各种介入治疗肝癌方法临床评价

<正>介入治疗作为治疗中晚期肝癌的主要手段[1],可分为经血管介入技术和非血管介入技术。1经血管介入技术1.1经肝动脉介入技术可分为选择性肝动脉灌注(TAI)、选择性肝动脉栓塞(TAE)、选择性肝动脉化疗栓塞(TACE)。目前,临床应用以TACE为主,在治疗不能手术切除和术后复发的肝癌患者中已被公认为首选疗法,其治疗原发性和转移性肝癌,尤其是局限性肝癌可获得较好的疗效[2]。传统观念认为,TACE可应用于外科手术前和术     

中晚期肝癌转化治疗方法的应用进展

手术切除治疗是肝癌患者获得长期生存获益的主要手段，但大多数患者确诊时已为中晚期，错失最佳手术时机。转化治疗可通过介入或系统疗法将不可切除肝癌转化为可切除肝癌，为这类患者提供手术机会。介入疗法为中晚期肝癌一线治疗手段，传统的经肝动脉化疗栓塞术不断改进的同时，也衍生出肝动脉放射栓塞术和肝动脉灌注化疗术，在肝癌转化治疗上均取得了不错的转化效果。以免疫检查点抑制剂及酪氨酸激酶抑制剂为代表的系统疗法也在肝癌转化治疗相关研究中取得突破。介入疗法联合系统疗法的转化治疗方案正逐步应用到临床研究中并体现出不错的前景。     

综合靶向消融治疗中晚期肝癌的临床研究

目的 探讨用氩氦刀冷冻 微波消融 化学消融等综合靶向消融治疗中晚期肝癌的疗效.方法 78例中晚期肝癌患者采用综合靶向消融治疗,先行肝动脉栓塞化疗,一周后行局部氩氦刀冷冻术、微波消融或化学消融术;56例单纯行动脉栓塞化疗.结果 治疗组1年生存率56.4%,对照组1年生存率36.9%;治疗组AFP平均值低于对照组,有显著性差异.结论 综合靶向消融治疗能提高中晚期肝癌患者的生存率,较单纯介入疗法治疗更为有效.     

肝癌的局部区域治疗

局部区域治疗在影像学引导下靶向杀伤肿瘤,是原发性肝癌最主要的非手术治疗方法,包括放射介入治疗（主要为肝动脉化疗栓塞）和局部消融治疗（瘤内乙醇注射、射频、微波、激光、高强度聚焦超声、冷冻等治疗）。肝动脉化疗栓塞主要应用于不能手术切除的中晚期肝癌,局部消融治疗适用于直径5cm以下的小肝癌。肝癌局部区域治疗强调针对具体病情选择合适的方法进行规范治疗。本文简要评述各种局部区域治疗方法的指征、治疗原则、技术要点和疗效,并讨论手术切除与局部消融治疗小肝癌的选择。     

原发性肝癌

甲胎蛋白、a-L-岩藻糖苷酶和铁蛋白联合检测对原发性肝癌的诊断意义，原发性肝癌行肝脾动脉双栓塞术后并发症的观察与护理，希罗达联合肝动脉栓塞化学药物治疗晚期原发性肝癌，冷循环射频消融微创治疗肝癌的临床研究，高强度聚焦超声联合肝动脉化疗栓塞治疗中晚期原发性肝癌105例分析，健脾理气方联合介入疗法治疗肝癌远处转移25例临床观察，射频消融肝脏恶性肿瘤并发症的防治。     

经皮经肝门脉导管药盒植入治疗肝癌7例报告

对于失去手术机会的中晚期肝癌患者,肝动脉灌注化疗栓塞术成为目前主要的治疗手段。同时联合微波治疗、热射频消融治疗、冷冻治疗、B超引导下的瘤体内无水酒精注射等治疗措施均有一定的疗效,故对中晚期肝癌由单一的治疗模式转变综合治疗模式。我科2002年10月至2004年6月对7例不能手术的中晚期肝癌患者经肝动脉灌注化疗栓塞术无效者,行经皮经肝门脉导管药盒植入,门静脉持续灌注化疗取得了较好疗效,现报道如下：     

门冬氨酸鸟氨酸在肝细胞癌肝动脉介入栓塞前后护肝作用的临床观察

目的 探讨对肝癌病人进行介入栓塞治疗前后给予门冬氨酸鸟氨酸的护肝作用。方法 选择经B超、CT、AFP等明确诊断为肝癌并且已为中晚期而不宜手术治疗的病人为研究对象，在对其进行肝动脉化疗和栓塞（TACE）治疗前后给予门冬氨酸鸟氨酸治疗13天。并设立对照组，通过生化检测观察介入治疗同时给予门冬氨酸鸟氨酸治疗的肝功能改变。结果 门冬氨酸鸟氨酸对介入治疗的肝癌病人的肝功能有明显的保护作用，病人介入后丙氨酸转氨酶、天冬氨酸转氨酶和胆红素有所升高，但能较快恢复正常。结论 门冬氨酸鸟氨酸可以防治介入栓塞导致的肝癌病人肝功能的进一步损害，保护和促进肝功能恢复，减少并发症，增加对介入治疗的耐受性。     

肝癌的介入治疗

肝癌是临床常见的恶性肿瘤，以手术治疗（包括肝移植）效果最佳。由于肝癌在起病初期较隐匿，当临床诊断明确时，受肿瘤大小、部位及肝功能等因素的影响，仅20％～30％的患者尚有手术机会，而化疗对肝癌治疗效果甚微。近年来，介入治疗以其创伤小、效果佳在临床逐渐得到重视。介入治疗主要包括经皮穿刺肝癌热凝固疗法、冷冻疗法、乙醇注射及放射性粒子置入内照射术，经肝动脉介入的动脉栓塞、放射性微球内照射及栓塞化疗术等。这些姑息疗法，在改善患者生活质量及预后的同时，有的还为手术治疗创造了时机。     

华蟾素注射液治疗中晚期肝癌临床研究进展

原发性肝癌是世界范围内高发的恶性肿瘤之一,其死亡率排名第三,每年有约50万新发患者,其中50％发生在中国。手术切除是治疗肝癌的首选方式,但由于肝癌发病特点,大多数患者确诊时已失去手术机会,此时以肝动脉化疗栓塞术为基础的综合介入治疗方法成为主要的治疗手段,然而,中晚期肝癌患者,受肝脏肿瘤负荷、肝功能、门脉癌栓的影响,部分患者存在肝脏介入术禁忌症,因此中医中药治疗中晚期肝癌凸显独特优势。     

中医药在肝癌介入治疗中的临床应用

肝癌介入治疗一般包括 :经导管肝动脉化疗栓塞 (TACE)、经皮穿刺瘤内注射、射频消融、高强度聚焦超声、微波固化、激光热疗、冷冻和氩氦刀靶向治疗等方法[1] ,在减轻肿瘤负荷、防治复发和提高生存率等方面起到了重要作用。但如何尽可能地减少介入治疗的不良反应和并发症 ,同时最大程度地提高肝癌患者的远期生存率仍是目前肝癌介入治疗领域亟待解决的课题。为了进一步提高肝癌介入治疗的效果 ,现将近年来中医药在肝癌介入治疗的临床研究作一概述。一、经导管肝动脉治疗(一 )肝动脉栓塞1.单味中药　进行肝动脉栓塞治疗术 ,首要的问题是栓塞…     

Surgical treatment of hepatocellular carcinoma: expert consensus statement

As the number of effective treatment options has increased, the management of patients with hepatocellular carcinoma has become complex. The most appropriate therapy depends largely on the functional status of the underlying liver. In patients with advanced cirrhosis and tumor extent within the Milan criteria, liver transplantation is clearly the best option, as this therapy treats the cancer along with the underlying hepatic parenchymal disease. As the results of transplantation has become established in patients with limited disease, investigation has increasingly focused on downstaging patients with disease outside of Milan criteria and defining the upper limits of transplantable tumors. In patients with well preserved hepatic function, liver resection is the most appropriate and effective treatment. Hepatic resection is not as constrained by tumor extent and location to the same degree as transplantation and ablative therapies. Some patients who recur after resection may still be eligible for transplantation. Ablative therapies, particularly percutaneous radiofrequency ablation and transarterial chemoembolization have been used primarily to treat patients with low volume irresectable tumors. Whether ablation of small tumors provides long term disease control that is comparable to resection remains unclear.     

肝癌微创介入治疗进展

原发性肝癌的治疗方法一直是许多学者研究的重点,近年来尽管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,因此目前原发性肝癌仍然是一种难治性恶性肿瘤。在治疗方面,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。近些年,随着设备和技术水平的提高,原发性肝癌的微创介入治疗得到了越来越多的重视,其中应用最为广泛的就是肝动脉化疗栓塞术(TACE)和组织消融术(TA)。该文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。     

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.     

Interventional therapies of unresectable liver metastases

Liver metastases are the major cause of mortality in patients with gastrointestinal carcinomas and other malignant tumors, carrying a poor prognosis and presenting considerable management. Surgical resection remains the only curative therapy for liver metastases up to now. However, only a small percentage of patients are suitable for curative resection due to many factors: multi-centric tumors, extrahepatic metastases, early vascular invasion, and coexisting advanced liver cirrhosis. In non-surgical cases, regional interventional therapies have led to a major break through in the treatment of unresectable liver metastases, which include transarterial chemoembolization (TACE), radiofrequency ablation (RFA), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), microwave coagulation therapy (MCT), percutaneous ethanol injection (PEI), and others. As a result of the technical development of locoregional approaches for unresectable liver metastases during recent decades, the range of combined interventional therapies has been continuously enlarged. The current roles of these treatment options for liver metastases are discussed in this review.     

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…     

Image-guided therapies in the treatment of hepatocellular carcinoma: A multidisciplinary perspective

A multidisciplinary approach to the treatment of patients with unresectable hepatocellular carcinoma(HCC) has led to improvements in screening, detection,and treatments. Interventional techniques includethermal ablation, transarterial chemoembolization, and radioembolization whilst stereotactic body radiation therapy also uses imaging to target the radiation. Both survival rates and cure rates have improved markedly since the introduction of these techniques. This review article describes the image guided techniques used for the treatment of HCC.     

Liver transplantation for hepatocellular carcinoma

The role of liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) has evolved over the past two decades, and transplantation has become one of the few curative treatment modalities for patients with HCC. Early results were poor, but the current restrictive selection criteria can yield excellent results. This review will discuss recent issues in the field, including (1) factors affecting the recurrence of HCC after LT; (2) the effect of downstaging HCC before LT, including transarterial catheter chemoembolization (TACE) and radiofrequency ablation (RFA); and (3) living-donor versus deceased-donor liver transplantation for HCC patients. The most important factors that have been described to affect LT survival include the tumor size, vascular invasion, and the degree of tumor differentiation. Recently, tumor markers, including alpha-fetoprotein and des-gamma carboxy prothrombin, were reported as predictors of HCC recurrence after LT. Furthermore, the experience accumulated with locoregional therapies such as TACE and RFA as bridging procedures to LT, along with the reduced waiting time under the HCC-adjusted MELD (model for endstage liver disease) system for organ allocation has led to improved outcomes. With the recent advances in adult living-donor liver transplantation (LDLT), there may be a marked change in the role of liver transplantation for hepatic malignancies, in particular for HCC.     

Anti-angiogenesis in hepatocellular carcinoma treatment: current evidence and future perspectives

Hepatocellular carcinoma(HCC) is among the most common cancer diseases worldwide.Arterial hypervascularisation is an essential step for HCC tumorigenesis and can be targeted by transarterial chemoembolization(TACE).This interventional method is the standard treatment for patients with intermediate stage HCC,but is also applied as bridging therapy for patients awaiting liver transplantation in many centers worldwide.Usually the devascularization effect induced by TACE is transient,consequently resulting in r...     

肝癌消融技术管理与多元化的肝癌消融治疗团队的构建

消融是肝癌治疗的重要手段之一。规范的消融技术、科学合理的治疗策略以及密切的团队合作是取得良好疗效的重要前提。尽管近年来肝癌消融治疗的效果随着消融技术的不断改进而逐渐提高,但肿瘤复发率仍较高,因此亟需能更好地提高肝癌消融治疗的效果和改善患者预后的治疗策略。多元化的肝癌消融治疗团队的构建是根据肝癌消融治疗的需求,在常规肝癌消融治疗团队的基础上提出的新概念。由于多元化的肝癌消融治疗团队较常规肝癌消融治疗团队具有更多的潜在优势,因此其是一个具有潜力的消融团队构建的新模式。