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1.
目的 评价肝动脉化疗栓塞及B超引导下注射^32P-胶体、无水乙醇(PEI)综合序贯介入治疗原发性肝癌的临床价值。方法 51例中晚期肝癌分为2组,23例综合序贯应用TACE+^32P+PEI治疗,28例单纯应用TAQCE治疗。结果 综合序贯组肿瘤缩小率、肿瘤完全坏死率、AFP下降率分别为91.29%、80.00%、87.5%,而单纯TACE组分别为39.27%、30.43%、41.46%,两组比较有 相似文献
2.
目的和方法研究肝双重血管灌注化疗治疗不能切除的中晚期肝癌,本研究将67例不能切除的肝癌分为两组,A组35例经肝动脉置泵化疗,B组32例经肝动脉、门静脉置泵化疗。结果对照分析发现:A组中位生存期8个月,一年生存率257%,5例新出现门静脉癌栓;B组明显优于A组,其中位生存期11个月,一年生存率429%,无新生门静脉癌栓,结论肝双重血管灌注化疗是肝癌区域化疗一合理治疗途径 相似文献
3.
多弹头自动导航射频(Radio Treguency,RF)是治疗肝癌的又一高新技术。1999年6月~1999年12月,我院采用RF治疗56例肝癌患者疗效满意,报告如下。 临床资料:本组男50例,女6例;年龄35~78岁,平均55岁。肿瘤位于右肝叶43例,左肝叶11例,尾叶11例。原发性肝癌40例,复发性肝癌10例,转移性肝癌6例。肿瘤直径10cm以上者18例.5~10cm者26例,5cm以内者12例。肝功能按Child分级:A级14例,B级33例,C级9例。AFP阳性31例,阴性25例。 手术方法… 相似文献
4.
目的:探讨肝动脉栓塞化疗术(TOCE另GS)、瘤内无水酒精注射术(PEI)和门静脉介入治疗术(PVE)即3介入治疗,联合特异性肿瘤细胞毒T淋巴细胞(CTLs)的综合序贯疗法在中晚期肝癌治疗中的优越性。方法:127例中晚期肝癌(Ⅱ~Ⅲ期,巨块型或结节型,肝功ChidlA或B级)患者随机分A、B、C3组。其中A组52例为治疗组,予综合序贯治疗,B组(45例)、C组(30例)为对照组,分别予TOCE、G 相似文献
5.
立体定向适形放射治疗原发性肝癌的疗效分析 总被引:2,自引:0,他引:2
立体定向适形放射治疗(3D:CRT,亦称光子刀)是治疗原发性肝癌的新方法。我院从1998年7月开展了此项治疗,现报告如下。材料和方法一、病例选择73例为住院患者,均符合原发性肝癌的诊断标准,无手术指征。①TAE PEI治疗组39例,男36例,女3例,年龄为34~70岁,平均51.8岁;肝功能ChildA级17例、B级17例、C级5例;肿瘤最大径为3.1~16.2cm(9.82±2.99)。②3D:CRT治疗组34例,男30例,女4例,年龄为22~78岁,平均48.7岁;肝功能ChildA级22例、B级11例、C级1例;肿瘤最大径为2.3~14.9cm(6.83±0.59)。两组具有可比性(各指… 相似文献
6.
与方法采用TACE,PVE、PEIT等多种不同局部治疗方法联合应用、治疗各种病理类型肝癌16例。结果与结论治后获完全缓解1例,瘤体缩小超过50%部分缓解9例,有效率达62.5%。治疗前后肝脏Doppler检查证实,治疗组瘤体中央动脉血供、周边成子灶门静脉血供均明显减少,甚至消失,半年生存率100%,一年生存率87.5%其中3例已存活2年以上;而单纯TACE、PEIT治疗组半年、一年生存率仅分别为75%、45%和85%、57.1%与前者相比明显差异。 相似文献
7.
ST-E1管引导下硬化治疗食管静脉曲张出血 总被引:1,自引:0,他引:1
冯崇炽 《中华消化内镜杂志》1999,16(6)
1993年5月~1997年4月,我院在ST-E1管引导下栓塞硬化治疗食管静脉曲张大出血45例。本法栓塞硬化均为一次注射完成,对比以前内镜下需多次硬化治疗才能达到曲张静脉消失,效果较为满意。现报告如下。1.临床资料:男33例,女12例。大出血史1~7次。肝功能Child分级:A级27例,B级12例,C级6例。合并肝癌3例,门脉分流术后6例。45例中急性大出血12例,行三腔管压迫,内科综合治疗33例,均为住院患者。2.治疗方法:应用OlympusGIFXQ30胃镜,外径为2cm的透明塑料管(Olym… 相似文献
8.
整合蛋白α5亚基表达与肝癌恶性表型 总被引:3,自引:0,他引:3
目的探讨整合蛋白α5亚基与原发性肝癌的关系。方法应用免疫组化技术(ABC法)和Northernblot杂交检测整合蛋白α5亚基在原发性肝癌中的表达。结果发现在79例癌与癌周组织α5阳性率分别为32.9%和81.0%,两者间差异有显著性(P<0.01)。直径≤5cm的肝癌α5阳性率高于直径>10cm的肝癌(55.6%比10.0%,P<0.01),分化较好的肝癌α5阳性率高于分化不良者(40.6%比16.0%,P<0.05),已发生明确肝内转移(包括肝内播散和门静脉癌栓形成)的肝癌α5阳性率低于未发生肝内转移者(20.6%比42.2%,P<0.05)。α5亚基表达与患者年龄、血清甲胎蛋白水平、乙型肝炎病毒感染、肝硬化有无等因素均无明显相关(P>0.05)。Northernblot杂交结果也同时显示,非侵袭性肝癌α5表达高于侵袭性肝癌。结论整合蛋白α5低表达与肝癌增大、分化程度低、侵袭转移发生等恶性表型相关,可能对这些恶性表型起负性调节作用。 相似文献
9.
地行肝动脉化疗栓塞(TACE)治疗并手术切除癌瘤的72例癌患者进行临床与病理分析。结果:(1)TACE可使肝癌患者腹痛消失,腹胀缓解,体重增加,无严重并发症。(2)TACE可使96.2%的AFP阳性肝癌患者AFP降低,转阴才占28.3%。(3)TACE后B超示肿瘤均缩小。(4)TACE能促进肝癌坏死和包膜形成。提示TACE治疗肝癌疗疗较好。 相似文献
10.
肝动脉灌注羟基喜树碱和栓塞治疗原发性肝癌 总被引:11,自引:9,他引:2
目的观察经肝动脉插管栓塞和灌注化疗药物羟基喜树碱、5FU、丝裂霉素(MMC)、顺铂治疗(TACE)进展期肝癌(HCC)21例的疗效和副作用.方法应用TACE治疗21例中晚期HCC患者,其中Ⅱ期15例,Ⅲ期6例.结果接受TACE患者21例,治疗总有效率为809%,平均生存期91mo,半年和一年生存率分别为715%和424%.Ⅱ期患者获得的平均生存期、半年和一年生存率分别为105mo,867%,60%;明显优于Ⅲ期患者的53mo,367%,0%(P<001).多次治疗的平均生存期为112mo,明显优于单次治疗的68mo(P<001).副作用有恶心、呕吐、发热、白细胞下降和肝功能异常.结论羟基喜树碱经肝动脉灌注联合栓塞是治疗进展期HCC的有效手段. 相似文献
11.
Therapeutic effects of a combination therapy (TAE and irradiation) and a radiation therapy alone were evaluated comparatively in 54 patients with HCCs. Twenty eight patients of them underwent external X-irradiation with a linear accelerator after TAE and the remaining twenty six did irradiation alone. The incidence of partial response was 82.1% in the combination therapy and 69.2% in the radiation therapy. The cumulative rates of survival in the combination therapy were 70.8% (1-year), 37.1% (3-year), and 27.9% (5-year), which were higher than those in the radiation therapy. The cumulative rates of recurrence in the former were lower than those in the latter. The prognoses after the both treatments were poor in the patients with advanced liver cirrhosis (Child C). In the patients with HCCs smaller than 5 cm in diameter or accompanied by portal vein thrombi, the combination therapy was superior to TAE alone in the cumulative rates of survival. It is considered from the above results that the combination therapy is useful in the patients with HCCs when properly selected. 相似文献
12.
目的观察重组人血管内皮抑制素(恩度)联合肝动脉介入治疗对中晚期肝癌无疾病进展生存期的影响。方法选取2011年3月-2015年5月福建省肿瘤医院收治的86例中晚期肝癌患者,按照配对设计分为治疗组和对照组。治疗组(n=43)采用恩度联合肝动脉介入治疗;对照组(n=43)采用肝动脉介入治疗联合口服中药肝复乐。计数资料组间比较采用χ2检验,计量资料组间比较采用t检验。Kaplan-Meier法进行生存分析,单因素分析采用Log-rank法,多因素回归分析采用Cox比例风险模型。结果治疗组和对照组的中位无疾病进展生存期分别为154 d[95%可信区间(95%CI):94~214 d]、70 d(95%CI:39~101 d),两组比较差异具有统计学意义(χ2=10.741,P=0.001)。单因素分析显示,肝硬化严重程度、肿瘤个数、门静脉主干癌栓/下腔静脉癌栓是中晚期肝癌患者预后的影响因素(χ2值分别为8.182、9.150、6.565,P值分别为0.004、0.027、0.038);多因素分析显示,肝硬化严重程度、门静脉主干癌栓/下腔静脉癌栓是恩度联合肝动脉介入治疗影响中晚期肝癌无疾病进展生存期的独立预后因素(P值分别为0.028、0.013)。结论恩度可延长中晚期肝癌介入治疗后的无疾病进展生存期,但对严重肝硬化、门静脉主干癌栓/下腔静脉癌栓患者优势不明显。 相似文献
13.
抗病毒治疗对乙型肝炎相关原发性肝癌患者生活质量及预后的影响 总被引:1,自引:0,他引:1
目的 探讨抗病毒治疗对乙型肝炎相关原发性肝癌患者生活质量的影响.方法 选择95例诊断为乙型肝炎相关性原发性肝癌且无手术治疗指征的患者,分为抗病毒联合介入治疗组22例、介入治疗组26例、抗病毒治疗组23例、常规治疗组24例.随访监测治疗后4、12、24及48周肝功能、腹部彩色超声或肝脏CT,每4周对患者生活质量包括食欲、体质量(排除腹水影响因素)及乏力情况进行现场或电话随访,所有患者随访4周至48周.统计学处理采用t检验和x2检验.结果 抗病毒联合介入治疗组、介入治疗组、抗病毒治疗组与常规治疗组患者24周生存率分别为86.4%(19例)、73.1%(19例)、73.9%(17例)、54.2%(13例),48周生存率分别为68.2%(15例)、46.2%(8例)、47.8%(11例)、16.7%(4例).抗病毒联合介入治疗组、介入治疗组及抗病毒治疗组患者1年生存率明显高于常规治疗组(P<0.05).抗病毒联合介入治疗组、介入治疗组及抗病毒治疗组患者12周内生活质量较常规治疗组明显改善,其中抗病毒联合介入治疗组改善最明显,其次为介入治疗组与抗病毒治疗组,常规治疗组在生活质量方面无明显改善.治疗24周后抗病毒联合介入治疗组及介入治疗组的肿瘤大小未明显增大,而常规治疗组患者的肿瘤较抗病毒治疗组增大明显.结论 在介入治疗及常规治疗的基础上联合抗病毒治疗可提高乙型肝炎相关原发性肝癌患者1年生存率、改善生活质量、延缓肿瘤生长. 相似文献
14.
Nakagawa K Yamashita H Shiraishi K Nakamura N Tago M Igaki H Hosoi Y Shiina S Omata M Makuuchi M Ohtomo K 《World journal of gastroenterology : WJG》2005,11(46):7237-7241
AIM: To clarify the efficacy and safety of three-dimensional conformal radiotherapy (3-D CRT) for this disease and to specify patient subgroups suitable for this treatment. METHODS: Fifty-two patients with HCC received PVI-targeted radiation therapy from January 1995 through December 2003. Portal venous invasion (PVI) was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy (57.0 Gy in average). RESULTS: Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type, transcatheter arterial embolization (TAE) after radiation therapy were statistically significant prognostic factors. Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant. CONCLUSION: The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with post-radiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function. 相似文献
15.
目的评估肝细胞癌(HCC)合并门静脉癌栓患者经肝动脉化疗栓塞术(TACE)治疗后的效果及影响预后的因素。方法回顾性分析2006年1月-2010年12月第四军医大学西京医院收治的152例行TACE治疗的HCC合并门静脉癌栓患者的临床资料。观察TACE术后肝衰竭、上消化道大出血、栓塞后综合征等发生情况,分析生存期资料与影响预后的因素。Kaplan-Meier法计算累积生存率,采用Log-Rank法进行单因素分析,Cox比例风险模型进行多因素分析。结果患者中位生存时间为5.0(95%可信区间:4.4~5.6)个月,6、12、18个月的累积生存率分别为37%、18%和9%。单因素分析显示肿瘤大小、肿瘤类型、肝两叶累及、远处转移和Child-Pugh分级是HCC合并门静脉癌栓患者行TACE治疗预后的影响因素(χ2值分别为5.108、11.542、6.036、12.319、22.574,P值均0.05);多因素分析显示肿瘤大小、肿瘤类型、远处转移和Child-Pugh分级是影响患者预后的独立危险因素(Wald值分别为11.243、5.021、7.651、25.876,P值均0.05);而HCC合并门静脉癌栓患者发生肝衰竭的唯一影响因素是Child-Pugh分级(P=0.015)。结论在肝功能良好的HCC合并门静脉癌栓患者中,TACE是安全有效的。肿瘤大小、肿瘤类型、远处转移、Child-Pugh分级是影响患者生存的最主要因素,为临床医生选择合适的介入治疗患者提供了有力证据。 相似文献
16.
目的 研究金属内支架置入联合三维适形放射治疗对原发性肝癌合并门静脉癌栓的治疗效果. 方法回顾性分析22例肝癌伴门静脉癌栓患者,其中门静脉支架置入联合适型放射治疗组(A组)10例,门静脉支架置入和经动脉化疗柃塞组(B组)12例.比较两组患者治疗后的不良反应发生情况及治疗前后肝功能变化情况,随访4、6、12个月的支架通畅率和3、6、12个月的生存率.肝功能比较采用Wilcoxon符号秩检验,支架通畅率曲线和生存率曲线的比较采用Log rank检验. 结果两组患者均成功建成门静脉通路,并通过经皮肝穿刺门静脉分支路径成功置放支架,门静脉狭窄均得到开通.患者均未发生腹腔出血,但术后均有不同程度的腹痛、发热、恶心、呕吐、肠胀气等症状,通过对症处理均在l周内缓解.A组患者均完成治疗,Ⅰ~Ⅱ度胃肠反应3例,Ⅰ~Ⅱ度骨髓抑制2例,对症处理后完全缓解.A组患者的4、6、12个月支架通畅率分别为90%,70%、30%,B组分别为50%,25%.16.7%,两组的通畅率曲线差异有统计学意义(χ<'2>=4.33,P<0.05).A组患者的3、6、12个月生存率分别为100%、80%、30%,B组分别为91.7%、41.7%,16.7%,对两组的生存率曲线差异有统计学意义(χ<'2>=4.05,P<0.05). 结论采用支架置入并联合三维适形放射治疗对肝癌伴门静脉癌栓有较好的疗效,且对肝脏的损害相对较小. 相似文献
17.
Deep N Srivastava Sanjay Thulkar Sanjay Sharma Girish K Pandey P Sahni P K Julka S K Acharya 《Indian journal of gastroenterology》2002,21(3):96-98
BACKGROUND: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used. 相似文献
18.
Augusto Cedrone Gian Ludovico Rapaccini Maurizio Pompili Antonio Aliotta Concetta Trombino Francescantonio De Luca Eugenio Caturelli Salvatore Caputo Giovanni Gasbarrini 《Liver international》1996,16(2):94-98
Abstract: During a 4-year period portal vein thrombosis was diagnosed in 20 Child class A patients with cirrhosis by means of ultrasound and ultrasound-Doppler study. Seventeen of them showed single or multiple focal liver lesions diagnosed as hepatocellular carcinoma by ultrasound-guided fine-needle biopsy and the remaining three a coarse liver echo-pattern without focal lesions. One patient was found to have developed portal vein thrombosis after the fifth ethanol injection of a single hepatocellular carcinoma lesion 17 mm in diameter. Ultrasound-guided fine-needle biopsy of the thrombus was performed on all the patients: portal vein thrombosis was neoplastic in 13 cases and non-neoplastic in seven cases (five patients with a single lesion; one with two lesions; one with coarse liver echo-pattern). Among the five patients with a single lesion, one had already been treated by percutaneous ethanol injection therapy. There were no complications related to the biopsy procedures. The diagnosis of non-neoplastic thrombosis allowed five new patients to be recruited for percutaneous ethanol injection treatment and allowed it to continue in the patient with portal vein thrombosis occurring after the fifth ethanol injection. The routine use of ultrasound-guided fine-needle biopsy of portal vein thrombosis yields an accurate diagnosis of the nature of the thrombus and can improve the selection for percutaneous ethanol injection treatment of patients with cirrhosis with hepatocellular carcinoma lesions. 相似文献
19.
目的 探讨血清AFP阴性(<20 ng/ml)的原发性肝癌(PLC)患者的临床特征及影响预后的相关因素。方法 回顾性分析我院2013年3月~2017年3月住院治疗的34例AFP阴性的PLC患者的临床资料,应用SPSS 17.0统计学软件对相关资料进行处理,采用Kaplan-Meier法估计总体生存率,采用COX回归模型进行多因素分析影响AFP阴性的PLC患者预后的相关因素。结果 在随访的3年中,34例患者1 a、2 a和3 a生存率分别为91.2%、85.3%和73.5%;单因素分析提示不同肿瘤大小(最大直径≤5 cm与>5 cm)患者生存期有显著性差异(P<0.05),远处转移灶数量<2处与≥2处患者生存期有显著性差异(P<0.05),有门脉癌栓与无门脉癌栓患者生存期有显著性差异(P<0.05),Child-Pugh分级C级与A/B级患者生存期有显著性差异(P<0.05),组织学分级高与组织学分级低患者生存期有显著性差异(P<0.05),发生肝外转移与无转移患者生存期有显著性差异(P<0.05),血清CEA水平高与CEA水平正常患者生存期有显著性差异(P<0.05),TACE疗效达到CR与PD患者生存期有显著性差异(P<0.05),进行了放疗与未进行放疗患者生存期有显著性差异(P<0.05);COX分析提示有门脉癌栓形成、Child-Pugh分级差、组织学分化低、发生肝外转移、血清CEA水平高、TACE疗效差和未进行放疗均是影响AFP阴性PLC患者预后的独立因素(均P<0.05)。结论 AFP阴性PLC患者预后与多种因素相关,及时行TACE治疗并达到完全缓解者或进行了补充放疗可能能延长生存期。 相似文献
20.
Cheung YC Ko SF Ng SH Chan SC Cheng YF 《World journal of gastroenterology : WJG》2005,11(18):2792-2795
AIM: To evaluate the dinical outcome and cost-effectiveness of transcatheter arterial ethanol-lipiodoi embolotherapy on hepatocellular carcinoma (HCC). METHODS: One hundred patients with HCC who were treated only by lobar or segmental transarterial embolization (TAE) with ethanol-lipiodoi mixture were enrolled in this study. The 1st- and 2nd-year survival rates were analyzed to evaluate the feasibility of its method. These outcomes of our patients were individually correlated to the Child-Pugh classification and the computed tomographic features of HCC. RESULTS: The overall 1st- and 2nd-year survival rates were 72% and 46%, respectively. The patients were classified into three groups according to their liver function status: 68 patients as Child-Pugh class A, 26 as Child B, and 6 as Child C. Child A had better survival rate than the Child B and/or C. The 1st-year survival rates of patients with Child A-C were 84%, 50%, and 33.3% respectively and the 2nd-year survival rates were 55.5%, 28.5%, and 33.3%, respectively. According to the computed tomographic features, solitary HCC with maximum diameter less than 5 cm had the best outcome with the lst-year survival rate of 100% and the 2nd-year survival rate of 71.4%, while solitary HCC with maximum diameter over 5 cm and multiple HCC had the lst-year survival rates of 75% and 63.7%, respectively, and the 2nd-year survival rates of 33.3% and 44.4%, respectively. Only one patient was complicated with abscess formation and was cured with antibiotic therapy. No mortality resulted from the procedures performed. CONCLUSION: TAE with ethanol-lipiodoi mixture is an economic, safe and feasible method for treating HCC, especially for the patients with smaller solitary HCC or with liver function status of Child-Pugh class A. 相似文献