经肝动脉导管注射无水乙醇碘化油乳剂治疗肝癌动静脉瘘

目的评价经肝动脉导管血管内注射无水乙醇碘化油乳剂栓塞治疗肝癌动静脉瘘的可行性及临床疗效。方法对22例肝癌动静脉瘘血管分别行超选择性插管注射无水乙醇碘化油乳剂,造影观察动静脉瘘闭塞情况及肿瘤的栓塞情况。结果22例肝癌动静脉瘘经肝动脉导管血管内注射无水乙醇碘化油乳剂2~15 ml,对分流量大的动静脉瘘配合明胶海绵栓塞。造影显示瘘口全部闭塞,未见明显不良反应,肿瘤栓塞密实。结论经肝动脉导管注射无水乙醇碘化油乳剂治疗肝癌动静脉瘘,疗效可靠,不影响对肿瘤的栓塞治疗。     

经肝动脉门静脉双管栓塞化疗治疗晚期肝癌

经肝动脉门静脉双管栓塞化疗治疗晚期肝癌杨才华刘永雄冯玉泉自１９９４年３月至１９９５年４月作者采用经肝动脉门静脉置入化疗泵，术后经肝动脉门静脉双管道反复栓塞化疗治疗１２例晚期肝癌患者。现报告如下：１．临床资料：本组患者男性１１例，女性１例，年龄最小２７...     

经导管肝动脉栓塞和肝动脉灌注化疗栓塞对原发性肝癌的介入效果

目的探究对原发性肝癌患者实施经导管肝动脉栓塞和肝动脉灌注化疗栓塞的疗效。方法以2012年1月至2015年8月我院106例原发性肝癌患者为观察对象,对此106例患者进行回顾性分析,共2组,观察组(56例,应用肝动脉灌注化疗栓塞治疗)、对照组(50例,应用经导管肝动脉栓塞治疗)。随访3年,对比两组患者的近期疗效、生存率、生存质量评分、中位生存时间、血清肿瘤标志物及毒副反应发生率。结果观察组患者客观缓解率(67.86%)明显高于对照组(42.00%),P0.05;观察组患者1年生存率(51.79%)、2年生存率(32.14%)、3年生存率(21.43%)略高于对照组(44.00%、24.00%、16.00%),但组间比较结果无显著差异,P0.05;观察组患者治疗后生存质量评分(70.45±0.78)分、中位生存时间(14.65±2.61)个月明显多于对照组(65.56±2.40)分、(12.12±2.23)个月,P0.05;观察组患者血清肿瘤标志物CEA、CA125、NSE及CA199均低于对照组,P0.05;两组患者毒副反应发生率无显著差异,P0.05。结论对原发性肝癌患者实施肝动脉灌注化疗栓塞治疗的近期疗效较经导管肝动脉栓塞治疗更佳,有助于提高患者生存质量评分,延长患者生存时间,但远期疗效无显著差异。     

肝动脉栓塞化疗联合乌苯美司胶囊对中晚期复发性肝细胞癌治疗的疗效分析

目的：分析中晚期复发性肝癌患者接受肝动脉栓塞化疗联合乌苯美司胶囊与单纯肝动脉栓塞化疗治疗的疗效差异。
　　方法：回顾分析2011年3月—2014年4月肝动脉栓塞化疗治疗的术后复发性肝癌及治疗后肝内复发的中晚期肝细胞癌患者68例。其中联合治疗组（34例）接受肝动脉栓塞化疗联合乌苯美司胶囊,对照组（34例）予以肝动脉栓塞化疗治疗。观察治疗后的效果和不良反应情况。
　　结果：联合治疗组有效率直径<3cm、3~5cm者优于对照组（P<0.05）;联合治疗组再次肝动脉栓塞化疗的间隔时间明显优于对照组（P<0.05);联合治疗组直径<3cm、3~5cm的患者生活质量较对照组明显改善,差异有统计学意义（P<0.05）;联合治疗组肝功能Child-Pugh分级改善明显高于对照组,差异有统计学意义（P<0.05）;肿瘤直径>5cm者在治疗有效率、生活质量和肝功能改善等方面两组均无统计学差异（P>0.05）;治疗后发热、疼痛恶心呕吐及肾功能改变两组无统计学差异（P>0.05）;联合治疗组白细胞的计数减较对照组少,两组差异有统计学意义（P<0.05）。
　　结论：肝动脉栓塞化疗联合乌苯美司治疗中晚期复发性肝癌效果明显,优于单纯肝动脉栓塞化疗,尤其是对肿瘤直径<3cm及3~5cm的小肝癌临床疗效好。     

得力生注射液联合肝动脉栓塞化疗和门静脉化疗对肝癌治疗的价值

目的探讨得力生注射液经肝动脉、门静脉途径应用，对预防肝癌术后复发转移的治疗作用。方法选择原发性肝癌切除术后行肝动脉、门静脉化疗的患者60例。将患者随机分成两组，联合得力生注射液经肝动脉和门静脉治疗组30例，对照组30例。检测和分析化疗前、后不同时期体液免疫指标、生活质量改善和复发率。结果两组患者随访3～24个月，对照组肿瘤肝内复发15例次，治疗组肿瘤肝内复发13例次，两组间无统计学差异；治疗组的体液免疫指标IgG、IgA、IgM浓度和生活质量评分有显著提高（P〈0．05），且化疗的毒副作用明显减少。结论得力生注射液联合肝动脉栓塞化疗和门静脉化疗治疗肝癌术后患者，可提高免疫力，改善生活质量；通过肝动脉和门静脉途径给药，可增强疗效，并能减少化疗的副作用。     

肝癌的介入放射治疗

作者对８６５例行介入放射治疗的肝癌（７７３例原发性，９２例转移性）进行放射形态学的观察。将病例分为三组：巨块型４５７例，结节型１２４例和弥散型２８４例。介入疗法包括：一次或重复化疗药物栓塞或肝动脉灌注，临床症状明显改善。术后平均存活期１４．８个月。同时也观察了因栓塞及各类不同栓塞剂而引起的明显并发症。同时讨论了患者存活期以及重复栓塞和肝转移性肿瘤的某些特性，并着重讨论过去认为单用化疗药物肝动脉灌注治疗效果不好的转移性肝癌与同时使用栓塞治疗的不同效果。     

肝动脉支铸型栓塞治疗原发性肝肿瘤40例报告

自１９８５年起用氰基丙烯酸酯（ＴＨ胶）肝动脉支铸型栓塞法治疗中、晚期肝癌３８例，胆管细胞癌和肝肉瘤各１例，随访观察８年。结果：本组病例的中位生存期为１２个月，平均生存期超过１８个月，３例生存６年半以上。讨论了肝癌供血特征和ＴＨ胶行肝动脉支铸型栓塞治疗原发性肝肿瘤的适应症及异位栓塞的防治办法，认为肿瘤血管完全闭塞可以提高生存期和治愈率。     

肝动脉化疗栓塞术联合中医治疗肝癌患者的辨证施护

目的观察肝动脉化疗栓塞术联合中医药治疗肝癌的，临床效果。方法对60例肝癌患者行肝动脉化疗栓塞术联合中医治疗及辨证施护，追踪患者生存时间。结果观察对象1、3、5年生存率分别为70．0％，28．3％，8．3％。结论对肝癌患者行肝动脉化疗栓塞术联合中医治疗及辨证施护能延长患者的生存时间。     

平阳霉素碘化油混合乳剂动脉栓塞在治疗肝血管瘤中的临床应用

目的分析和探讨平阳霉素碘化油混合乳剂(PLE)动脉栓塞在肝血管瘤介入治疗中的临床疗效。方法运用超液态碘化油 明胶海绵颗粒和PLE,对我院42例肝血管瘤患者进行动脉栓塞治疗,其中24例运用PLE进行栓塞治疗,运用PLE时其中6例患者追加明胶海绵颗粒进行栓塞,术后2~6个月观察碘油沉积、肿瘤大小变化及并发症的发生。结果所有病例术前肝动脉造影显示“枝上挂果”“早出晚归”的异常血管湖样改变,栓塞后肿瘤内碘油沉积良好;术后1例出现严重并发症,4例栓塞后无明显效果,其他患者肿瘤均缩小,20例患者肿瘤缩小>50%。结论平阳霉素碘化油混合乳剂动脉栓塞治疗肝血管瘤是一种疗效肯定,安全理想的治疗方法。     

氩氦刀超低温冷冻术联合肝动脉、门静脉置泵双灌注治疗肝癌合并门静脉癌栓

目的：探索治疗原发性肝癌合并门静脉癌栓的治疗方法。方法：采用氩拟刀超低温冷冻联合肝动脉,门静脉置泵双灌注化疗栓塞治疗肝癌合并门静脉癌栓患者12例,结果：全部病例1周内肿瘤中层匀液化坏化,2个月内肿瘤明显缩小;9例门静脉癌栓缩小,3例癌栓消失,结论：氩氦刀联合肝动脉,门静脉泵双灌注栓塞化疗是一种治疗肝癌合并门静脉癌栓的较为有效方法。     

Peroxisomal branched chain fatty acid beta-oxidation pathway is upregulated in prostate cancer

Overexpression of alpha-methylacyl-CoA racemase (AMACR), an enzyme involved in branched chain fatty acid beta-oxidation, in prostate cancer has been reported. Here, we report that an enzyme downstream from AMACR in the peroxisomal branched chain fatty acid beta-oxidation pathway-D-bifunctional protein (DBP)-is also upregulated in prostate cancer at both mRNA and protein levels, accompanied by increased enzymatic activity. Furthermore, our data suggest that pristanoyl-CoA oxidase (ACOX3), which is expressed at extremely low level in other human organs studied including the liver, might contribute significantly to peroxisomal branched chain fatty acid beta-oxidation in human prostate tissue and some prostate cancer cell lines. In contrast to these results for peroxisomal enzymes, no significant expression changes of mitochondrial fatty acid beta-oxidation enzymes were observed in prostate cancer tissues through comprehensive quantitative RT-PCR screening. These data for the first time provide evidence for the selective over-activation of peroxisomal branched chain fatty acid beta-oxidation in prostate cancer, emphasizing a new metabolic change during prostate oncogenesis.     

Early Disease Progression after Intravesical Bacillus Calmette-Guérin (BCG) Therapy for Superficial Bladder Cancer

Background : Disease progression after Bacillus Calmette-Guérin (BCG) instillation therapy for bladder cancer is not rare. The purpose of this study was to evaluate the outcome of patients treated with BCG for superficial bladder cancer, focusing on the patients who developed invasive disease during follow-up. The possible mechanism and risk factors for early progression after BCG therapy are discussed. Methods : A total of 25 patients with superficial bladder cancer (pTa, pT1, and/or pTis) were treated with intravesical BCG instillation (80 mg in 80 mL saline) once a week for eight weeks. Four of the 25 patients received maintenance therapy with BCG (once a month for 3 to 10 months). Patients were followed every three months and underwent cystoscopy, biopsy, and urinary cytology at these intervals. Disease progression was defined as invasion to muscle or prostate, or development of metastatic disease. Clinicopathological features of the patients, especially those with progression, were analyzed. Results : Progression was observed in six of the 25 patients (including four of 19 patients with carcinoma in situ and two of five patients treated prophylactically with BCG). The average time to progression was 8.7 months. Four patients died of cancer despite intensive treatment. Two patients are alive: one without evidence of disease after cystectomy and the other with metastatic disease. Conclusions : Proper patient selection, careful follow-up, and immediate aggressive therapy in case of progression were considered to be important factors to obtain satisfactory results with BCG therapy for bladder cancer.     

米托蒽醌灌注预防膀胱癌术后复发的疗效观察(附98例报告)

目的　评价米托蒽醌 (MTZ)膀胱灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法　对 98例浅表性膀胱癌患者行TURBT或膀胱部分切除术 ,术后 1周予MTZ 12mg 生理盐水 5 0ml膀胱内灌注 ,药物于膀胱内保留 2h ,每周 1次 ,连续 8周 ,以后每月 1次 ,连续 12个月。定期做血尿常规、肝肾功能及膀胱镜检查 ,并记录每次膀胱灌注后的全身及局部反应。　结果　 98例均未见全身性药物不良反应 ,随访 6～ 2 4个月 ,平均 13个月 ,复发 6例 ,复发率 6 .2 %。　结论　MTZ膀胱灌注防止膀胱癌术后复发疗效满意 ,安全性好     

Cholangiocellular carcinoma of the liver

Of the 118 patients with primary liver cancer treated in our clinic during a 6 year 7 month period, 11 patients had cholangiocellular carcinoma of the liver. Ten (90.9 percent) of the 11 patients underwent surgery, and 9 (90 percent) had major hepatic resection with no operative deaths. Seven were still alive at the time of the study 2 months to 4 years 1 month after surgery. Three patients died from recurrence 9 months, 11 months, and 1 year 4 months after surgery. The 1 and 3 year actuarial survival rates after hepatic resection were excellent (85.7 and 61.2 percent, respectively) compared with the 1 and 3 year rates of 58.8 and 0 percent in the Japanese series. Even though the cholangiocellular carcinomas in our 11 patients were in the advanced stages, good results were obtained by hepatic resection. If they were detected at a much earlier time, an even more remarkable survival rate could be expected.     

Weaning of immunosuppression in living donor liver transplant recipients

BACKGROUND: Some reported studies have indicated the possibility of immunosuppression withdrawal in cadaveric liver transplantation. The aim of this study was to evaluate the possibility and feasibility of weaning living donor liver transplant recipients from immunosuppression. METHODS: From June of 1990 to October of 1999, 63 patients were considered to be weaned from immunosuppression. They consisted of 26 electively weaned patients and 37 either forcibly or incidentally weaned patients (nonelective weaning) due to various causes but mainly due to infection. Regarding elective weaning, we gradually reduced the frequency of tacrolimus administration for patients who survived more than 2 years after transplantation, maintained a good graft function, and had no rejection episodes in the preceding 12 months. The frequency of administration was reduced from the conventional b.i.d. until the start of weaning to q.d., 4 times a week, 3 times a week, twice a week, once a week, twice a month, once a month, and finally, the patients were completely weaned off with each weaning period lasting from 3 to 6 months. The reduction method of nonelective weaning depended on the clinical course of each individual case. When the patients were clinically diagnosed to develop rejection during weaning, then such patients were treated by a reintroduction of tacrolimus or an additional steroid bolus when indicated. RESULTS: Twenty-four patients (38.1%) achieved a complete withdrawal of tacrolimus with a median drug-free period of 23.5 months (range, 3-69 months). Twenty-three patients (36.5%) are still being weaned at various stages. Sixteen patients (25.4%) encountered rejection while weaning at median period of 9.5 months (range, 1-63 months) from the start of weaning. All 16 were easily treated with the reintroduction of tacrolimus or additional steroid bolus therapy. CONCLUSIONS: We were able to achieve a complete withdrawal of immunosuppression in some selected patients. Although the mechanism of graft acceptance in these patients has yet to be elucidated, we believe that a majority of long-term patients undergoing living donor liver transplantation may, thus, be potential candidates to be successfully weaned from immunosuppression.     

手术治疗大肠癌肝转移的疗效分析及预后因素探讨

探讨大肠癌术后肝转移手术切的疗效及影响术后生存率的有关因素,总结改进远期疗效的措施。方法对８７例大肠癌肝转移病人术后进行长期随访,并对治疗中相关因素进行统计分析,对比研究。结论早发现早切除,治疗中的相关因素,术后密切则,发现早期复发和转移,争再切除以及加强术后综合治疗是提高过期疗效的关键。     

Cytomegalovirus, human herpesvirus-6, and human herpesvirus-7 in adult liver transplant recipients: diagnosis based on antigenemia

Human herpesvirus (HHV)-6, HHV-7, and cytomegalovirus (CMV) that remain latent after primary infection can be reactivated during immunosuppression following organ transplantation in liver transplant recipients. The aim of this study was to monitor active infections for HHV-6, HHV-7, and CMV among adult liver transplantation recipients using antigenemia detected by an immunoperoxidase staining. Twenty-eight adult liver transplant patients were monitored using antigenemia in blood samples obtained at the time of transplantation, as well as weekly in the first month and once a month for 6 months. Of these patients, 28.5% showed positive CMV antigenemia; 39.2%, HHV-6 antigenemia; and 14.2%, HHV-7 antigenemia. The detection of the three viruses was considered to be independent of one another (P>.05). The results described above showed that few patients remain free of beta herpesviruses after liver transplantation. Most patients were infected sequentially and not concurrently. Antigenemia has been considered useful to detect active HHV-6 and HHV-7 infections. Antigenemia can be more efficiently interpreted when compared with polymerase chain reaction results, although other studies are necessary to establish the reference of HHV-6 and HHV-7 antigenemia.     

单发直径≤3 cm肝肿瘤No-touch射频消融治疗的安全性及近期疗效分析(附50例报告)

目的探讨No-touch射频消融术(radiofrequency ablation,RFA)治疗直径≤3 cm单发肝肿瘤的安全性和疗效。方法 2015年9月至2017年6月采用cooltip电极对直径小于3 cm单发肝肿瘤50例病人进行No-touch RFA治疗。其中,治疗原发性肝癌49例(初发31例、复发18例),转移性肝癌1例。肿瘤平均直径1.8 cm,治疗前、后检查肝功能、增强CT扫描、磁共振检查、超声造影以及细针肝穿刺活检。观察RFA治疗时间、次数和术后住院时间,RFA治疗后的并发症以及肿瘤完全毁损率,并随访病人的生存情况。结果 50例病人共行No-touch RFA治疗51次,其中1例病人1个月内连续治疗2次。每例平均为1.02次;每次治疗时间平均为8.2 min;术后平均住院时间为3.2 d。Notouch RFA治疗后1个月内复查CT或磁共振,单次治疗后的肿瘤完全毁损率为98.0%,甲胎蛋白(AFP)阳性的22例病人在No-touch RFA治疗后6~12个月内有14例转阴,5例明显下降。50例病人随访时间从2015年9月开始至2017年6月止,其总体生存率为100%,术后总体无瘤生存率为90.0%(45/50)。结论 No-touch RFA对直径小于3 cm的单发肝肿瘤的治疗是一种微创、安全有效的方法。     

Profile of Plasma Angiogenic Factors Before and After Hepatectomy for Colorectal Cancer Liver Metastases

Background Circulating angiogenic factors in patients with colorectal cancer liver metastases may promote tumor growth and contribute to liver regeneration after partial hepatectomy. Methods We analyzed blood samples from 26 patients with colorectal cancer liver metastases before and after liver resection and used samples from 20 healthy controls as a reference. Plasma levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and hepatocyte growth factor (HGF) were measured, and levels were correlated with recurrence. Results The median preoperative levels of all four factors were significantly higher and more variable in colorectal cancer liver metastasis patients than in controls. HGF and bFGF levels increased significantly 3 days and 1 month after hepatectomy, respectively, and returned to near preoperative levels at 3 months. Postoperative VEGF and EGF levels remained relatively stably increased over 3 months. After a median follow-up of 19 months, 10 patients (42%) experienced recurrence. Higher preoperative VEGF and HGF levels correlated with subsequent recurrence (P = .018 and .021, respectively), and a preoperative adjusted total value of all four factors accurately identified patients at low, moderate, and high risk of recurrence (P = .034). Patients who experienced disease recurrence also had relatively higher bFGF levels 3 months after operation (P = .035). Conclusions Plasma angiogenic factors are increased in patients with colorectal cancer liver metastases and remain increased at least 3 months after partial hepatectomy. Measurement of certain factors before and after hepatic resection can predict recurrence. Targeted biological agents may counteract the tumor-promoting effects of these circulating factors on subclinical disease.     

经尿道等离子电切联合内分泌治疗晚期前列腺癌导致下尿路梗阻的临床疗效

目的探讨晚期前列腺癌致下尿路梗阻的治疗方法。方法29例患者均采用“通道法”经尿道等离子前列腺电切加睾丸白膜下切除术,术后1周开始应用氟他胺0．25g,每天3次口服,3个月后复查PSA,PSA〈2ng／ml时,再服药1个月后停药,以后每个月复查PSA,PSA〉4ng／ml时又重新开始治疗。结果所有患者术后1个月国际前列腺症状评分（IPSS）降至9．0±1．1分,最大尿流率（Qmax）上升为17．6±2．4ml／s,膀胱残余尿量约为40±20ml。术后3个月19例PSA〈2ng／ml,另外10例降到术前的10％。PSA、IPSS、Qmax及膀胱残余尿量均较术前有明显改善（P〈0．05）,随访5年26例患者仍健在。结论“通道法’’经尿道等离子前列腺电切联合内分泌治疗可有效解除下尿路梗阻,提高患者生活质量。