双途径介入化疗与单纯肝动脉栓塞化疗治疗晚期肝癌的临床观察

目的研究肝动脉化疗栓塞基础上经皮经肝门静脉灌注化疗治疗晚期肝癌的疗效.方法对49例不能手术切除的晚期原发性肝癌随机分组,行单纯肝动脉化疗栓塞治疗与在肝动脉化疗栓塞基础上加用经肝门静脉灌注化疗,对比分析.结果肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌患者的半年、一年、二年、三年生存率分别为100%、76.5%、35.29%、23.53%,AFP及全身转移的发生率明显降低,与对照组有显著差异.结论肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌疗效优于单纯性经肝动脉化疗栓塞.     

肝动脉栓塞、门静脉置泵化疗治疗中晚期原发性肝癌

肝动脉栓塞、门静脉置泵化疗治疗中晚期原发性肝癌阎汉荣（安阳市人民医院，安阳４５５０００）自１９８６年６月至１９９６年６月，我院共收治无法切除的中晚期原发性肝癌６２例，均采取ＴＨ胶（α－氰基丙烯酸正辛酯）行肝动脉栓塞和门静脉置泵化疗，化疗以替加氟（喃氟...     

原发性肝癌肝动脉化疗栓塞合并LAK/IL-2灌注治疗的临床Ⅲ期观察

评价肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗原发性肝癌的初步疗效。方法不能切除的肝癌患者经肝动脉化疗栓塞后灌注自体ＬＡＫ细胞及ＩＬ┐２，并与单独行肝动脉化疗栓塞的不能切除肝癌患者比较其肿瘤大小，生活质量的变化及毒副反应。结果经肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗的２２例肝癌有效率（ＣＲ＋ＰＲ）为１３．６％，包括１例完全缓解和２例部分缓解，而单独化疗栓塞对照组１７例中仅１例显示部分缓解（有效率５．９％）。化疗栓塞＋ＬＡＫ／ＩＬ┐２治疗组与单独化疗栓塞对照组中ＭＲ、ＳＤ、ＰＤ分别为５、１２、１例和１、１１、４例。治疗组中大多数病人生活质量改善或稳定，而对照组中生活质量则无提高。两组病人的毒副反应均较轻而短暂。结论经肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗原发性肝癌疗效较优于单独肝动脉化疗栓塞治疗，原发性肝癌更有效的综合治疗方案有待进一步探索     

经肝动脉栓塞化疗联合微波刀治疗中晚期肝癌的临床疗效分析

探讨联合应用经肝动脉化疗栓塞联合微波刀治疗中晚期肝癌的临床应用价值。方法:收集经病理、AFP和（或）影像学证实的不能手术切除的中晚期肝癌患者63例,按治疗方法随机分为经肝动脉化疗栓塞治疗组和经肝动脉化疗栓塞联合微波刀治疗组,经肝动脉化疗栓塞治疗组31例,联合治疗组32例。结果:经肝动脉化疗栓塞治疗组与联合治疗组治疗后患者AFP定量平均下降率分别为52.2%（12/23）和80.0%（20/25）,两组间差异有统计学意义（P<0.05）;经肝动脉化疗栓塞治疗组的完全坏死率为12.9%（4/31）;而联合治疗组的完全坏死率为34.4%（11/32）,经统计学分析两组有明显统计学意义。经肝动脉化疗栓塞治疗组在1个疗程治疗结束6个月后复查影像学发现肝癌复发率为32.3%（10/31）;联合治疗组肝癌复发率为9.4%（3/32）,两者间差异有显著意义（P<0.05）。经肝动脉化疗栓塞治疗后患者1年的生存率为64.5%（18/31）,而经联合治疗后患者1年生存率为87.5%（28/32）,两组间差异有统计学意义（P<0.05）。结论:经肝动脉化疗栓塞联合微波消融治疗可显著提高中晚期肝癌患者的生存率,延长患者生存期。      

原发性肝癌患者手术前后入肝血流量的观察

作者用Ｂ超多普勒复合装置测定了６２例肝癌患者手术前后的入肝血流量。结果：①无门脉主干癌栓的肝癌患者术前肝固有动脉血流量和门静脉血流量均大于对照组；②肝固有动脉结扎加栓塞术后，门静脉血流量增加；③右半肝切除术后肝固有动脉血流量的减少较肝右动脉结扎加栓塞术后更为明显；④门静脉主干癌栓经治疗（肝动脉和门静脉灌注化疗）缩小后，门静脉血流量增加，肝固有动脉血流量减少；⑤门静脉血流增加的量与肝固有动脉血流量减     

原发性肝癌肝切除术肝动脉与门静脉灌注化疗的比较

目的评价原发性肝癌根治性切除术后肝动脉灌注化疗与门静脉灌注化疗的疗效，探讨原发性肝癌根治性切除术后复发及转移的预防途径。方法经病理确诊的原发性肝癌７５例，其中４２例行根治性切除及术后选择性肝动脉插管化疗，３３例行根治性切除及术后门静脉灌注化疗。每隔１～３个月重复，定期复查。结果原发性肝癌切除术后肝动脉灌注化疗组的术后复发率（２１．４３％）低于门静脉灌注化疗组（３６．３６％），且生存时间（１１．４个月）明显较门静脉灌注化疗组（７．６个月）长，而门静脉灌注化疗组的转移率（９．０９％）明显低于肝动脉灌注化疗组（３２．１４％）。结论原发性肝癌根治性切除术后行肝动脉灌注化疗较门静脉灌注化疗疗效好，而原发性肝癌切除术后同时结合肝动脉、门静脉灌注化疗对术后预防肿瘤的复发与转移可能更为理想     

肝细胞癌伴门静脉癌栓不同治疗方法的比较

目的 比较肝细胞癌合并门静脉癌栓(ｔｕｍｏｒ ｔｈｒｏｍｂｉ ｉｎ ｐｏｒｔａｌ ｖｅｉｎ,ＰＶＴＴ）不同治疗方法的疗效及其意义。方法 １４７例肝细胞癌伴门静脉主干或第１分支癌栓的住院患者,按不同治疗方法分成４组：保守治疗组（Ａ组,１８例）;肝动脉结扎和（或）肝动脉插管化疗组（Ｂ组,１８例）,术后定期栓塞化疗;肝癌联同ＰＶＴＴ切除组（Ｃ组,７９例）;手术切除＋肝动脉化疗栓塞和（或）肝动脉置管或门静脉     

肝动脉化疗栓塞联合静脉注射三氧化二砷治疗原发性肝癌近期疗效观察

目的观察肝动脉化疗栓塞联合全身静脉注射三氧化二砷（AS2O3）治疗原发性肝癌的近期疗效。方法对32例中晚期原发性肝癌患者采用常规化疗药物经皮肝动脉栓塞治疗，每4周重复，同时给予三氧化二砷注射液10-15mg静脉滴注，每日1次，连用14天，每4周重复为1个疗程，2-3个疗程后观察疗效。结果近期疗效，均按要求完成2-3个疗程，随访1年以上，PR13例，NC14例，PD5例，总有效率40.6%，临床获益率为84.4%。生活质量，改善18例（56.3%），稳定11例（34.4%）。不良反应轻。结论肝动脉化疗栓塞（TACE）联合静注三氧化二砷治疗中晚期原发性肝癌近期疗效较好，毒副作用小。     

肝动脉栓塞化疗加电化学治疗肝癌近期疗效观察

目的：比较无手术指征肝癌患者单纯肝动脉栓塞化疗与在肝动脉栓塞化疗基础上行电化学治疗的近期疗效。方法：选择无手术指征的肝癌患者59例,随机分为单纯肝动脉栓塞化疗组（化疗组）和肝动脉栓塞化疗加电化学治疗组（化疗＋电疗组）,比较两种治疗方法的近期疗效。结果：在肝动脉栓塞化疗基础上行电化学治疗在肿瘤缩小、肝区疼痛消失方面优于单纯肝动脉栓塞化疗。结论：无手术指征肝癌患者在肝动脉栓塞化疗的基础上行电化学治疗近期疗效显著。     

肝动脉栓塞治疗原发性肝癌的进展

原发性肝癌经临床确诊后,多属中晚期,仅有５％的病人能行手术切除。因此,肝动脉栓塞（ｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｅｍｂｏｌｉｚａｔｉｏｎ,ＴＡＥ）被公认为是治疗不能切除的中晚期肝癌的首选方法（１）。Ｋａｔｏ于１９８１年首次开展肝动脉化疗栓塞。国内于１９８４年首先运用ＬＰＴＡＥ治疗肝癌。现在该领域的研究取得很大进展,已从肝动脉栓塞发展到肝段动脉栓塞和肝动脉、门静脉双途径栓塞,使肝癌患者的生存期显著延长,其中部分患者获得二期切除的机会。现将近几年来国内开展的肝动脉栓塞疗法的情况综述如…     

Primary liver cancer: pattern of metastasis

The causes of death and patterns of metastasis of 43 patients with primary liver cancer were studied and discussed in comparison with reports in the literature. Data from 6 recent reports of 1,673 patients showed that the 3 leading causes of death from hepatoma were liver failure (34%), bleeding (30%), and advanced cancer (24%). Distribution of sites of metastasis in 1,497 patients with hepatoma from 7 reports showed that the 3 leading sites were: lung (median 44%), portal vein (35%), and portal lymph node(s) (27%). The pattern of metastasis of hepatoma arising from cirrhotic liver is somewhat different from that of the noncirrhotic liver; the former are more likely to involve the portal vein, whereas the latter involves more regional lymph node(s). Compared to hepatoma, cholangiocarcinoma is less likely to metastasize to the lung or portal vein, but more likely to involve lymph node(s), peritoneum, and bone and/or marrow.     

肝细胞癌合并门静脉癌栓的治疗进展

门静脉癌栓是中晚期肝癌患者最常见的并发症之一,已成为影响肝癌患者术后复发转移和总体生存预后的主要因素之一。近年来,随着医疗技术的不断发展,肝癌精准治疗和多学科协作诊疗等理念不断深入,除传统的手术治疗外,局部消融术、靶向药物治疗、肝动脉栓塞化疗、三维适形放疗等多种手段的联合应用,经过临床应用证实疗效更加显著,肝癌合并门静脉癌栓的综合治疗理念已贯穿始终。本文就肝细胞癌伴门静脉癌栓的最新治疗进展做一综述,以供临床参考。     

老年中晚期原发性肝癌患者生活质量及其对生存期的影响

目的:观察老年中晚期原发性肝癌患者的生活质量状况及其对生存期的影响。方法:回顾性分析2014年01月至2016年12月我院收治的115例老年原发性肝癌患者,调查他们的生活质量指数（LQI）,比较不同LQI水平原发性肝癌患者的生存情况,并分析影响预后的危险因素。结果:本组患者生活质量的总分是（118.72±34.26）分,LQI是0.59±0.13。参照患者1年生存状态,LQI的最佳临界值为0.63,曲线下面积为0.696。高LQI组的中位生存时间为16.5个月,显著高于低LQI组的12.4个月(P=0.037）。与低水平LQI组比较,高水平LQI组的年龄、谷丙转氨酶（ALT）、谷草转氨酶（AST）、凝血酶原时间（PT）、总胆红素（TBIL）和甲胎蛋白（AFP）水平以及门静脉癌栓发生率、保守治疗率更小或更低,白蛋白（ALB）水平和BCLC分期更高,差异均有统计学意义（P<0.05）。单因素分析结果显示,老年中晚期原发性肝癌的预后与ALB、AFP、Child-Pugh分级、门静脉癌栓、肝外转移、BCLC分期、药物保守治疗和LQI相关（P<0.05）。多因素分析结果显示,AFP≥400 ng/ml、BCLC C期和药物保守治疗是预后的独立危险因素（P<0.05）,而非门静脉癌栓、非肝外转移、LQI≥0.63是其独立保护因素（P<0.05）。结论:老年中晚期原发性肝癌患者生活质量较低,生活质量越低,预后越差。     

Clinical application of chemotherapy via the portal vein with liposome-encapsulated adriamycin in inoperable metastatic liver cancer

We studied the effects of liposome-entrapped adriamycin (L-ADM) administered via the portal vein and the clinical application of this treatment in the therapy and inhibition of liver metastasis, experimentally and clinically. Liposomes composed of egg phosphatidylcholine (cholesterol 50 mol%) were used as drug carriers. We examined the distribution in tissues and antitumor effect of freeze-dried L-ADM administered via the portal vein to rabbits bearing VX2 tumors. The liver concentration of ADM increased after delivery and cardiac uptake decreased compared with free drug treatment. The life span was prolonged by L-ADM treatment compared with the control group and the free ADM group. This L-ADM administration was confirmed to be safe and revealed a decrease in the heart toxicities compared with free adriamycin. Nineteen cases were studied from Jan. 1986 to May 1991 via the portal vein and the clinical effects were evaluated. From Mar. 1988 to date, 10 cases were treated with L-ADM (20-30 mg every 2 weeks/body) in patients with inoperable cases using subcutaneously implanted reservoir. The median survival was 450 days; 275 days for colon cancer, 492 days for gastric cancer, and 1,052 days for uterine cancer (range: 136-1,152 days), compared with 141 days (range: 52-253 days) in 9 cases of historical control treated with free-ADM via the portal vein. These results suggest that chemotherapy via the portal vein with L-ADM for metastatic liver cancer may increase survival time.     

肝动脉栓塞加门静脉置泵治疗晚期原发性肝癌(附160例病例分析)

延长晚期原发性肝癌患者的生存时间，提高生活质量，为二期手术切除创造条件。方法：采用肝动脉栓塞化疗加门静脉置泵，术中栓塞药物为：ADM、泛影葡胺、碘化油及MMC；术后门静脉药泵常用ADM、干扰素注射。结果：术后二个月复查B超，肿瘤缩小明显者（缩小至原肿瘤1／3）者74例，占46％，其中18例施行二期肝癌切除术，160例1年后存活率78．6％，2、3、5年存活率分别为65．6％、43．5％及16．3％。结论：采取肝动脉栓塞加门静脉置泵治疗晚期原发性肝癌160例，效果良好，延长了晚期原发性肝癌的生存时间，为二期手术切除创造了条件。     

TACE联合门静脉支架治疗伴门静脉癌栓原发性肝癌的效果分析

目的 研究肝动脉化疗栓筛(TACE)联合门静脉支架植入术治疗伴门静脉癌栓原发性肝癌的效果.方法 在遵循随机对照原则和入选标准的基础上,选取2012年7月至2015年1月确诊为原发性肝癌伴门静脉癌栓15例患者为观察组,选取2010年1月至2012年6月于我科确诊为原发性肝癌伴门静脉癌栓但仅接受TACE治疗的15例患者为对照组,而观察组则接受肝动脉化疗栓筛(TACE)联合门静脉支架植入术治疗.对比两组患者治疗前后肝功能主要指标和并发症情况,并随访两组患者的生存时间.结果 与治疗前比较,两组患者治疗后肝功能主要指标水平差异明显,均具有统计学意义(P<0.05),且观察组肝功能主要指标改善情况显著优于对照组,差异均具有统计学意义(P<0.05).与对照组比较,观察组出现肝性腹腔积液、肝性脑病、严重感染及肺转移患者例数明显减少,且差异均具有统计学意义(P<0.05).与对照组比较,观察组总生存时间明显延长,且差异均具有统计学意义(P<0.05).结论 肝动脉化疗栓筛(TACE)联合门静脉支架植入术不仅可降低患者并发症的发生率,同时还可有效改善中晚期患者的肝功能,其在延长患者生存时间上也有显著的效果,值得临床推广运用.     

原发性肝癌并发门静脉癌栓的治疗策略

 门静脉癌栓是原发性肝癌的常见并发症,一旦发生,常预示着病情已处晚期,难以逆转,预后极差。文章介绍了门静脉癌栓现有的治疗方法,提倡多学科综合治疗,提高晚期肝癌患者的生存期。     

大肠癌术后门静脉置泵灌注化疗预防肝转移临床疗效分析

目的:探讨大肠癌术后门静脉置泵灌注化疗预防肝转移的临床疗效。方法:46例大肠癌患者随机分成治疗组和对照组,治疗组术后自门静脉化疗泵注药(5-FU、MMC和EPI),对照组自周围静脉注药。结果:治疗组5年生存率55·00%(11/20),肝转移率12·50%(3/24);对照组5年生存率33·33%(6/18);肝转移率27·27%(6/22);两组相比差异有统计学意义,P<0·01。结论:大肠癌术后门静脉置泵灌注化疗预防肝转移效果好。5年生存率明显提高。     

Effect of selective internal radiation therapy and hepatic arterial chemotherapy on normal liver volume and spleen volume.

OBJECTIVE: To determine the effect of selective internal radiation therapy (SIRT) and hepatic arterial chemotherapy (HAC) on normal liver volume and spleen volume in patients receiving these treatments for advanced liver cancer. METHODS: In a phase III clinical trial to assess the benefit of SIRT over HAC one group of patients received SIRT + HAC while a second group received HAC only. All patients in this trial who had abdominal CT scans available before treatment, and at 3, 6, and 12 months after treatment were evaluated. Changes in normal hepatic parenchyma (NHP) volume, portal vein diameter and spleen volume were calculated for each patient and analysed for significant trends. RESULTS: The mean NHP volume decreased by 17% (P = 0.001) 12 months after treatment among patients receiving SIRT + HAC (N = 22), while the mean NHP volume among patients treated with HAC only (N = 15) was unchanged at 12 months. The mean portal vein diameter increased by 9% in both treatment groups, P = 0.048 and P < 0.001, respectively. The mean spleen volume increased by 48% (P < 0.001) and 26% (P = 0.001), respectively, in the two groups 12 months after treatment started. There was no clinical evidence of hepatic failure, portal hypertension or splenic dysfunction in any of the patients. CONCLUSIONS: Treatment of patients with SIRT + HAC causes contraction of the normal hepatic parenchyma, while treatment with HAC alone has no significant effect. Treatment with either SIRT + HAC or HAC alone causes a significant increase in portal vein diameter and spleen volume by 12 months after treatment. The increase in spleen volume and portal vein size is likely to be due to portal hypertension resulting from scarring within the liver as a result of chemical and radiation hepatitis.     

Tumor and liver drug uptake following hepatic artery and portal vein infusion

Anatomic dye injection studies of the blood supply of colorectal hepatic metastases suggest that tumors are supplied predominantly by the hepatic artery. Using 13N amino acids with dynamic gamma camera imaging in patients with colorectal hepatic metastases, it has been shown that hepatic artery infusion results in a significantly greater nutrient delivery to tumor compared with portal vein infusion. However, direct measurements of drug levels in tumor following hepatic artery and portal vein infusion in humans have not previously been reported. Patients with metastatic colorectal cancer confined to the liver received fluorodeoxyuridine (FUdR) through the hepatic artery or through the portal vein. All patients had previously failed systemic chemotherapy. Five patients with hepatic artery catheters were matched (by age, serum lactic dehydrogenase levels, percent hepatic replacement, and tumor size) with five patients with portal vein catheters. At operation, 3H-FUdR (1 microCi/kg) and 99mTc-macroaggregated albumin (MAA) (6 mCi) were injected into the hepatic artery or portal vein. Liver and tumor biopsies were obtained two and five minutes later. 3H and 99mTc were measured per gram tissue by scintillation and gamma counting. The mean liver levels following hepatic artery infusion (23.9 +/- 11.4 nmol/g) and portal vein infusion (18.4 +/- 14.5 nmol/g) did not differ. However, the mean tumor FUdR level following hepatic artery infusion was 12.4 +/- 12.2 nmol/g, compared with a mean tumor FUdR level following portal vein infusion of 0.8 +/- 0.7 nmol/g (P less than .01). This low level of tumor drug uptake after portal vein infusion of FUdR predicts minimal tumor response to treatment via this route. Thus, regional chemotherapy for established colorectal hepatic metastases should be administered through the hepatic artery.