放射性磷玻璃微球治疗晚期肝癌的量效关系

目的 探讨核素微球治疗晚期肝癌的量效关系。方法 对４４例不能切除的晚期肝癌施行＾３２Ｐ玻璃微球（ｐｈｏｓｐｈｏｒｕｓ－３２ ｇｌａｓｓ ｍｉｃｒｏｓｐｈｅｒｅｓ,＾３２Ｐ－ＧＭＳ）肝动脉灌注治疗,根据吸收剂量分为高、中、低三个剂量组,手术前后以各项肝功能指标及动脉血酮体比（ａｒｔｅｒｉａｌ ｂｌｏｏｄ ｋｅｔｏｎｅ ｂｏｄｙ ｒａｔｉｏ,ＡＫＢＲ）等监测肝功能,并以ＡＦＰ、ＣＴ、单光子发射型计算机     

~（32）磷－玻璃微球肝动脉灌注治疗晚期肝癌的初步应用

作者评价了３２磷－玻璃微球作为新的内放射栓塞剂治疗晚期肝癌的疗效及毒副作用。自１９９４年３月至１９９５年４月，作者采用术中肝动脉插管或经Ｓｅｌｄｉｎｇｅｒ′ｓ导管栓塞治疗不能切除的晚期肝癌患者２４例，肿瘤直径３．６～１８．５ｃｍ（平均１１．３ｃｍ），主瘤位于右叶９例，左叶１例，弥散于全肝１４例。栓塞部位：右肝８例，全肝１６例。治疗用放射剂量１２００～８０００ｒａｄ（平均３２５０ｒａｄ）。治疗结果：微球主要浓集于癌区，癌与肝的放射性强度比为３．３∶１。术后１～３个月，肿瘤缩小＞５０％者１７例，＜５０％者５例，增大２例；术后３、６、１２、１８、２４个月生存率分别为９２％、７５％、５４％、３３％、２９％。作者认为：３２磷－玻璃微球肝动脉栓塞在不能切除的肝癌的治疗中具有较好的效果，使用安全，值得进一步研究及推广。     

肝细胞癌经皮穿刺肝动脉化疗栓塞缩小后切除及疗效分析

作者为探讨不能切除的肝细胞癌经肝动脉化疗栓塞（ＴＡＣＥ）缩小后行肿瘤切除的疗效,总结了５９例肝细胞癌患者的经验。本组患者首次ＴＡＣＥ前肿瘤直径５．６～２０．０ｃｍ,平均９．４３ｃｍ,每人接受ＴＡＣＥ１～６次,平均２．９次,手术前肿瘤直径缩小至３．２９ｃｍ,末次ＴＡＣＥ距手术时间１～７个月,平均２．５个月。ＡＦＰ阳性３５例,ＴＡＣＥ治疗后１３例转为正常。５９例患者中行肝段、联合肝段或肝部分切除５６例,左三叶切除２例,左半肝切除１例。切除的肿瘤各有４０％～１００％坏死,其中９例１００％坏死。ＴＡＣＥ后１３例ＡＦＰ转为正常的患者中,９例镜下仍见癌细胞。５９例患者１、３、５年生存率分别为７９．７％、６５％和５６％。作者认为ＴＡＣＥ可为一期不能切除的肝癌患者争取手术切除的机会,且可获得满意疗效。     

家猪肝动脉内给予32磷-玻璃微球的毒性反应研究

目的　评估正常家猪肝动脉内给予３２ 磷玻璃微球（３２ＰＧＭＳ） 后的急性和亚急性毒性反应。方法　１０ 只健康家猪经皮肝动脉内接受人类治疗剂量的３２ＰＧＭＳ（５ 只猪）、惰性３１ＰＧＭＳ（５ 只猪） ；２ 只猪作全程空白对照。术后按第１ 、２、４ 、８ 或１６ 周分期处以安乐死，取不同部位的肝组织进行光镜、电镜检查和超微形态计量分析。结果　给药组１、２ 周肝细胞核异常率（Ｎａｂｎ） 和线粒体变异率（ Ｍｖａｒ） 与其他各组比较差异均有显著性（ Ｐ＜ ０．０１，Ｐ＜ ０ ．００１）；给药组第８ 周与第１６ 周比较Ｎａｂｎ 无统计学意义（ Ｐ＞０ ．２０）。给药后第１、２ 周异常肝细胞多见；第４ 周异常肝细胞减少，血窦内皮破坏明显；第８ 周异常肝细胞少见，血窦内皮修复；第１６ 周肝组织形态学表现正常。结论　３２ＰＧＭＳ肝动脉给药正常肝组织宏观吸收剂量不超过１９０Ｇｙ 只是引起临床上允许的肝内变化，肝脏组织损伤修复的时间约８ 周以上。     

^32磷—玻璃微球肝动脉灌注治疗晚期肝癌的初步应用

作者评价了＾３２磷－玻璃微球作为新的内放射栓塞剂治疗晚期肝癌的疗效及毒副作用。自１９９４年３月至１９９５年４月，作者采用术中肝动脉插管或经Ｓｅｌｄｉｎｇｅｒ＇ｓ导管栓塞治疗不能切除的晚期肝癌患者２４例，肿瘤直径３．６￣１８．５ｃｍ（平均１１．３ｃｍ），主瘤位于右叶９例，左叶１例，弥散于全肝１４例。栓塞部位：右肝８例，全肝１６例。治疗用放射剂量１２００￣８０００ｒａｄ（平均３２５０ｒａｄ）。治疗结果     

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目的 介绍用肝门区域血管阻断法切除最大径１０～３０ｃｍ,且经病理证实的肝细胞癌９６例的经验。复发的相关因素和疗效。方法 用肝门务砭解剖法游离阻断相应血管如肝右叶或右叶多亚役切除阻断肝动脉（ＨＡ）和门静脉（ＰＶ）右支（５４例次）,中叶切除阻断睡ＰＶ右前支和ＨＡ和ＰＶ左内支（１０例次）、左叶切除阻断ＨＡ和ＰＶ左支（１１例次）,左外段切除阻断ＨＡ和ＰＶ左外支（１５例次）。结果 （１）手术死亡率３．１％;     

肝动脉栓塞加手术切除治疗大肝癌37例

作者报告３７例大肝癌采用肝动脉栓塞（ＴＡＥ）加手术切除的疗效及临床病理研究结果。３７例肝癌直径５～２４ｃｍ（平均１１．２Ｃｍ）。ＴＡＥ与动脉灌注化疗同时进行。化疗药物括氟尿嘧啶（５－ＦＵ）、阿霉素（ＡＤＭ）或表阿霉素（Ｅ－ＡＤＭ）、丝裂霉素（ＭＭＣ）和顺铂（ＣＤＤＰ）。多采用三种药物联合方案。肝动脉末梢栓塞剂采用国产或进口碘化油,用明胶海绵颗粒作近端栓塞。手术切除前进行１～４次ＴＡＥ,每次相隔４～６周。１７例ＡＦＰ值增高者ＴＡＥ后１０例降至正常水平。肿瘤直径由平均１１．２ｃｍ降至８．５ｃｍ（缩小２６％）。栓塞后手术切除病理标本显示９２％有肿瘤组织坏死,范围达４０％～１００％。１、２、３年生存率分别为８０％、６６．７％和５３．３％。作者认为ＴＡＥ加手术切除是大肝癌的有效治疗方法。     

肝细胞生长因子受体在人肝细胞癌中表达的研究

作者应用分子杂交法，研究肝细胞生长因子受体（ｃ－ｍｅｔ）ｍＲＮＡ在人肝细胞癌中的表达及其意义。Ｎｏｒｔｈｅｒｎ杂交分析结果表明：在癌组织中有１６例ｃ－ｍｅｔ表达阳性，在癌周肝中有１２例ｃ－ｍｅｔ表达阳性。ｃ－ｍｅｔ在肝细胞癌组织中与癌周肝组织中的表达阳性的例数差异无显著意义（Ｐ＞０．０５）。经统计学处理发现ｃ－ｍｅｔ和肝细胞癌分化程度、分期、大小、ＨＢｓＡｇ、ＡＦＰ、门静脉癌栓间无显著相关（Ｐ＞０．０５）。作者认为ｃ－ｍｅｔ基因可能在肝癌形成及转移过程中起调节作用。     

肝细胞癌合并门静脉癌栓的手术切除及疗效观察

目的 探索肝细胞癌合并门静脉癌栓（ＰＶＴＴ）手术切除的疗效及其影响预后因素。方法 总结近１０年１１１例肝细胞癌合并门静脉主干或第一分支癌栓的患者,均行肝癌联同门静脉左或右支癌栓切除或经左、右支断端取栓或切开主干取栓,其中２２例患者切除肿瘤及癌栓后行肝动脉和（或）门静脉插管。３２例患者术后经肝动脉化疗栓塞和（或）经门静脉导管化疗。另１４例ＰＶＴＴ患者仅行保守治疗（非手术组）,２０例ＰＶＴＴ患者行探查     

转化生长因子-β1及其Ⅱ型受体在肝细胞癌中的基因表达

目的 探讨转化生长因子－β１（ＴＧＦ－β１）及其Ⅱ型受体（ＴＧＦ－βＲⅡ）在肝细胞癌中的基因表达。方法 用ＲＴ－ＰＣＲ和免疫组化技术,分别检测３０例肝癌组织和癌旁肝组织中ＴＧＦ－β１及ＴＧＦ－βＲⅡ在ｍＲＮＡ和蛋白水平的表达。结果 （１）ＴＧＦ－β１ｍＲＮＡ阳性表达,在肝癌组织中为２４／３０,癌旁肝组织中为２６／３０,Ｐ〉０．０５;但ＴＧＦ－β１蛋白水平在肝癌组织阳性表达低于癌旁肝组织（Ｐ〈０．０     

局部内放疗预防肝癌切除术后复发的研究

目的了解肝内局部^32P玻璃微球（^32P-GMS）埋置对肝癌切除术后预防复发的效果。方法A组29位肝细胞性肝癌病人于肿瘤切除后局部埋置^32P-GMS，B组为同期38位肝癌病人行肝癌切除术后未埋置^32P-GMS。观察术后不同时间肝、血和尿中的放射性分布。随访统计两组病人的复发率和生存率。结果肝内局部埋置^32P-GMS的病人未发现血和尿中放射性分布。A组术后半年、1年、2年、3年及3年以上的复发率明显低于B组，存活率明显高于B组，具有统计学意义。两组手术死亡率及术后并发症发生率无明显差异。结论肝癌切除术后局部埋置^32P-GMS可以减少复发，延长病人的生存时间。     

Treatment of hepatocellular carcinoma with esophageal varices

This report describes 53 patients with hepatocellular carcinoma (HCC) complicated with esophageal varices. Esophageal varices were due to cirrhosis of the liver in all cases. Hepatic resection and blocking operations such as Sugiura procedure, transabdominal esophageal transection or Hassab's operation were performed for the treatment of HCC and esophageal varices in 6 cases with satisfactory results. Non-operative treatments such as TAE or arterial infusion chemotherapy for HCC and blocking operations for esophageal varices were performed in 17 cases. Late deaths were recognized in 10 cases. Causes of late deaths were carcinoma of the liver in 7 cases and ruptured varices in only 1 case. In 13 cases with severe hepatic failure, only endoscopic sclerotherapy was performed for the treatment of esophageal varices. However 8 cases of 13 had rebleeding from esophageal varices and died after sclerotherapy. We concluded that effective treatments for HCC complicated with esophageal varices were to perform both the hepatic resection and the blocking operation and these treatments prolong the long-term survival of patients with HCC with esophageal varices.     

Resection of hepatocellular carcinoma with tumor thrombus of the portal vein after neoadjuvant regional chemotherapy

We report a successfully managed case of far-advanced hepatocellular carcinoma (HCC) by intraarterial infusion therapy. A 55-year-old man was admitted to our hospital with abdominal pain and subileus. Abdominal ultrasonography, computed tomography, and angiography revealed HCC with obstruction of the main portal vein due to tumor thrombus. Serum levels of α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) were elevated. Neoadjuvant chemotherapy was tried with a course of low-dose cisplatin (CDDP) +5-fluorouracil (5-FU) intrahepatic arterial infusion through the indwelling catheter via the subcutaneous reservoir port. After 7 weeks of administration (total dose CDDP 370 mg/5-FU 18.5 mg), the main tumor size was effectively reduced. Serum levels of AFP and PIVKA-II decreased markedly. Adverse effects were tolerated. Following the chemoinfusion therapy, posterior segmentectomy and thrombectomy were performed. Reconstruction of the portal vein was not necessary because we removed the tumor thrombus without resecting the portal vein. The postoperative course was uneventful, and the patient has been doing well more than 2 years after surgery, with no evidence of recurrence or metastasis. Preoperative low–dose CDDP +5-FU intrahepatic arterial infusion therapy in combination with hepatic resection may be an effective treatment for advanced HCC with portal vein tumor thrombus. Received: December 31, 2001 / Accepted: June 17, 2002 Offprint requests to: H. Kamiyama     

Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis.

OBJECTIVE: To evaluate prognostic factors after resection of hepatocellular carcinoma (HCC) in patients with Child-Turcotte class B and C cirrhosis. SUMMARY BACKGROUND DATA: Although hepatic resection remains the mainstay in the treatment of HCC and can be performed with low morbidity and mortality rates in patients without cirrhosis, its role is poorly defined for patients with severe cirrhosis. METHODS: From 1986 to 1996, partial hepatectomy was performed for HCC in 63 patients with Child-Turcotte class B (n = 46) and C (n = 17) cirrhosis. There were 46 men and 17 women, with an average age of 61.2 years (range 35 to 79 years). Associated conditions were diabetes mellitus in 45, esophageal varices in 32, severe hypersplenism in 26, cholelithiasis in 13, gastroduodenal ulcer in 6, and hiatal hernia, gastric lymphoma, splenic abscess, and pancreatic cyst each in 1. Concomitant surgical procedures were performed for most of these conditions. RESULTS: Major complications occurred in 17 patients (27%), six (9.5%) of whom died within 1 month after surgery. The overall in-hospital death rate was 14.3%. Liver failure and intraabdominal sepsis were mostly fatal complications. The overall and disease-free survival rates, respectively, were 70.2% and 64.5% at 1 year, 43.5% and 23.8% at 3 years, and 21.4% and 14.9% at 5 years. Multivariate analysis with the Cox regression model revealed that favorable factors for survival were Child class B, no transcatheter arterial embolization before surgery, young age, and low alanine aminotransferase (ALT) level before surgery. CONCLUSIONS: Hepatic resection can provide a favorable result in young patients with HCC complicating Child class B cirrhosis with low hepatitis activity, but transcatheter arterial embolization before surgery should be avoided in such patients.     

Clinical evaluation of operative and non-operative treatment in hepatocellular carcinoma with main portal vein tumor thrombus]

It has been well recognized that results of treatment in hepatocellular carcinoma with main portal vein tumor thrombus (Vp 3 HCC) are very poor. But we tried aggressive transcatheter treatment (one shot or continuous hepatic arterial infusion, TAE) and hepatectomy with postoperative TAE in 52 cases by Vp3 HCC in recent 10 years. Analysis of the results disclosed that PR or CR cases were observed only in the series of continuous hepatic arterial infusion therapy. And cumulative survival rate was the best in the series of hepatectomy (50% survival interval is 18 months). We concluded that hepatectomy and resection of the tumor thrombus with postoperative TAE is the best treatment in Vp3 HCC.     

Hepatic Artery Chemoembolization for Hepatocellular Carcinoma in Patients Listed for Liver Transplantation

We retrospectively analyzed all listed patients having hepatic artery chemoembolization (HACE) for hepatocellular carcinoma (HCC) stage T2 or less. Outcomes were transplantation, waiting list removal, death, and HCC recurrence. Twenty patients (mean age 55.7 years; 15 males) were identified. Twelve (60%) were transplanted, seven (35%) were removed from the list and one (5%) remains listed. Fourteen (70%) are alive. All 12 transplanted patients are alive (mean 2.94 years); one of seven removed from the list is alive (mean 1.45 years). Survival was significantly higher for those transplanted or listed vs. removed from the list (100% vs. 14.3%, p = 0.0002). No HCC's recurred. Three patients (15%) were removed from the list after prolonged waiting times before MELD. Hepatic artery chemoembolization induced deterioration and removal from the list of one (5%) patient. Survival for those transplanted was excellent(100%), but overall survival was significantly lower (61.3%) at a mean 5.48 years. Hepatic artery chemoembolization for listed patients with 相似文献   

Hepatic artery infusion chemotherapy

Hepatic artery chemotherapy was given to 36 patients, using totally implantable devices consisting of a port and external pump. Twenty-seven patients had inoperable liver metastases of colorectal origin. The infusion system was inserted by laparotomy into the hepatic artery via the gastroduodenal artery. There was no operative mortality. Thirteen infusion systems could not be used for chemotherapy due to dislodgement, early death and lack of follow-up. FUdR was infused every two weeks. There were minor local complications like thrombosis of the system and dislodgement of the port. Toxic effects could be managed by reducing the dose. Response to chemotherapy was evaluated by survival, clinical condition, CEA, ultrasound and CT six months after onset of arterial chemotherapy. Ten/twenty-three patients (43%) responded to therapy, eight of them died on the average 19 months after initial chemotherapy. Six patients were non-responders, seven had stable disease. Five/ten patients developed extrahepatic metastases. Mean survival time was 13.1 months, mean interval until relapse 10.6 months.     

Hepatic Artery Chemoembolization in 122 Patients with Metastatic Carcinoid Tumor: Lessons Learned

Background Hepatic artery chemoembolization (HACE) is a treatment option in the management of metastatic carcinoid. We reviewed our experience to identify potential factors that influence survival. Methods The records of 122 patients with metastatic carcinoid tumor undergoing HACE were reviewed. Log-rank analysis and Cox proportional hazards were applied to identify factors predictive of decreased survival. Results Median follow-up after HACE was 21.5 months. Complications occurred in 23% with periprocedural mortality of 5%. Radiographic tumor regression was seen in 82%, with stabilization of disease in 12%. Median duration of CT response was 19 months. Improvement in symptoms occurred in 92% for median duration of 13 months. HACE resulted in complete normalization of serum pancreastatin in 14%, with greater than 20% reduction in another 66%. Median overall survival was 33.3 months after HACE. Only pancreastatin level ≥5,000 pg/ml was associated with decreased survival by multivariate analysis. Conclusion HACE offers symptom palliation and long-term survival in patients with incurable carcinoid metastases. Although safe, it should be approached cautiously in patients with significant tumor burden as evidenced by pancreastatin levels ≥5,000 pg/ml. We do not recommend whole-liver embolization in these patients but prefer a staged approach to each lobe of the liver. Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, Los Angeles, California, May 22, 2006.