp中的沉降时间、速度;实验组用粒径250μm的S Fe3O4 Lp对右肾动脉栓塞,对照组用Lp栓塞。两组于术后不同时间比较栓塞效果、观察血生化和病理学改变。结果　五种粒度的Fe3O4 微粒能在一定时间范围内悬浮于Lp中;栓塞效果实验组优于对照组;实验组栓塞部位Fe3O4 微粒与Lp存留存在明显正相关关系(P<0.005,r=0.76)。结论　粒径为250μm的S Fe3O4 Lp对兔肾动脉栓塞效果好,无明显毒副反应;栓塞过程中Fe3O4 微粒与Lp具有同步、同向性,是S Fe3O4 Lp发挥导向性栓塞的基础。     

超液化碘油混合抗癌药物栓塞治疗中晚期肝癌

本文报告超液化碘油混合抗癌药物经皮肝动脉栓塞治疗51例中晚期肝癌。术后50例临床病情改善,治疗2次后肿瘤显著缩小(>50%)16例,中度缩小(20～50%)21例,轻度缩小(<20%)7例;5例为弥漫型难以判定肿块大小,另2例未复查。所有肿瘤缩小的病例均可见肿瘤血管减少。治疗后3个月、6个月、9个月和1年以上生存率分别为100%、82.4%、59.8%和23.5%,其中生存期大于9个月者均为团块型或多结节型。     

NECROSIS OF PORTAL TUMOR EMBOLUS OF HEPATOCELLULAR CARCINOMA BY LIPIODOL TRANSCATHETER CHEMO-EMBOLIZATION. A Case Report

We describe a case of hepatocellular carcinoma in which a tumor embolus in the portal vein and 3 of 4 intrahepatic metastases were necrosed completely by Lipiodol transcatheter chemo-embolization (Lipiodol-TCE). Tumor emboli in the portal vein and intrahepatic metastases usually cannot be necrosed by conventional transcatheter chemo-embolization alone, because small nodules such as intrahepatic metastases and tumor emboli in the portal vein are supplied blood from the portal vein. However, in this case, Lipiodol-TCE was effective against tumor emboli in the portal vein and intrahepatic metastases. ACTA PATHOL JPN 38: 1363-1367, 1988.     

Selective effects of Lipiodolized antitumor agents

Lipiodol Ultra-Fluid (Lipiodol) remains selectively in the tumor for an extended time when applied through arteries feeding the tumor. Although lipophilic antitumor drugs are selective when combined with Lipiodol, wide application of common hydrophilic agents is limited, as these compounds are insoluble in oil. We propose "Lipiodolization" of water-soluble agents using as an intermediate Urografin, a water-soluble contrast medium. Thirteen patients with primary hepatocellular carcinoma were treated with this Lipiodol-Urografin system containing antitumor agents. Marked decrease in serum alpha-fetoprotein (AFP) levels, decrease in tumor size in the hepatic imaging, and histologic studies of the resected specimen revealed this mode of therapy to be effective in 10 of 13 patients (77%) with hepatocellular carcinoma. Lipiodolization of antitumor agents is a new approach to selective cancer chemotherapy.     

New oily agents for targeting chemoembolization for hepatocellular carcinoma

PURPOSE: The evaluation of new oily agents for targeting chemoembolization for hepatocellular carcinoma. METHODS: Five types of oily preparation were injected into the hepatic artery of 54 rabbits inoculated with VX2 carcinoma cells in order to evaluate (1) the safety of these preparations, (2) their histologic distribution and the amount of agents remaining at tumor sites, and (3) computed tomographic (CT) images obtained. Of these preparations, three were made by mixing non-iodinated poppy seed oil and a thickener and then adjusted to have a viscosity lower than, equal to, or higher than that of lipiodol. A fourth preparation was a mixture of lipiodol and a thickener with a higher viscosity than lipiodol alone, and the fifth preparation was lipiodol alone. RESULTS: (1) No injury to the hepatic parenchyma was observed hematologically or histologically. (2) With increase in the viscosity, a significantly larger amount of agent remained at the tumor site. No agent was present at normal sites 14 days after intraarterial injection, regardless of which preparation was given. (3) On CT scans following intraarterial injection, tumor cells were visibly deeply stained in the non-iodinated preparation groups, while the lipiodol groups were not evaluable because of excessively high attenuation. CONCLUSION: The non-iodinated oily preparations and highly viscous oily preparations developed in the present study were more useful than lipiodol for treatment of hepatic tumors.     

支气管动脉碘油化疗栓塞术对非小细胞肺癌患者生活质量的影响

[目的]探讨支气管动脉碘油化疗栓塞术对非小细胞肺癌患者近期生活质量的影响.[方法]采用肺癌治疗功能评价量表FACT-L中文版对33例使用超选择支气管动脉碘油化疗栓塞术治疗的非小细胞肺癌患者的近期生活质量进行测定,分析介入术前、术后1个月及3个月患者生活质量的变化,并与同期采用全身化疗的30例非小细胞肺癌患者进行比较.[结果]化疗栓塞组术后1、3个月的生活质量评分均较术前明显提高(P＜0.01).与全身化疗比较,化疗栓塞组在临床疗效和提高患者术后生活质量程度方面优于全身化疗组(P＜0.05).与疾病症状和治疗副作用有关的项目评分(分别为生理状况和附加关注)显示,化疗栓塞组在分项评分中同样优于全身化疗组(P＜0.05).[结论]超选择支气管动脉碘油化疗栓塞术比全身化疗更能提高中晚期非小细胞肺癌患者的生活质量.     

碘油乳剂的制作及其对肝脏增强的实验研究

目的将40％碘油乳化成40％碘油乳剂，对其物理性质进行测定和观察，然后探讨其对动物肝脏的增强效应。材料和方法40％碘油10ml、蒸馏水15ml、两种适量的乳化剂及其他物质混合后形成初乳，应用乳均机和超声乳化机将初乳乳化成40％碘油乳剂。11只杂种犬，在不同时期静脉、肝动脉、肠系膜上动脉分别注射稀释为15％碘油乳剂及60％泛影葡胺，然后在不同时期行CT扫描。结果乳剂颗粒平均直径0．63u，95％在1.0u以下，最大不超过5．2u，放置12个月颗粒大小分布不变。静脉乳剂肝脏增强最大平均CT值为75HU，泛影葡胺为21．8HU（P＜0.01）；肝动脉乳剂最大平均CT值为120．5HU，泛影葡胺为50．7HU（P＜0．01）；间接门脉乳剂最大平均CT值为117．8HU，泛影葡胺为41．6HU（P＜0．01）。结论我们制作的碘油乳剂颗粒小、稳定性好、毒性低、显影力强。     

经支气管动脉介入治疗肺癌58例疗效分析

目的探讨支气管动脉化疗栓塞术治疗肺癌的临床疗效及应用价值。方法对58例肺癌患者行支气管动脉造影明确其分支及肿瘤血管情况,超选择性插管至肿瘤供血动脉,先行局部化疗药物(含顺铂、丝裂霉素及5-FU)灌注,后以碘化油加顺铂混合乳剂进行栓塞。结果58例大多血供丰富,二次介入治疗者肿瘤血管减少。完全缓解5例,部分缓解43例,稳定10例。有效率82.8%。症状总缓解率55.7%。结论支气管动脉化疗栓塞术治疗肺癌近期疗效较好,可以明显缓解症状,提高患者的生存质量。