肝动脉门静脉置入皮下埋藏式药泵的应用与护理

原发性肝癌手术切除是首选的治疗方法 ,但术后易复发 ,亦有 50 %以上的肿瘤不能切除[1 ] 。因此 ,术后辅以肝动脉或门静脉置入皮下埋藏式药泵进行配合化疗和栓塞及免疫联合治疗 ,具有提高疗效减少复发的优点[1 ,2 ] 。现就此药泵的应用与护理报告如下。1　临床资料1 1　一般资料　本组 74例 ,男 65例 ,女 9例。年龄 35～ 70岁 ,平均 53.55岁。肿瘤切除后置泵 48例 ,晚期肝癌 ,不能切除置泵 2 6例。肝动脉门静脉双置泵 2 9例 ,肝动脉置泵 33例 ,门静脉置泵 1 2例。1 2　插管途径　手术中肝癌切除与否均选择胃网膜右动脉插管至肝固有动脉或…     

晚期直肠癌的外科治疗体会

晚期直肠癌可出现多种并发症，如出血、疼痛、肠梗阻等。治疗方法：肝转移病人行Hartmann手术 肝转移癌切除2例，Hartmann手术 肝动脉置管化疗4例，单腔乙状结肠造口术 直肠上动脉置管化疗2例，双腔乙状结肠造口术 直肠上动脉置管化疗5例、单腔乙状结肠造口术3例，双腔乙状结肠造口术4例，无肝转移病人行Hartmann手术6例，单腔乙状结肠造口术 直肠上动脉置管化疗11例，双腔乙状结肠造口术 直肠上动脉置管化疗8例，横结肠造口3例，非手术治疗12例。原发癌灶的治疗，我们认为晚期病人以微创，姑息或局部切除为主，手术的目的只是为了解除梗阻，缓解疼痛症状，为以后采用其他治疗方法创造了条件和机会，对于中上段直肠癌主要采用Hartmann手术或单腔乙状结肠造口术，Hartmann手术术式简例，而且可以获得一定的根治效果，对于下段直肠癌主要采用双腔乙状结肠造口术，但术后习缩机会较多；本组对不能切除者采用单腔／双腔乙状结肠造口术加直肠上动脉置管化疗，直肠上动脉置管化疗可使肿瘤组织缺血，坏死，肝转移癌的治疗，直肠癌发生肝转移50％～70％，初次就诊肝转移率20％～40％，直肠癌病人自发现肝转移其自然病程7～13个月，五年生存率不足3％，肝转移癌手术切除后五年生存率达25％～40％，故手术是治疗肝转移癌的最佳选择。直肠癌术后肝转移主要发生在2年内，所以术后定期复查，及早发现转移灶，十分重要。     

放疗加双重介入治疗肝转移癌34例报告

自1993年6月至1997年4月共收治34例肝转移癌患者。分别施以放射治疗、肝动脉插管灌注化疗(TAI)和肝动脉栓塞(TAE)、B超引导下的经皮肝穿肿瘤内无水酒精注射(PEI)、静脉化疗以及上述疗法的综合治疗。报告如下。     

肝动脉化疗栓塞联合全身化疗治疗肝转移性肿瘤的疗效分析（附58例报告）

目的探讨肝动脉化疗栓塞联合全身化疗治疗肝转移性肿瘤的疗效。方法回顾分析2004年1月至2009年12月我院6年来收治肝脏转移性肿瘤58例,原发病灶来源：大肠癌28例,胃癌18例,食管癌8例,小肠癌4例,经皮股动脉穿刺肝动脉化疗栓塞（TAE）,共118次治疗。联合全身化疗方案：大肠癌、小肠癌使用奥沙利铂,胃癌、食管癌使用紫杉醇。结果治疗后总有效率48.2%及半年、一年、二年的生存率分别为89.6%、55,2%、31.0%。结论肝动脉化疗栓塞联合全身化疗治疗是治疗肝脏转移性肿瘤重要手段,能达到病灶缩小,缓解症状,延长寿命,提高生活质量。     

手术治疗结直肠癌肝转移(附19例报告)

目的探讨结、直肠癌肝转移的外科治疗。方法对1993-01～1999-01收治的19例结、直肠癌肝转移患者行外科治疗。其中6例同期切除,10例分期切除,1例肝动脉结扎加无水乙醇注射,2例通过肝动脉结扎加化学药物泵灌注治疗(化疗)而获得二期手术切除机会。手术方式行肝不规则楔形切除16例,左半肝切除3例。结果术后1、3、5年生存率分别为89%、58%、21%。6例同期肝切除者平均生存期23个月,10例分期肝切除者的平均生存期32个月。结论掌握手术时机和适应证,积极进行肝动脉灌注化疗,提高手术切除成功率是提高生存率的关键。     

结肠癌肝转移肝动脉置管化疗疗效分析

目的 探讨结肠癌肝转移肝动脉置管化疗的临床意义方法 163例结肠癌肝转移患者随机分为两组,观察组82例行手术治疗,术中无论能否切除肝脏转移瘤,均行肝动脉置管并给予肝动脉化疗;对照组81例采取全身化疗和(或)手术治疗.化疗方案均采用FOLFOX4方案,并对可能影响经肝动脉置管化疗治疗疗效的因素行Cox回归多因素分析.结果 肝动脉置管化疗组中为生存期(MS)、累计生存率、总有效率(CR+PR)、副作用耐受率均较对照组明显提高.结论 结肠癌肝转移肝动脉置管化疗可明显提高患者的疗效,Cox回归多因素分析结果显示:肿瘤的分化程度、肝转移瘤为单发或多发、肿瘤能否切除,肿瘤局部的血供,是否伴发门静脉癌栓和疗效密切相关,有统计学意义.     

肝癌的肝动脉栓塞化疗与肝动门脉联合介入治疗的对比分析

目的 对单纯肝动脉碘油栓塞化疗与肝动门咏联合治疗肝癌的疗效进行对比分析。方法 对30例肝癌患者单纯施行肝动脉碘油栓塞化疗；对17例肝癌患者施行肝动脉碘油性栓塞化疗联合经皮门静脉穿刺灌注化疗。结果 单纯肝动脉栓塞化疗组；50％病人肿瘤缩小(显效36.7％，有效13.3％)。平均生存期10.22个月，一、二、三年生存率分别是40％，3.3%和0％动门咏联合介入治疗组；82.4％病人肿瘤缩小(显效41.2%，有效41.2％)。平均生存期19．25％个月，一、二、三年生存率分别是76．4％，52.9%和11.8%。结论 肝动门脉联合介入治疗肝癌的疗效优于单纯肝动脉栓塞化疗。     

介入治疗在提高中晚期肝癌二期切除率中的疗效及意义

目的探讨中晚期原发性肝癌（HCC）经门静脉、肝动脉双重介入治疗使肿瘤缩小后切除的疗效及意义。方法30例中晚期肝癌患者（肿瘤直径8．0～20．0cm，平均10．2cm）在超声引导下行门静脉化疗及经皮穿刺肝动脉化疗栓塞（TACE），观察肝功能，AFP，各肝叶体积及不良反应，并择期手术切除肿瘤。结果手术前肿瘤平均直径缩小至4．9cm，末次TACE距手术时间为1～3个月，平均1．6个月。25例AFP阳性中9例转正常。30例患者中，行肝段、联合肝段或肝部分切除25例，左半肝切除4例，左外叶切除1例。切除肿瘤中各有60％～100％坏死，其中12例100％坏死。1、3、5年生年率分别为80％、68％、59％。结论术前经门静脉、肝动脉双重介入治疗可为一期不能切除的中晚期肝癌患者提供二期手术机会，提高手术的安全性，对预防转移、延迟复发、改善预后有肯定意义。     

肝动脉化疗栓塞后二期切除中晚期原发性肝癌(附18例报告)

切除18例经肝动脉化疗栓塞后缩小的中晚期原发性肝癌，均采用经股动脉插管肝动脉注药及栓塞剂。手术指征；肿瘤有所缩小，境界清楚，门静脉主干无癌检，肝功能大致正常．患者全身情况允许，无肝内转移或远处转移病灶。手术方式：除3例行常温下全肝血流阻断切肝法外，余均为肝门间歇阻断法不规则肝叶切除或肿瘤局部切除术。本组无手术死亡，16例获随访，随访时间4个月到4年，11例仍健在，存活2年以上者3例。     

肝动脉化栓塞后二期切除中晚期原发性肝癌（附18例报告）

切除１８例经肝动脉化疗栓塞后缩小的中晚期原发性肝癌均采用经股动脉插管肝动脉注药及栓塞剂。手术指征：肿瘤有所缩小，境界清楚，门静脉主干无癌栓，肝功能大致正常，患全身情况允许，无肝内转移或无处转移病灶。手术方式：除３例行常温下全肝血流阴断切肝法外，余均为肝门间歇阻断法不规则肝叶切除或肿瘤局部切除术。本组无手术死亡，１６例获随访，时间４个月到４年，１１例仍健在，存活２年以上３例。     

不可切除的结肠直肠癌肝转移治疗方案的进展

对于结肠直肠癌肝转移(CLM)患者而言,将肝转移灶完整切除是疾病治疗的重要目标之一。由于大多数患者在诊断初期肝转移灶是不可切除的,而采用化疗可以将肝转移灶降期使切除成为可能。对于不可切除的CLM患者接受全身化疗的研究已经证实,治疗反应率、肝转移灶切除率和生存率均有所提高。在最初不可切除的CLM患者中采用肝动脉灌注(HAI)联合氟尿嘧啶,同时辅助全身化疗的方法可以提高治疗反应率和肝转移灶切除率。所有的治疗策略应该由一个多学科团队共同制定。     

介入栓塞术联合化疗治疗结直肠癌肝转移的疗效观察

目的：探讨介入栓塞术联合化疗治疗结直肠癌肝转移的临床效果。方法选取2009年2月~2010年12月在本院进行治疗的结直肠癌肝转移的患者76例,随机分为对照组和治疗组,对照组采用常规的化疗进行治疗,治疗组在对照组的基础上采用介入栓塞术进行治疗,比较两组患者的临床效果。结果观察组的临床疗效明显优于对照组。结论对结直肠癌肝转移的患者进行介入栓塞术以及化疗的联合治疗,具有较好的临床效果,并且还能够延长患者的生存期,提高患者的生存质量,值得在临床上推广使用。     

Curing patients with liver metastases from colorectal cancer

Colorectal cancer is the third commonest malignancy worldwide and the second commonest cause of cancer-related deaths.1,2 Around 15-25% of patients with colorectal cancer have metastases at presentation, and a further 20-25% develop them subsequently.3 Management for metastatic disease is mainly palliative and traditionally 5-year survival has been rare.3-5 In colorectal cancer, metastases mostly occur in the liver and in 30-50% of patients with liver involvement, this is the only site of spread. For those with liver-only metastases, resection of these lesions provides a chance of longer-term survival or even cure (e.g. 5-year survival 25-71%).4,6-13 Here we focus on recent advances in chemotherapy for patients with initially unresectable liver metastases, aimed at rendering such lesions operable, with potential improvements in survival.4,13,14.     

Severe enteropathy associated with raltitrexed and oxaliplatin chemotherapy: report of two patients experiencing this rare, potentially lethal gastrointestinal adverse event

Among the several different combination chemotherapy regimens for the treatment of patients with metastatic colorectal cancer, oxaliplatin plus raltitrexed has shown encouraging therapeutic results and a fairly good toxicity profile. Here, we report on two patients with metastatic colorectal cancer receiving this combination therapy, which leads to severe enterocolitis and neutropenia resulting in death in one patient. One patient was a 67-year-old woman suffering from an adenocarcinoma of the sigmoid colon with multiple liver metastases. The other patient was a 74-year-old woman with colon cancer, and metachronous multiple pulmonal and hepatic metastases. In both patients, palliative chemotherapy consisted of oxaliplatin 130 mg/m2 in combination with raltitrexed 3 mg/m2 on day 1 every 21 days. Both patients developed neutropenia in combination with severe enterocolitis after the fourth and the second chemotherapy cycle, respectively. Despite antibiotic treatment, diarrhea persisted in both patients for weeks. One patient died 17 days after hospital admission because of enteric sepsis with bleeding of the colonic mucosa and multiorgan failure. The other patient recovered completely and was discharged from hospital after 8 weeks. Severe enterocolitis, a hitherto infrequently recognized adverse event, which has been described in association with 5-fluorouracil/leucovorin and oxaliplatin chemotherapy, may also occur with raltitrexed and oxaliplatin. Physicians should be aware of this rare, although potentially lethal, gastrointestinal toxicity.     

The efficacy of hybrid chemotherapy with intravenous oxaliplatin and folinic acid and intra-hepatic infusion of 5-fluorouracil in patients with colorectal liver metastases: a phase II study

Summary Intra-arterial chemotherapy in patients with liver metastases from colorectal cancer has some limitations such as hepatic toxicity and extra-hepatic progression. With the aim of overcoming these limitations, a phase II trial was designed to assess the efficacy and tolerability of a hybrid chemotherapy regimen with systemic infusion of oxaliplatin and folinic acid associated with intra-arterial 5-fluorouracil. Thirty-nine patients with colorectal liver metastases were recruited. The median age was 59 years, 30 patients (77%) had synchronous metastases, and half of the patients were chemo-naive. A total of 313 chemotherapy cycles were administered (median number 8). Treatment was well tolerated and hepatic toxicity negligible. Out of 34 evaluable patients an ORR of 41%. was observed. Eight patients (21%) underwent radical liver surgery. The median time to progression (TTP) was 10 months (range 2–63) and the median overall survival (OS) 21 months (range 6–63). Extra-hepatic progression was observed in six patients. Our results suggest that this regimen is active even if technical complications are frequent. Our aim to reduce hepatic toxicity and extra-hepatic progression was reached.     

伊立替康联合对症支持疗法在转移性结直肠癌治疗中的临床应用

目的 评价伊立替康联合对症支持疗法在不能耐受联合化疗的转移性结直肠癌患者治疗中的临床疗效及不良反应.方法 选取我院原发肿瘤、淋巴结及远处转移(TNM)分期均为Ⅳ期的结直肠癌患者共24例,卡氏行为状态评分为40～ 60分,完全随机将患者分为观察组(13例)和对照组(11例).观察组患者第1、8天给予伊立替康125 mg/m2静脉滴注,30 ～ 90 min内滴完,联合对症支持治疗;对照组患者单纯给予对症支持治疗.观察2组患者临床疗效和不良反应发生情况.结果 观察组治疗有效率为15.4％(2/13),疾病控制率53.8％(7/13);对照组治疗有效率为0,疾病控制率为8.2％(2/11).治疗1年后随访,观察组患者的生存率高于对照组[53.8％(7/13)比27.3％(3/11),P＜0.05].治疗后,观察组生存质量提高患者的比率高于对照组,差异有统计学意义[53.8％(7/13)比27.3％(3/11),P＜0.05].化疗的不良反应大多数患者可耐受,并未因此中断治疗.结论 与单纯给予对症支持治疗相比,伊立替康联合支持治疗可以改善不能耐受联合化疗的转移性结直肠癌患者的疾病控制率,提高患者生存率和生活质量,且患者耐受性和依从性好.     

Colon cancer angiogenesis and antiangiogenic therapy

Metastatic development is the primary cause of cancer treatment failure and is responsible for most deaths from colorectal cancer. For the majority of patients, by the time primary colorectal cancers are diagnosed, sub-clinical or clinically relevant liver metastases have already occurred. The formation of liver metastases represents a highly selective sequence in which a subpopulation of cells, within a tumour, express genes that allow them to progress through distinct steps and spread to distant organs. Modification of gene expression in these cells leads to transformation, growth, angiogenesis, invasion, dissemination, survival in systemic circulation and attachment in the organ of metastases. Existing therapies directed at metastatic disease of the liver have had minimal impact on outcome. Contemporary treatment regimens are not likely to significantly alter the natural history of liver metastases. Consequently, understanding the molecular and biological mechanisms of colorectal cancer may allow for the development of therapeutic strategies designed to prevent and treat liver metastases. Standard chemotherapy regimens have had only minimal success in effectively treating metastatic colorectal cancer. This review focuses on the molecular and biological mechanisms of colorectal cancer angiogenesis. In addition, this report will evaluate the novel antiangiogenic therapeutic strategies targeting colorectal cancer and hepatic metastases.     

胃肠间质瘤的诊断与治疗分析

目的探讨胃肠道间质瘤(GIST)的诊断及治疗方法。方法回顾性分析经手术后病理证实的GIST 16例临床资料。结果肿瘤位于胃部10例,小肠5例,直肠1例。其中12例达到外科根治性切除。2例因肿瘤广泛转移行姑息切除。2例伴肝转移者中1例行原发灶及转移灶切除,1例不能切除的肝转移灶,术后辅以药物治疗。术后平均随访22个月,12例中术后复发转移3例,复发间期平均14个月,其中2例再次手术治疗,其他1例带瘤生存12个月。结论外科手术切除原发灶及肝转移灶是治疗GIST的首选有效方法,不易切除的肝转移灶,术后应辅以药物治疗。GIST远期仍存在较高的复发转移率。对复发转移病例,仍应争取再手术治疗。