原发性肝癌肝切除术（附97例报告）

报告原发性肝癌切除术９７例（１０２例次）其中３例术后复发再次肝切除１，２，５年生存率分别为６６．１％，５２．１％，２３．０％，作者认为，手术切除是肝癌治疗的有效方法，术后应定期复查Ｂ超和甲胎蛋白（ＡＦＰ）并进行综合治疗，对不能切除的大肝癌，可经区域血管栓塞和化疗缩小后行二期手术切除。     

肝动脉化疗栓塞治疗原发性肝癌的疗效及影响因素

目的观察肝动脉化疗栓塞治疗对原发性肝癌的疗效及影响因素．方法单纯化疗（Ａ组）；化疗加碘油栓塞（Ｂ组）；化疗加碘油加明胶海绵栓塞（Ｃ组）．结果５年内肝动脉化疗栓塞治疗中、晚期肝癌４２８例，３８６例经２个月～５０个月随访．肿瘤缩小率：Ａ组１４％，Ｂ组５５％，Ｃ组７９％（三组间Ｐ＜００１）．肿瘤基本消失：Ｃ组５％，Ａ，Ｂ两组无１例消失．生存时间：１年生存率Ａ组０％，Ｂ组１０％，Ｃ组４５％，其中１２例患者获Ⅱ期手术切除，切除标本病理检查见肿瘤区癌细胞全部或部分凝固坏死，瘤旁癌细胞稀疏．结论影响疗效因素与肿瘤的病理类型及血供情况，门静脉主干瘘和癌栓、肝动脉插管治疗方式有关．     

间断抑酸治疗防止消化性溃疡复发的临床观察

目的：本文观察间断抑酸治疗对防止消化性溃疡复发的作用。方法：选７０例每年发作两次以上的溃疡病患者，经抑酸治疗愈合后作对象。４４例间断用Ｈ２受体阻滞剂治疗两年，其中２３例是诱因存在期持续治疗为Ⅰ组；２１例是每１２周治疗两周为Ⅱ组，２６例未用任何治疗为对照组。结果：三组的溃疡复发率在一年内分别是２６１％（６／２３）、３３３％（７／２１）及６９２％（１８／２６），两年内分别是４３５％（１０／２３）、４７６％（１０／２１）及９６２％（２５／２６）。对照组均显著高于Ⅰ、Ⅱ组（Ｐ＜００１）。结论：间断抑酸治疗能有效地防止消化性溃疡复发     

脾栓塞治疗免疫性血小板减少性紫癜

２１例慢性免疫性血小板减少性紫癜（ＩＴＰ）和２例ＥＶＡＮＳ综合征患者接受部分脾动脉栓塞治疗。结果：显效１４例，占６０．９％，良效５例，占２１．７％，总有效率８６．６％。术后观察１年以上者８例，５例仍为显效，３例（３７．５％）复发，２例经强的松等治疗再获良效，１例无效。对照组：２５例ＩＴＰ患者作切脾治疗。显效１７例（６８．０％），良效５例（２０．０％），无效３例（１２．０％）总有效率８８．０％。两组比较（Ｐ＞０．０５）差异无显著性。     

肝癌碘油沉积良好患者的影像随访

我们以肝动脉数字减影血管造影（ｄｉｇｉｔａｌ ｓｕｂｔｒａｃｔｉｏｎ ａｎｇｉｏｇｒａｐｈｙ，ＤＳＡ）为标准，回顾性分析２６例碘油沉积良好肝癌患者计算机断层摄影术（ｃｏｍｐｕｔｅｄ ｔｏｍｏｇｒａｐｈｙ，ＣＴ）和磁共振成像（ｍａｇ—ｎｅｔｉｃ ｒｅｓｏｎａｎｃｅ ｉｍ－ａｇｉｎｇ，ＭＲＩ）对原发灶肿瘤残留和肝内新病灶显示情况，比较ＣＴ和ＭＲＩ对肝动脉化疗栓塞（肝ＴＡＣＥ）的随访价值。 １．资料与方法：２６例原发性肝癌患者，均为男性，年龄３２～８３岁（平均５４．４岁）。６例经活检或手术证实，其余２０例经…     

肝动脉大剂量化疗药栓塞治疗老年人肝癌

老年人原发性肝癌３０例，经肝动脉插管灌注顺铂１００－１６０ｍｇ，阿霉素３０－６０ｍｇ，丝裂霉素６－２０ｍｇ，其中２１例用４０％碘化油栓塞，共治疗７２次，与同期５９岁以下原发性肝癌患者３０例进行比较。疗效：老年组无完全缓解者，部分缓解１４例（４６．７％），好转１０例（３３．３％），病情稳定６例（２０．０％）；对照组分别占３．３％，５０．０％，３６．７％，１０．０％。两组之间的疗效，生存期和毒副反应…     

区域性灌注体毛药液治疗老年肝癌38例报道

目的探讨一种新的末梢动脉栓塞剂，减少栓塞盲区。方法将粉碎灭菌的自体毛发颗粒混入抗癌药液及水性造影剂，经导管灌入靶动脉，对３８例老年中晚期肝癌病人进行栓塞化疗结果影像学证实发丝样肿瘤血管及肿瘤染色消失，肿瘤直径缩小５０％以上者７３．７％（２８／３８），缩小２５％～５０％者２１．０％（８／３８），肿瘤无变化或缩小２５％以下者５．３％（２／３８）。ＡＦＰ下降者８１．６％（３１／３８）。６、１２、１８、２４个月生存率分别为１００％、８３．３％、７５％、６６．７％。临床症状及肝功能均有改善。所有病人均未发生异位误栓及排异反应，栓塞后综合征轻微。结论自体毛发颗粒作为永久性末梢动脉栓塞剂治疗老年肝癌是安全有效的     

原发性肝癌自发性破裂的治疗

原发性肝癌自发性破裂的治疗江苏省启东肝癌防治研究所（２２６２００）张宝初原发性肝癌自发性破裂（肝癌破裂）是肝癌严重并发症之一。国外报告，肝癌破裂占同期住院病例８％～１４．５％，国内为４．８５％～２５．７％，我所为６．５％。肝癌破裂发病突然，病情凶险，...     

辛伐他汀降脂治疗对血管内皮依赖性舒张功能的影响

目的研究辛伐他汀对原发性高胆固醇血症患者血管内皮依赖性舒张功能的影响。方法采用高分辨超声技术，对２５例原发性高胆固醇血症患者降脂前后和２５例血浆胆固醇水平正常的对照者的血管内皮依赖性舒张功能进行检测。结果发现原发性高胆固醇血症组肱动脉血流介导性舒张较正常组明显减弱（３．５％±２．８％和１４．５％±３．４％，Ｐ＜０．００１），而二组对硝酸甘油的反应无显著性差异（２０．５％±７．２％比２２．９％±４．３％，Ｐ＝０．４９）。２５例原发性高胆固醇血症患者服用辛伐他汀５～１０ｍｇ治疗３．８±０．８月后，血浆总胆固醇从６．３１±０．７０ｍｍｏｌ／Ｌ降至５．０６±０．６３ｍｍｏｌ／Ｌ，同时肱动脉内皮依赖性舒张较治疗前明显改善（１０．０±３．２％比３．５±２．８％，Ｐ＜０．００１），而治疗前后肱动脉对硝酸甘油的反应无显著性改变。结论原发性高胆固醇血症患者存在血管内皮依赖性舒张功能障碍；经辛伐他汀降胆固醇治疗后，受损的血管内皮依赖性舒张功能得到明显改善     

C／EBP在肝癌组织及其癌旁组织的表达和意义

Ｃ／ＥＢＰ是近年发现的一种真核细胞转录调控因子，与细胞分化状态有关，Ｃ／ＥＢＰ主要存在于分化成熟的组织细胞中，在分化不良的细胞存在较少或检测不到。本文采用兔抗Ｃ／ＥＢＰ多肽抗体，经免疫组化ＡＢＣ染色，对３１例原发性肝细胞癌（２６例带癌旁肝组织）和２６例原发性肝内胆管细胞癌（１５例带癌旁肝组织）及１５例正常肝组织的表达情况进行了分析，结果发现Ｃ／ＥＢＰ抗原在３１例原发性肝细胞癌中阳性表达８例（２５．８％），２６例原发性肝内胆管细胞癌中阳性反应１０例（３８．５％），而４１例相应癌旁、１５例正常肝组织全部呈阳性反应。本试验中原发性肝细胞癌和原发性肝内胆管细胞癌组织Ｃ／ＥＢＰ阳性表达率低于相应的癌旁组织及正常肝组织，前者与后者差异显著（ｐ＜０．０５）。     

原发性肝癌MRI的特异性诊断

回顾性研究２４例原发性肝癌的ＭＲＩ表现,探讨原发性肝癌ＭＲＩ的特异性征象。结果：Ｔ１加权像高低混杂信号占５８％;肿瘤周围纤维包膜占５４％;门静脉或下腔静脉受压变扁移位占２９％,管腔内瘤栓形成占２５％;肝包膜凹陷征占４％。这些征象对原发性肝癌的诊断具有特异性,有助于与其它肝脏占位性病变相鉴别。     

小肠平滑肌类肉瘤肝转移的影像学评价和介入治疗

目的 评价小肠平滑肌类肉瘤肝脏转移的影像学表现和介入治疗的短期疗效。方法 回顾性分析7例小肠平滑肌类肉瘤肝脏转移病例,共计46个病灶。病灶直径2-18cm不等。所有患者均行肝脏CT三期扫描和肝动脉造影。介入治疗7例均采用肝动脉化疗栓塞术（TACE）,1例行左锁骨下动脉植入化疗药盒导系统术（肝动脉PCS术）。3例肿瘤中心液化坏死明显的患者还行经皮坏死物引流和肿瘤内无水酒精注射。结果 46个肝脏转移病灶均表现为实质性或囊实性占位,肿瘤较大时囊变成份增加。CT动脉期增强扫描肿瘤明显强化,肝动脉造影肿瘤血管、染色丰富。随访3-10月（平均6.7月）,4例经肝TACE术后肿瘤缩小,1例进行肝动脉PCS要患者肿瘤大小无变化,2例肿瘤增大。3例经皮肿瘤坏互物引流者肿瘤缩小明显。结论 小肠平滑肌类肉瘤肝脏转移以肝动脉供血为主,为富血供肿瘤。肝TACE术、肝动脉PCS术和经皮坏死物引流术是其治疗的有效方法。     

肝结核瘤的诊治探讨

目的探讨肝结核瘤的诊断与外科治疗措施。方法报告１９８０年１月～１９９３年１２月施行的肝切除术患者３４３例，其中术后经病理证实为肝结核瘤者８例。对该８例患者的诊断和治疗措施进行综合分析。结果８例中５例误诊为肝脏肿瘤，仅３例确诊。所有患者均行手术治疗，随访７例４年均无复发。结论对有结核病史的肝脏占位患者应高度怀疑为肝结核瘤；Ｂ超或ＣＴ导向下的肝穿刺活组织检查能明确诊断；治疗方式为施行肿瘤所在区域的肝段切除或局灶性切除，术后应用抗结核药物治疗以巩固疗效。     

CT portography and post-lipiodol CT in the preinterventional work-up of primary and secondary liver tumors. A single center experience

BACKGROUND/AIMS: The evaluation of the clinical use of CT portography (CTp) and post-lipiodol CT (CT post-lip) in terms of therapeutic implications in patients with liver malignancies, particularly hepatocellular carcinoma (HCC). METHODOLOGY: We prospectively evaluated 130 patients with CTp and CT post-lip: 109 with HCC and underlying cirrhosis (group I) and 21 with liver metastases considered for surgical resection (group II). All patients also underwent hepatic angiography (hA). Mean lesion size was 4.6 cm and 2.2 cm for group I and II respectively. Previous contrast-enhanced CT studies were available for comparison. RESULTS: Diagnostic CTp examinations resulted in only 84.4% of group I due to enhancement in homogeneities and in all patients from group II. In comparison with the referral CT, additional lesions were seen in 83.6% of the HCC group and in 66.6% of the metastatic group that implicated treatment alterations in 15.21% and in 23.8% of them, respectively. Hepatic angiography revealed hypervascularity in 91.3% of HCC lesions and in 33.3% of metastatic ones. CT post-lip images suitable for evaluation resulted in 104/130 patients (80%). At CT post-lip false negative results were observed in 33.73% patients with HCC and in 30.95% patients with liver metastases. Selective lipiodol retention was seen in only 50% of the biopsy proved satellites. CONCLUSIONS: CTp reveals additional lesions that have therapeutic implications in at least 15% of HCC patients and in 20% of patients with metastatic disease, and should be routinely included in the preinterventional work-up particularly for cases in which intraarterial or percutaneous treatment is scheduled. By contrast, CT post-lip seems to be of limited value unless it is evaluated in combination with CTp and angiography.     

针吸细胞学对肝占位性病变的诊断价值

细针细胞学穿刺肝占位性病变201例，能够明确诊断良恶性者183例，其中80例有手术后病理组织学对照，73例组织学完全符合，准确率达91.4%，着重探讨原发性和继发性肝癌的细胞学特征。结论：经皮肝穿刺细胞学诊断肝癌很有价值。     

肝内胆管细胞癌CT诊断及鉴别诊断

目的：探讨肝内胆管细胞癌的CT表现及其他肝内肿瘤的鉴别要点。方法：回顾性分析经手术及病理证实的18例肝内胆管细胞癌的CT资料，术前均经CT平扫和增强扫描，6例经延迟扫描。结果：18例CT平扫均表现为单发低密度病灶，密度均匀者3例，不均匀者15例；肝包膜回缩证10例；边缘清楚4例，不清楚14例；伴有肝内胆管扩张及肝内胆管结石8例；有脾肿大者3例，不均匀者15例；肝包膜回缩证10例；边缘清楚4例，不清楚14例；伴有肝内胆管扩张及肝内胆管结石8例；有脾肿大者3例。增强扫描病灶均匀为轻度强化，且不同程度地出现线样或网格状强化。结论：肝内胆管细胞癌有一定的CT特征，大多可与肝内其他占位病变鉴别。     

原发性颈淋巴结结核的治疗体会及Elispot技术的诊断价值

目的 探讨原发性颈淋巴结结核的各种治疗方法的优缺点及评价酶联免疫斑点(Elispot)检测外周血中结核分枝杆菌性抗原特异性γ一干扰素水平在颈淋巴结结核中的诊断价值.方法 回顾分析89例原发性颈淋巴结结核患者的临床资料,30例(A组)采用内科治疗(化疗l～1.5年),28例(B组)行肿块全部切除加区域性颈淋巴结清扫术,16例(C组)行淋巴结结核病灶切除术,15例(D组)行病灶切开刮除、开放引流术,所有手术患者术后均化疗1年.用Elispot技术对患者外周血中产生结核菌抗原特异性γ一干扰素的水平进行定量检测,同时检测患者的结核抗体.结果 A组中22例肿块继续增大并增多(73.3%),其中9例形成脓肿破溃;B组无一例复发;C组5例复发(31.3%);D组3例形成结核性窦道,4例再发淋巴结肿块(46.7%);保守治疗和手术治疗复发率比较有明显统计学差异(χ2=9.69,P<0.01),保守治疗复发率明显升高;三种手术方式复发率比较也有明显统计学差异(χ2=14.47,P<0.01),此4组患者手术愈合时间有统计学差异(F=104.44,P<0.01),B组患者手术愈合时间最短.复发率最低;Elispot、结核抗体检测患者的阳性率分别是87.6%、62.9%(χ2=14.61,P<0.01).结论 原发性颈淋巴结结核的治疗应以手术为主, 手术治疗能缩短治疗时间,减少药物用量及不良反应,能明显提高治愈率.降低复发率,而手术方式首选肿块伞部切除加区域性颈淋巴结清扫术;Elispot技术优于结核抗体,可用于颈淋巴结结核的辅助诊断.     

血清蛋白相关磷脂酶A2及核苷酸结合寡聚化结构域样受体蛋白3水平与老年冠心病严重程度的相关性

目的 分析血清脂蛋白相关磷脂酶A2(Lp-PLA2)及核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)水平与老年冠心病患者冠状动脉(冠脉)病变严重程度的相关性.方法 回顾性采集医院2017年1月至2019年7月200例老年冠心病患者资料,采集同期医院接受常规全身体检的健康老年人群80例体检资料,将其作为健康对照组.全部...     

Insulinoma: diagnostic strategies and surgical treatment. A 22-year experience.

BACKGROUND/AIMS: The efficacy of preoperative localization methods and the results of the surgical treatment of insulinoma were studied. METHODOLOGY: Fifty-nine patients referred for surgical treatment were studied and the results of the diagnostic tools for tumor localization were compared with findings at surgical intervention. The influence of the type of surgical procedure in the immediate and late postoperative course was also studied. RESULTS: Ultrasonography had a sensitivity of 30%, computed tomography 25%, angiography 54%, portal vein sampling 94%, endoscopic ultrasonography 27% and magnetic resonance 17%. Intraoperative palpation localized 98.2% of the tumors and by the addition of intraoperative echography, all lesions were identified. In 55 patients with benign lesions, 22 enucleations, 25 distal pancreatectomies, 7 pancreatectomies plus enucleation and one duodenopancreatectomy were performed. Malignant tumors were treated by pancreatic resection, postoperative hepatic artery embolization and systemic chemotherapy. There was no postoperative mortality. Pancreatic fistula was the most common complication. Three patients who underwent distal pancreatectomy developed late diabetes (9.3%). CONCLUSIONS: Extensive preoperative investigation, mainly with invasive methods, is not indicated and by combining intraoperative palpation and echography most of the cases can be adequately dealt with. Preservation of pancreatic tissue with enucleation and preservation of the spleen are the best choice for treatment of benign insulinomas.     

Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors

Objectives

We report single center experience on the outcome and toxicity of SBRT alone or in combination with surgery for inoperable primary and metastatic liver tumors between 2007 and 2014.

Patients and methods

Patients with 1–4 hepatic lesions and tumor diameter ≤9 cm received SBRT at 46.8Gy ± 3.7 in 4–6 fractions. The primary end point was local control with at least 6 months of radiographic followup, and secondary end points were toxicity and survival.

Results

Eighty-seven assessable patients (114 lesions) completed liver SBRT for hepatoma (39) or isolated metastases (48) with a median followup of 20.3 months (range 1.9–64.1). Fourteen patients underwent liver transplant with SBRT as a bridging treatment or for tumor downsizing. Eight patients completed hepatic resections in combination with planned SBRT for unresectable tumors. Two-year local control was 96% for hepatoma and 93.8% for metastases; it was 100% for lesions ≤4 cm. Two-year overall survival was 82.3% (hepatoma) and 64.3% (metastases). No incidence of grade >2 treatment toxicity was observed.

Conclusion

In this retrospective analysis we demonstrate that liver SBRT alone or in combination with surgery is safe and effective for the treatment of isolated inoperable hepatic malignancies and provides excellent local control rates.