术前短程冲击放疗、术后后装放疗治疗原发性肝癌

目的 探讨术前短程冲击放疗和术后后装照射治疗原发性肝癌的治疗效果。方法 自1998年5月至1999年10月，将50例行肝癌切除术的原发性肝癌病人随机分为放疗组和对照组，每组25例。放疗组术前先行放疗6Gy，共3次，休息2周后再手术。术中放置施源管3－6根，确定驻留点2－8个，术后3－10d行后装照射，单次剂量10Gy，照射2－4次，总剂量20－40Gy。对照组手术前后不放疗。手术前后定期查血常规、肝功能、AFP、CT、B超、胸片，记录术中出血量。结果 放疗组术前放疗后肿瘤明显缩小（P＜0.05)；术中出血量显著低于对照组（P＜0.05)；后装照射后AFP转阴率100％（16／16），对照组63.6%（9／14）（P＜0.01)；6个月复发率0，低于对照组20％（5／25）（P＜0.01)；6个月生存率100％（25／25）无显著差异（P＞0.05)。结论 手术前短程冲击放疗和术后后装放疗是提高原发性肝癌近期治疗效果，降低复发率的有效手段。     

术前短程冲击放疗和术后后装放疗治疗原发性肝癌

目的：探讨术前短程冲击放疗和术后后装照射治疗原发性肝癌（PLC）的效果。方法：50例行肝癌切除术的PLC患者随机分为放疗组和对照组，每组25例。放疗组术前先行放疗6Gy，共3次，休息2周后再手术。术中放置施源管3－6根，确定驻留点2－8个，术后3－10d行后装照射，单次剂量10Gy，照射2－4次，总剂量20－40Gy。对照组手术前后不行放疗。结果：放疗组术前放疗后肿瘤明显缩小（P＜0．05）；术中出血量显著低于对照组（P＜0．05）；后装照射后AFP转阴率100％（16／16），对照组56．3％（9／14）（P＜0．01）；放射组术后6个月复发率（0）显著低于对照组（20．0％）（P＜0．01）；6个月生存率（100％）与对照组（92．0％）无显著差异（P＞0．05）。结论：手术前短程冲击放疗和术后后装放疗是提高PLC近期治疗效果，降低复发率的有效手段。     

微波热凝治疗转移性肝癌

转移性肝癌是临床上常见的疾病，虽然手术切除是有效的方法之一，但有相当多的病例在手术切除后再次复发，和转移性肝癌常是以多发出现，手术切除并不都适宜，仅有5%～10%的病人适合手术切除。从2001年6月至2004年8月，作者应用微波经皮肝穿刺热凝损毁原发性肝癌的方法（PMCT），开始对转移性肝癌行该项治疗，共治疗了47例，126个转移性癌灶，对疗效、生存率进行了总结，报告如下。     

术中肠腔内置管在急诊左半结肠切除一期吻合术中的应用

自1994年以来,我们采用术中肠腔内置管的方法,应用于急诊左半结肠切除一期吻合术13例,经临床观察,取得了较好的效果,现报道如下。 1 临床资料 本组13例,男9例,女4例。年龄10～68岁,平均47岁。其中左半结肠痛合并梗阻8例,左半结肠癌合并穿孔1例,乙状结肠扭转坏死1例,外伤致     

原发性及转移性肝癌射频毁损治疗

近年来随着集束(多弹头)射频电极针的研制成功,肝癌射频毁损(radiofrequency ablation,RFA)治疗得到迅速发展,成为目前国内外肝癌治疗的一个热点。我院自1999年8月开展肝癌射频毁损治疗,至今共治疗76例,效果良好,现将结果报告如下。资料及方法1.病人情况:从1999年8月至2000年7月,对76例病人共168个肿瘤实施了 RFA 治疗。其中男     

转移性肝血管外皮瘤一例报道

病人:女,70岁。因体检发现肝占位性病变5d就诊,体检未见异常。AFP、CA1 9 9、CEA正常。B型超声示:肝右前叶下段4 9.4mm×37.9mm低回声团块,边界可见,内回声不均,中心见液性区。CT示:肝脏平扫右前叶4 .7cm×3.8cm内分隔低密度影,边缘清晰,增强动脉期明显强化,呈粗分隔状,门脉期密度稍减为略高密度影,延迟期分隔呈等密度。诊断:肝右前叶占位,血管源性肿瘤可能。病人于1 979年行下肢血管外皮瘤切除术,病理示:良性血管外皮瘤。1 996年行左肺肿瘤切除术,病理示:转移性低度恶性血管外皮瘤。本次行右肝肿瘤切除术(V段) ,术中见:肝右前叶下段一…     

前列腺癌近距离后装放疗临床疗效观察

前列腺癌近距离后装放疗临床疗效观察吴小候何梓铭梁思敏陈绪元自１９９３～１９９６年，对１２例Ｃ期前列腺癌采用经尿道１９２Ｉｒ近距离后装放射治疗，近期疗效较好。报告如下。临床资料前列腺癌１２例。年龄６５～８１岁。均有显著的尿频、排尿困难等症状，其中尿潴留...     

转移性肝癌的外科治疗(附208例报告)

目的　探讨转移性肝癌手术治疗效果。方法　回顾性分析我院近7 年来收治的208 例转移性肝癌患者资料,根据治疗方式不同,将其分为切除性手术组(116 例)与非切除性手术组(92 例),比较两组的治疗效果。结果　全组手术无死亡,术后1、3、5年生存率分别为56.3%、23.1%和13.0%。切除性手术组患者1、3、5 年总生存率分别为74.1%、39.7%和23.3%,非切除性手术组患者1、3、5年生存率分别为33.7%、2.2%和0,前者的治疗效果明显好于后者(P<0.05)。结论　切除性手术是转移性肝癌有效的治疗方法,能耐受切除者应力争切除治疗。     

扩大的右后叶肝切除治疗转移性肝癌

作者于1990年4月至1996年6月，对10例转移性肝癌患者施行了扩大的右后叶肝切除（ERPS）。原发肿瘤源于结肠者5例，直肠3例，胆管和胃各1例，5例为多发性转移癌，对其中4例在施行ERPS的同时，对右后叶以外的转移灶附加肝楔形切除。所有转移癌均为非同步型，原发癌手术至肝切除的时间为7～48个月。术前肝功能检查和丐除青绿15分钟储留率无明显异常。通过右侧第9肋间隙作胸腹联合切口。切开揭肌，使术者左手能进入右侧胸腔，以便能托起肝右叶，在其上部分离肝实质。然后切开镰状韧带和冠状韧带，分离肝上区，显露肝右静脉（RHV）和下腔静…     

手术切除结直肠癌肝多个转移瘤的效果分析

目的对于结直肠癌患者肝内存在多个转移瘤,手术切除的价值存在争议,本文旨在研究手术切除大肠癌肝多个ΚΣ瘤的效果。方法回顾性分析1996年1月至2006年12月收治的经手术切除的结直肠癌肝转移瘤患者60例,比较肝内单个转移瘤(35例)与多个转移瘤(25例)患者临床和预后资料。结果两组均无手术死亡。多个转移瘤组和单个转移瘤组相比,手术并发症为12.0%vs11.4%(P=1.000);平均住院时间为(14.9±5.1)dvs(15.7±5.8)d(P=0.844);中位生存期为28个月vs35个月(P=0.089);中位无瘤生存期为16个月vs19个月(P=0.112);肝内复发率为72.0%vs51.5%(P=0.109)。多个转移瘤组3、5年总生存率分别是48.4%、30.8%,单个转移瘤组分别为68.6%、57.7%(P=0.165)。结论手术切除结直肠癌肝脏多个转移瘤可取得与单个转移瘤相似的效果。手术切除不应视为肝多个转移瘤的禁忌证。术后辅以全身化疗常可以改善预后。     

大肠癌伴同时性肝转移126例临床分析

目的探讨大肠癌肝转移的临床特点与诊治效果。方法对126例大肠癌肝转移的临床资料进行回顾性总结分析。结果大肠癌同时性切除肝转移灶的手术切除率为17.5%(22/126),同时切除肝转移灶的病例1年生存率68.2%(15/22),3年生存率为40.9%(9/22),5年生存率为18.2%(4/22);而未切除肝转移灶的病例1年生存率为54.8%(57/104),3年生存率为16.3%(17/104),5年生存率为0%,两组生存率比较差异有显著性意义(P0.05)。结论手术同时切除肝转移灶为大肠癌伴同时性肝转移的首选治疗方法。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

目的 比较FOLFOX-6方案全身化疗与传统以氟尿嘧啶为主的肝动脉灌注化疗对结直肠癌术后肝转移病人的疗效并分析影响结直肠癌术后肝转移病人的预后因素.方法 46名结直肠癌术后肝转移病人随机分配到全身化疗组(实验组)和介入治疗组(对照组),对比观察近远期疗效、毒副作用和生活质量.将影响预后的临床特征和治疗方式进行单因素和多因素分析.结果 实验组、对照组总生存率差异有统计学意义(P=0.048),中位生存时间分别为15.0个月和11.2个月(P＜0.05);治疗总有效率两组差异有统计学意义(50%和10%;P=0.011);两组治疗期间的PS评分差异无统计学意义(P=0.126).毒副作用除骨髓抑制、腹痛外,其它比较差异均无统计学意义.单因素分析显示,原发病灶是否浸润浆膜、肝转移灶分布、肝转移病灶最大直径、肝转移灶数目、原发癌有无淋巴结转移以及治疗方式与预后相关.多因素分析后发现,肝转移灶最大直径、肝转移病灶数目、原发癌灶是否浸透浆膜层和治疗模式为影响预后的独立因素.结论 以草酸铂为主的FOLFOX-6方案比传统的以氟尿嘧啶为主的肝动脉灌注化疗有更好的治疗缓解率和远期疗效;肝转移灶最大直径＞5 cm、肝转移灶多发和原发病灶浸透浆膜层提示病人预后不良,采取以草酸铂为主的全身化疗,预后更好.传统药物介人治疗需要改进,局部介入与全身治疗结合的方式值得进一步探究.     

Long-term survival in patients with ovarian metastases from colorectal carcinoma

Background: Ovarian metastases (OM) are a relatively uncommon consequence of primary colorectal carcinoma (CRC). The authors present a retrospective review of the impact of elective and therapeutic oophorectomy on the natural history of CRC. Methods: Patients with primary CRC from January 1964 through March 1996 were reviewed. Survival from the time of OM diagnosis was estimated by the Kaplan-Meier method; differences between groups were based on the log-rank test. Results: A total of 155 patients were studied. Synchronous OM occurred in 90 patients (58.1%); metachronous OM occurred in 65 patients (41.9%). Estimated 5-year survival for patients with synchronous OM was 9%, versus 20% for metachronous OM (P<.0001). Resection of metastatic disease was associated with an improved 5-year survival for synchronous OM (15% vs. 0%,P=.0001) and metachronous OM (24% vs. 0%,P<.0001) if patients were disease-free postoperatively. Other clinical characteristics, including age, menopausal status, stage, and location of primary tumor, had no significant impact on survival. Conclusions: Ovarian metastases from colorectal carcinoma are associated with a poor outcome. Although there is no survival advantage associated with resection of occult microscopic disease, long-term survival is possible if patients are rendered surgically disease-free.Presented at the 51st Annual Cancer Symposium of The Society of Surgical Oncology, San Diego, California, March 26–29, 1998.     

Multiple fibre interstitial photodynamic therapy of patients with colorectal liver metastases

Multiple fibre interstitial photodynamic therapy (IPDT) was performed in patients with colorectal hepatic metastases (CRHM) to determine treatment response and side-effects. Ten patients aged 48–75 years with 16 CRHM (seven solitary) were sensitized with (111 mg m⁻²) haematoporphyrin derivative intravenously. Forty-eight hours later a custom-designed light delivery system guided by ultrasound allowed 630 nm light from a copper vapour pumped-dye laser split into four 200 μm optical fibres to be geometrically positioned within the metastasis. This was performed percutaneously in four patients and at laparotomy in six. Metastases were imaged using computerized tomography and volumes measured by planimetry. Growth was expressed as a ratio relative to the initial volume (RVG). Following IPDT no complications occurred. Three metastases were not treated because of technical problems. No patient suffered skin photosensitivity reactions. Twelve weeks following IPDT, 12 metastases of less than 60 cc initial volume had a mean RVG of 0.99 (s.d. 0.27). One large solitary metastasis continued to grow after IPDT with a RVG of 1.9 after 12 weeks. Untreated hepatic metastases had a mean RVG of 2.13 after 12 weeks. These data suggest that IPDT can reduce the growth of small hepatic metastases and can be performed with low morbidity when applied at laparotomy and with minimally invasive techniques.     

结直肠癌肝转移根治性切除预后因素分析

目的 分析影响结直肠癌肝转移患者根治性手术切除预后的临床病理因素,探讨改善患者预后的方法.方法 收集2005年1月至201 1年12月江苏省苏北人民医院和复旦大学附属肿瘤医院收治的103例结直肠癌肝转移根治性切除患者的临床资料.采用Kaplan-Meier法计算生存率,用Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 103例患者均获随访,随访时间10～ 60个月,术后1、3、5年生存率分别为90％、49％、39％.单因素分析结果显示:肝转移灶数目、大小、分布、术前CEA水平、手术并发症、术后化疗是肝转移灶切除术后的影响因素(x2值分别为24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05);多因素分析显示,肝转移灶数目、肝转移灶切除术前CEA水平、手术并发症是影响预后的独立因素(Wald=7.974、12.051、11.547,P＜0.05).结论 肝转移灶数目、肝转移灶切除术前CEA水平和手术并发症是影响结直肠癌肝转移患者预后的独立因素.适当扩大手术切除的适应证,加强对高危患者的随访和术后辅助化疗,可能改善肝转移患者的预后.     

Unique site- and time-specific patterns of recurrence following resection of colorectal carcinoma hepatic metastases in patients staged by FDG-PET

BACKGROUND/PURPOSE: We recently reported that patients staged by positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) prior to liver resection for metastatic colorectal cancer had an excellent 5-year survival. In this study, the site- and time-specific patterns of recurrence were examined in patients staged by FDG-PET and the results compared to historical literature control data. METHODS: From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET. A prospective database was maintained. RESULTS: One hundred patients were studied; 48 patients had no evidence of recurrence, 30 patients had recurrence within 12 months of resection, and 22 patients had recurrence after 12 months. Seventy percent of patients with recurrence within 1 year of resection had intrahepatic recurrence. Furthermore, 86% of patients with recurrence more than 1 year after resection had extrahepatic recurrence. We reviewed all published case series of conventionally staged patients. This pattern of early recurrence in the liver and later recurrence in extrahepatic sites has not been reported in any of the conventionally staged series. CONCLUSIONS: There is an interesting difference in the pattern of recurrence of FDG-PET-staged patients and conventionally staged patients who undergo liver resection. Several explanations seem possible. One potential explanation requiring further study is that the pattern of recurrence is due to the convergence of two factors-that FDG-PET more effectively detects extrahepatic disease than conventional staging and that liver resection gives a growth spurt to hepatic metastases.     

Surgery for multiple hepatic colorectal metastases

The purpose of this review is to address three important questions concerning hepatic resection for multiple colorectal metastases. (1) Is the number of tumors truly a significant prognostic factor? (2) Are patients with four or more tumors contraindicated for hepatic resection? (3) Up to how many nodules should we attempt to resect? Although the efficacy of surgical resection for one to three hepatic metastases is clear, based on several reports, the literature regarding the resection of four or more metastatic lesions is conflicting. Review of the data at our institutions showed that the number of tumors was a significant prognostic factor, because patient survival after liver resection for multiple metastases was worse than that for single metastasis. However, patients with two or three nodules and those with four or more nodules showed the same survival curves, or those with four or more metastases fared even better. Therefore, patients with four or more metastases should be considered for hepatic resection. The maximum number of hepatic tumors in longterm survivors reported in the literature has been increasing, and the limit for the number of respectable metastases has not yet been determined. Because liver resection is still the only treatment that offers a cure, surgery for multiple metastases may be justified as long as the operation is safe and technically feasible.     

原发性结直肠癌肝转移危险因素分析

目的：初步判断结直肠癌患肝转移的危险性，方法：选择10个可能会影响肝转移的因素：患年龄、性别、地区分布、肿瘤病理类型、部位、大小、浸润深度、侵犯肠管周径、术前癌胚抗原（CEA）水平及淋巴结转移情况，建立原发性结直肠癌肝转移危险性预测的Logistic回归模型，结果：年龄、术前CEA水平和淋巴结转移情况这3个因素对肝转移影响较为显，其回归系数分别为0．0215，0．9584和0．6404；标准误分析为0．0113，0．02740和0．29892；P值分别为0．0379，0．0005、0．0268。其他因素如浸润肠壁深度及侵犯肠管周径等对肝转移的发生也有影响，但非独立的危险因素。结论：年龄、术前CEA水平和淋巴结转移情况是原发性结直肠癌肝转移的3个显性的危险因素。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.