经肝动脉化疗栓塞术联合射频消融治疗原发性肝癌的现状

近年来在原发性肝癌治疗领域中新兴治疗方法层出不穷,但由于病变多发生于进展期肝病或肝硬化的基础上,导致原发性肝癌仍然是一种难治性恶性肿瘤。外科手术切除及肝移植虽是根治性治疗方法,但由于移植相关问题的复杂性及原发性肝癌本身的隐匿性,使得上述两种治疗方法并不能适用于大多数患者。而近些年随着设备和技术水平的提高,原发性肝癌的介入治疗得到了越来越多的重视,这其中应用最为广泛的就是经肝动脉化疗栓塞术(TACE)和经皮肝穿刺射频消融(RFA)。主要讨论上述两种介入疗法联合应用治疗原发性肝癌的有效性、可行性,以及近年来介入治疗在原发性肝癌治疗领域的研究进展。     

经肝动脉化疗栓塞术联合射频消融治疗

近年来在原发性肝癌治疗领域中新兴治疗方法层出不穷,但由于病变多发生于进展期肝病或肝硬化的基础上,导致原发性肝癌仍然是一种难治性恶性肿瘤。外科手术切除及肝移植虽是根治性治疗方法,但由于移植相关问题的复杂性及原发性肝癌本身的隐匿性,使得上述两种治疗方法并不能适用于大多数患者。而近些年随着设备和技术水平的提高,原发性肝癌的介入治疗得到了越来越多的重视,这其中应用最为广泛的就是经肝动脉化疗栓塞术（TACE）和经皮肝穿刺射频消融（RFA）。主要讨论上述两种介入疗法联合应用治疗原发性肝癌的有效性、可行性,以及近年来介入治疗在原发性肝癌治疗领域的研究进展。     

还原型谷胱甘肽在原发性肝癌介入治疗中护肝作用的观察

目的探讨还原型谷胱甘肽(GSH)在原发性肝癌病人介入治疗中的护肝作用。方法原发性肝癌病人72例,随机分为两组,对照组和治疗组各36例。所有病例在行肝动脉灌注化疗(HAI)及肝动脉栓塞治疗(HAE)的同时进行保肝治疗,对照组给予能量合剂、门冬氨酸钾镁和肌苷静脉滴注,当天介入治疗前使用一次,介入治疗后1次/日×7天。治疗组在上述给药的基础上加用GSH1500mg/m2.d静脉滴注,当天介入治疗前使用一次,介入治疗后1次/日×7天。治疗前后监测肝功能变化及腹水生成情况。结果介入治疗后第3天两组病人皆出现不同程度的肝功能受损,但治疗组ALT、AST、TBIL上升幅度均较对照组低(P<0.05)。介入治疗后第7天两组病人肝功能皆好转,但治疗组ALT和AST显著低于对照组,TP显著高于对照组(P<0.05)。两组腹水生成率的差异无统计学意义(P>0.05)。结论GSH在原发性肝癌病人介入治疗中可产生显著的保肝作用。     

老年人原发性肝癌的介入治疗

肝动脉化疗栓塞治疗肝癌,是国内外近年来开展的一种新疗法,并在治疗中晚期原发性肝癌中取得了肯定的疗效。我们对43例老年人原发性肝癌进行了介入治疗。现将治疗方法和效果报告如下。     

糖尿病合并原发性肝癌患者介入术后感染发生状况及其影响因素分析

目的分析糖尿病合并原发性肝癌患者介入治疗后发生感染的影响因素,以期指导未来临床该疾病介入治疗后防治感染方案的制定。方法回顾性分析,搜集2019年2月至2020年10月期间入院行介入治疗后发生感染的42例糖尿病合并原发性肝癌患者的临床资料,将其纳入感染组;另搜集同时间入院行介入治疗后未发生感染的40例糖尿病合并原发性肝癌患者的临床资料,将其纳入未感染组。记录并对比两组基线资料,找出可能导致糖尿病合并原发性肝癌患者介入治疗后发生感染的高危因素。结果将糖尿病合并原发性肝癌患者介入治疗后发生感染的情况作为因变量(1=发生,2=未发生),经Logistic回归分析显示,糖尿病病程、原发性肝癌病程、放化疗、Child-Pugh分级、围术期侵入性操作、贫血、胰岛素抵抗指数均可能是糖尿病合并原发性肝癌患者介入治疗后发生感染的影响因素(OR=73.667、85.500、61.667、380.00、74.000、218.667、68.889,P<0.05)。结论糖尿病病程(≥1年)、原发性肝癌病程(≥1年)、放化疗(是)、Child-Pugh分级、围术期侵入性操作(≥3次)、贫血(是)、胰岛素抵抗指数均可能是糖尿病合并原发性肝癌患者介入治疗后发生感染的影响因素,临床针对合并上述高危因素的患者,给予针对性干预治疗,对提高糖尿病合并原发性肝癌患者介入治疗效果,促进良性结局具有关键意义。     

老年中晚期原发性肝癌患者介入治疗的临床效果

目的 研究老年中晚期原发性肝癌患者应用肝癌介入治疗的临床效果和对患者的肝功能影响。方法 老年中晚期原发性肝癌患者186例随机分为对照组和研究组93例。对照组应用碘化油加吡柔比星混悬液栓塞实施治疗，研究组应用碘化油加吡柔比星混悬液加聚乙烯醇栓塞微球栓塞，比较两组治疗前、后血清中甲胎蛋白(AFP)和肝功能指标水平、治疗的有效率、发生不良反应情况及2年存活率。结果 治疗后，研究组AFP下降更加明显(P<0.001),白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)各项肝功能指标改善情况均明显优于对照组(P<0.001),治疗有效率2年存活率明显高于对照组(P<0.05)。两组不良反应发生情况无明显差异(P=0.156)。结论 老年中晚期原发性肝癌应用肝癌介入治疗临床疗效确切，有助于改善患者的肝功能，促进存活率的提高。     

原发性肝癌淋巴细胞表型变化与转移和复发的关系

原发性肝癌是最常见的恶性肿瘤之一 ,虽然手术是其首选有效的治疗方法 ,但由于患者多合并肝硬化 ,且易发生肝内及远处转移 ,能获手术治疗者仅占 2 0 %左右 ,放、化疗难以彻底消灭肿瘤细胞 ,同时易损伤正常组织 ,降低全身和肝脏局部免疫力。因此 ,近年来生物免疫治疗已渐成为肿瘤治疗的第四模式。为探讨免疫治疗与介入治疗对原发性肝癌患者淋巴细胞表型的影响及其临床相关性 ,2 0 0 0～2 0 0 1年 ,我们对 42例中晚期原发性肝癌患者采用动脉栓塞 (TACE)与干扰素联合治疗 ,现报告如下。1　资料与方法1 .1　一般资料　本文中晚期原发性肝癌患…     

中西医结合治疗中晚期原发性肝癌313例

对中晚期原发性肝癌(Midadvanced HCC),多采用肝动脉化疗栓塞术(TACE)、超声酒精局部介入治疗(PEI)以及综合保守治疗等,但总体的临床疗效多年来未见明显提高,如肝癌细胞的相对5年生存率仍然偏低。因此如何提高中晚期尤其是晚期肝癌的临床疗效,始终是肝癌研究的重要方向之一。我们在上述常规治疗方法的同时,配合应用中医中药治疗,并与相应的常规治疗方法进行了前瞻性地对比观察,发现中医中药配合治疗能显著提高不同常规治疗方法的临床疗效,现报告如下。     

肝动脉插管介入化疗治疗原发性肝癌患者肝功能的变化

目的分析TAE和TACE对肝癌患者肝功能的影响。方法在介入治疗前后对原发性肝癌患者进行肝功能Child-Pugh评级分析。结果在介入治疗前ChildA级为181例,介入治疗术后下降为116例;术后血清总胆红素和天冬氨酸转氨酶均有轻微的升高,胆碱酯酶和白蛋白有轻微的下降,但无显著性的统计学意义(P0.05)。结论介入治疗对原发性肝癌患者肝功能有一定的影响,应积极采取术前术后的保肝治疗。     

血清TK-1检测对原发性肝癌的诊断及介入治疗后效果评估的意义

目的 探讨血清TK-1检测对原发性肝癌诊断及介入治疗后效果评估的意义. 方法 应用免疫印迹-增强化学发光法检测28例健康人及54例原发性肝癌患者介入治疗前、治疗后1周及治疗1月后的血清TK-1 水平,分别进行比较、分析. 结果 肝癌组与健康对照组之间血清TK-1水平差异有统计学意义(P＜0.01).介入治疗1月后TK-1水平显著下降(P＜0.01).介入治疗1月后血清TK-1水平＜2 pmol/L组的治疗效果明显好于＞3 pmol/L组,差异有统计学意义(P＜0.01). 结论 血清TK-1检测在原发性肝癌的辅助诊断、疗效监测等方面具有一定的临床应用价值.     

原发性肝癌综合介入治疗现状与困惑

由于起病隐匿,肝癌发现时仅有20%~30%的患者有机会接受外科切除或肝移植治疗。目前,介入治疗已成为中期和部分晚期肝癌的首选方案,并且越来越多的学者认识到肝癌综合介入治疗的重要性和必要性。以经肝动脉化疗栓塞术(TACE)为主,联合多种方法(TACE联合局部治疗、TACE序贯手术治疗、TACE联合全身治疗)的综合介入治疗模式使得肝癌治疗手段更加丰富且疗效更佳。但联合治疗的适应证、时机选择以及治疗后复发、转移等问题仍需要未来进一步探索和研究。     

Combined interventional therapies of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, responsible for an estimated one million deaths annually. It has a poor prognosis due to its rapid infiltrating growth and complicating liver cirrhosis. Surgical resection, liver transplantation and cryosurgery are considered the best curative options, achieving a high rate of complete response, especially in patients with small HCC and good residual liver function. In nonsurgery, regional interventional therapies have led to a major breakthrough in the management of unresectable HCC, which include transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave coagulation therapy (MCT), laser-induced thermotherapy (LITT), etc. As a result of the technical development of locoregional approaches for HCC during the recent decades, the range of combined interventional therapies has been continuously extended. Most combined multimodal interventional therapies reveal their enormous advantages as compared with any single therapeutic regimen alone, and play more important roles in treating unresectable HCC.     

原发性肝细胞癌介入治疗的现状与进展

临床对原发性肝细胞癌(HCC)的治疗已取得了长足进步,其中以介入放射学为主的综合治疗在整个治疗中占据重要地位.HCC的介入治疗方法主要包括以肝动脉化疗栓塞(TACE)为代表的血管内介入治疗和以局部消融为主的非血管介入治疗,而介入结合靶向治疗更进一步丰富了HCC介入治疗的内涵.本文将分别从HCC介入治疗的不同方法、原理、...     

结直肠癌肝转移的治疗进展

结直肠癌的发病率和死亡率逐年上升,肝转移是主要死因。本文阐述了目前临床上使用较多的治疗方式及进展。分为系统性治疗,包括了新辅助化疗、转化治疗和分子靶向治疗;及局部治疗,包括手术切除、放射治疗、射频消融及介入治疗等。各种治疗手段各有优缺点,多学科综合治疗团队模式的推广,将为结直肠癌肝转移患者制定出较适合的方案,实现个体化治疗。     

Interventional treatments for hepatocellular carcinoma

Introduction Hepatocellular carcinoma (HCC) ranks thefifth in overall frequency (the fifth in men and the eighth in women) and fourth inannual mortality. About 372 000 new cases of HCC are diagnosed each year, constituting 4.6% of all new human cancers (6.3% in men and 2.7% in women).[1] Surgical treatments including hepatic resection and liver transplantation are considered the most effective treatments of HCC. However, less than 20% of HCC can be treated surgically because of multi- foc…     

Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients’ survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.

     

Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue.     

Interventional treatment for unresectable hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization(TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidatesfor systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies(TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.     

Conversion therapy in liver transplantation for hepatocellular carcinoma: What's new in the era of molecular and immune therapy?

BackgroundHepatocellular carcinoma (HCC) is the sixth most common cancer globally, with limited therapies and unsatisfactory prognosis once in the advanced stages. With promising advances in locoregional and systematic treatments, fast development of targeted drugs, the success of immunotherapy, as well as the emergence of the therapeutic alliance, conversion therapy has recently become more well developed and an effective therapeutic strategy. This article aimed to review recent developments in conversion therapy in liver transplantation (LT) for HCC.Data sourcesWe searched for relevant publications on PubMed before September 2022, using the terms “HCC”, “liver transplantation”, “downstaging”, “bridging treatment” and “conversion therapy.”ResultsConversion therapy was frequently represented as a combination of multiple treatment modalities to downstage HCC and make patients eligible for LT. Although combining various local and systematic treatments in conversion therapy is still controversial, growing evidence has suggested that multimodal combined treatment strategies downstage HCC in a shorter time, which ultimately increases the opportunities for LT. Moreover, the recent breakthrough of immunotherapy and targeted therapy for HCC also benefit patients with advanced-stage tumors.ConclusionsIn the era of targeted therapy and immunotherapy, applying the thinking of transplant oncology to benefit HCC patients receiving LT is a new topic that has shed light on advanced-stage patients. With the expansion of conversion therapy concepts, further investigation and research is required to realize the full potential of conversion treatment strategies, including accurately selecting candidates, determining the timing of surgery, improving the conversion rate, and guaranteeing the safety and long-term efficacy of treatment.