双侧髂内动脉置管持续化疗灌注在妇科恶性肿瘤治疗中的应用

目的：探讨双髂内动脉置管持续化疗灌注对妇科恶性肿瘤术前、术后治疗中的临床意义。方法：采用双侧髂内动脉插管,先超选择对肿瘤或肿瘤术后区域给予长春新碱1mg,丝裂霉素10mg,环磷酰胺600mg分别稀释至20ml灌注,然后给予顺铂100～120rag稀释至1000ml经输液泵持续7—8h灌注治疗。结果：23例（42例次）双侧髂内动脉插管置管成功率为100％,5例达到减瘤目的后而行手术切除,15例手术切除后和2例二次手术切除后行介入治疗,均无复发;1例灌注后出现下肢神经损伤。结论：对妇科恶性肿瘤进行髂内动脉置管持续灌注化疗,可缩小肿块,减瘤作用明显,为手术切除肿瘤提供机会。同时,可明显抑制肿瘤术后的复发及提高肿瘤术后化疗的疗效,并改善症状。     

髂内动脉化疗栓塞药泵置入联合手术治疗浸润性膀胱癌

目的：探讨治疗浸润性膀胱癌的有效方法。方法：对60例经手术、病理证实并获随访的浸润性膀胱癌患者分为A、B两组,A组30例为髂内动脉化疗栓塞药泵置入后手术治疗组,B组30例为单纯手术治疗组,分析比较两组患者术后复发率、病死率的差异,了解介入联合手术治疗的效应。结果：A组患者术前髂内动脉化疗栓塞后完全缓解率（CR）为16．7％（5／30）,部分缓解率（PR）为70％（21／30）,有效率（CR＋PR）为86．7％。术后切除标本病理检查光镜下可见大片状癌细胞变性坏死,间质见炎细胞浸润。A组死亡4例（13．3％）,B组死亡8例（26．7％）。A组复发6例（20％）,B组复发14例（46．7％）。结论：髂内动脉化疗栓塞药泵置人后手术治疗浸润性膀胱癌,安全有效,能显著提高膀胱癌的疗效。     

奥美拉唑预防肝动脉化疗栓塞术后急性胃粘膜病变出血

目的观察奥美拉唑预防肝动脉化疗栓基术后急性胃粘膜病变出血的临床效果。方法46例病人术后当日静脉滴注奥美拉唑40mg，每天1次，并设非奥美拉唑对照组，疗程7天。结果奥美拉唑组出血率显著低于非奥美拉唑组（8．7％和27．5％，P〈0．005）。结论奥美拉唑对肝动脉化疗栓塞术后急性胃粘膜病变出血有良好的预防作用。     

经子宫动脉途径介入治疗输卵管妊娠

目的：探讨经子宫动脉途径治疗输卵管妊娠的可行性和临床疗效。方法：采用介入方法治疗34例输卵管妊娠患者,以4．1－5．0F导管行超选择性子宫动脉内灌注MTX（氨甲喋呤）50－100mg,灌注后用明胶海绵栓塞子宫动脉。术前、术后观察临床症状,体征、尿β-hCG(人绒毛膜促性腺激素）值及肿块大小变化。结果：34例中31例获得成功,成功率达91％。无不良反应发生。40支子宫动脉造影,显示输卵管动脉37支,显示率为92．5％;卵巢染色27例次,发现率达68％。6例显示孕囊染色,显示率为18％。结论：子宫动是输卵管的主要供血动脉,经子宫动脉途径介入治疗输卵管妊娠安全有效,并要预防和控制破裂大出血。     

地佐辛与哌替啶用于子宫动脉栓塞术术后镇痛效果对比观察

目的：对比观察地佐辛与哌替啶用于子宫动脉栓塞术后的镇痛效果及不良反应。方法：选择行子宫动脉栓塞术后80例,随机分为观察组和对照组各40例;观察组在手术结束时于滴壶内加注地佐辛0．1mg／kg,对照组加注哌替啶1．0mg／kg,分别记录两组患者术后24h内疼痛程度（VAS）评分,以及恶心、呕吐、瘙痒、嗜睡等不良反应发生情况。结果：观察组术后1h、2h、4h、12h的VAS分值均显著低于对照组（P〈0．05）;观察组术后24h内恶心、呕吐、瘙痒及嗜睡发生率显著低于对照组（P〈0．05）。结论：地佐辛用于子宫动脉栓塞术后镇痛不仅效果较好,且安全性较高。     

晚期宫颈癌血管内介入治疗的临床研究

目的 采用超选择性子宫动脉化疗栓塞治疗２８例晚期宫颈癌,探讨其疗效及并发症。材料与方法 治疗组２８例采用超选择子宫动脉化疗栓塞治疗,对照组３２例采用常规全身静脉化疗。结果 超选择性子宫动脉化疗栓塞治疗组完全有效（ＣＲ）＋部分有效（ＰＲ）为９２．９％（２６／２８）,全身静脉化疗组ＣＲ＋ＰＲ为３１．３％（１０／３２）,两组比较Ｐ〈０．０１。治疗组１０例获Ⅱ期手术切除。结论 采用超选择子宫动脉化疗检塞是     

超选择子宫动脉插管连续灌注化疗治疗子宫恶性肿瘤

目的：探讨超选择性子宫动脉插管连续灌注化疗(percutaneous transuterine arterial infusion chemotherapy,PTIC)治疗子宫内膜癌和宫颈癌的临床效果。资料与方法：PTIC治疗47例子宫恶性肿瘤（连续5天灌注化疗药物）。PTIC后47例患者均接受子宫切除根治术。有危险预后因素者接受放疗。结果：47例子宫动脉造影均可见肿瘤血管及肿瘤染色。化疗后复查者肿瘤血管和肿瘤染色均明显减少。12例子宫内膜癌和16例宫颈癌对PTIC有反应。术中发现肿瘤体积减小，手术时间缩短，术中出血量减少。结论：PTIC可使肿瘤体积减小、坏死，有效控制宫旁浸润和淋巴结转移。减小手术难度，缩短手术时间，减少术中出血量。     

PET／CT代谢体积对进展期肠型胃癌新辅助化疗疗效的价值

目的探讨基于肿瘤^18F-FDG摄取的MTV在肠型胃癌新辅助化疗（NAC）疗效评价中的应用价值。方法回顾性分析NAC前后均行^18F-FDGPET／CT检查的41例肠型胃癌患者（男28例,女13例）,根据术后病理分级分为有效组和无效组。对化疗前后的原发灶SUVmax减少率、MTV减少率与病理分级的关系进行Spearman分析,利用ROC曲线分析比较MTV减少率、SUVmax减少率预测病理学反应的效能。同时以术后病理为“金标准”,利用x^2检验比较以传统影像学为基础的实体瘤疗效评价标准（RECIST）1．0与PET／CTMTV减少率预测NAC后病理学反应的准确性。结果41例患者中,有效组20例,无效组21例。化疗前后SUVmax减少率、MTV减少率与病理分级的r分别为0．434和0．763（均P〈0．01）,预测病理学反应的AUC分别为0．789和0．943,差异有统计学意义（Z=2．114,P〈0．05）。以MTV减少率49．4％为评价化疗有效的阈值,其预测病理学反应灵敏度为90．0％（18／20）,特异性为90．5％（19／21）,准确性高于RECIST1．0[90．2％（37／41）和80．5％（33／41）;x^2=7．14,P〈0．05]。结论在FDG摄取的胃癌患者中,^18F-FDGPET／CT可用于NAC治疗反应的评价。MTV可作为评价治疗反应有效性的重要指标。     

术中温热低渗灌洗化疗及术后动脉插管化疗在胃癌中的应用

探讨胃癌手术切除后腹腔及肝转移的防治方法，对218例胃癌切除术后病人随机分成术中腹腔温热低渗灌洗化疗及术后动脉灌注化疗126例（简称治疗组）和单纯术后静脉化疗92例（简称对照组），并对其腹腔转移率，肝转率为3年生存率进行对照研究。结果治疗组腹腔转移率27％，肝脏转移率12．7％，3年生存率69．5％，对照组腹腔转移率44．5％，肝脏转移率26．1％，3年生存率47．8％，本结果表明，术中温热低渗灌洗化疗及术后动脉化疗对进展期胃癌术后腹腔复发和肝转移有良好的防治作用。     

卵巢动脉参与盆腔病变供血的介入诊疗研究

目的 观察卵巢动脉（OVA）参与盆腔疾病供血的出现频次，评价经导管栓塞OVA参与盆腔疾病供血的安全性。方法 用前瞻性方法对96例接受髂内-子宫动脉栓塞或化疗栓塞的患者进行了选择性OVA造影术，包括盆腔恶性肿瘤63例、子宫肌瘤17例、产科出血性疾病16例，平均年龄46岁。有盆腔手术史者12例。既往曾行髂内-子宫动脉栓塞术者6例。存在一侧或两侧子宫动脉发育不良者8例，两侧子宫动脉发育良好者（除去手术和已行栓塞治疗的患者）70例。对参与盆腔病变供血的OVA进行了选择。降栓塞术，观察OVA参与盆腔疾病供血的频次、影响因素，评价栓塞OVA的安全性和临床意义。结果 96例中，两侧OVA插管成功者58例（60.4％），一侧插管成功者38例（39．6％）。选择性造影发现至少有一侧OVA参与盆腔病变供血者33例（34．4％），包括盆腔恶性肿瘤18例、子宫肌瘤5例、产科出血性疾病10例。33例中有盆腔手术史者7例，曾行髂内-子宫动脉栓塞术者5例，存在一侧或两侧子宫动脉发育不良者8例，两侧子宫动脉发育良好者13例。OVA参与盆腔疾病供血的高发因素有：与孕产相关的出血性疾病（X^2=6．73，P=0．009）、既往有盆腔手术史（X^2=3．55，P=0．04）、既往曾行子宫动脉栓塞术（X^2=6，80，P=0．009）、存在一侧或两侧子宫动脉发育不良（X^2=3．40，P=0．04）。对33例参与盆腔供血的OVA进行了栓塞术，操作成功率为100％，无重要并发症。4例与产科相关的出血性疾病，曾行两侧髂内-子宫动脉栓塞后出血未止，经栓塞参与供血的OVA后出血立即停止。4例介入治疗后出现一过性卵巢功能减退症状。结论 OVA参与盆腔疾病供血的发生率达34％。在行髂内-子宫动脉栓塞或化疗栓塞术时，如发现OVA参与盆腔病变供血，补充OVA栓塞术是安全和有价值的。     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

盐酸法舒地尔在妇科介入治疗中的应用

目的探讨经子宫动脉介入诊治过程中子宫动脉痉挛的发生率,评估盐酸法舒地尔对解除子宫动脉痉挛的有效性和安全性。方法 2007年07月至2011年11月87例接受经子宫动脉造影和介入治疗患者,在子宫动脉插管造影、灌注化疗及血管栓塞过程中发生子宫动脉痉挛,并根据子宫动脉痉挛程度分为轻度、中度、重度、顽固性4类。对于中、重度、顽固性子宫动脉痉挛者给予导管内缓慢推注盐酸法舒地尔5 mg,观察子宫动脉痉挛解除时间,记录推注前后血压、心率变化情况,同时观察患者有无头晕、头痛、视物模糊、消化系统及过敏等不良反应。结果 87例中有65例(75%)发生不同程度子宫动脉痉挛,其中轻度5例、中度16例、重度4I例、顽固性3例。给中度以上子宫动脉痉挛者推注5 mg盐酸法舒地尔后,5 min内均能迅速解除痉挛,成功实施介入诊治。推注盐酸法舒地尔前后血压、心率差异均无统计学意义(P>0.05),1例患者发生低血压、颜面潮红,心慌。结论盐酸法舒地尔可安全、有效、迅速缓解子宫动脉痉挛。     

肠系膜下动脉在晚期卵巢癌及其术后复发介入治疗中的价值

目的 探讨肠系膜下动脉在晚期卵巢癌及其术后复发患者介入治疗中的价值.方法 对34例晚期卵巢癌及术后复发患者(其中晚期22例,术后复发12例)在行常规双侧髂内动脉和(或)子宫动脉化疗和(或)栓塞后,对肠系膜下动脉参与供血者行灌注化疗,并观察其疗效.结果 本组病例中,共有26例肠系膜下动脉参与肿瘤供血.灌注化疗后3周随访CT见肿块皆有不同程度缩小.1例另行栓塞治疗,未出现肠坏死等并发症;其中卵巢癌术后复发者肠系膜下动脉有异常供血占90.9%(20/22),而晚期者则占50.0%(6/12),2组间差异有统计学意义(X2=7.2,P=0.007);卵巢癌FIGO分期Ⅲ期占61.5%(8/13),Ⅳ期占85.7%(18/21),2组间差异无统计学意义(X2=2.608,P=0.16).结论 在晚期卵巢癌,尤其是术后复发患者的血管内介入治疗中,肠系膜下动脉常参与肿瘤的血供,故常规仅行双侧髂内动脉和(或)子宫动脉介人治疗往往疗效不佳.因此对此类患者行血管内介入治疗时,常规探查肠系膜下动脉并进行灌注化疗,具有重要的临床价值.     

白芨在经肝动脉化疗栓塞术治疗大鼠肝细胞癌实验中的应用

目的评价白芨在经肝动脉化疗栓塞术(transarterialchemoembolization,TACE)治疗ACI大鼠肝细胞癌实验中的应用价值。方法在30只ACI大鼠肝包膜下植入MorrisHepatom3924A肝癌瘤块(2mm3),移植术后13d进行MR检查,测量肿瘤体积(V1),第14天时,经大鼠胃十二指肠动脉逆行插管至肝动脉,采取以下治疗方案A组01mg丝裂霉素+01ml碘油+10mg白芨(10只);B组01mg丝裂霉素+01ml碘油+10mg白芨+肝动脉结扎(10只);C组01mg丝裂霉素+01ml碘油(对照组,10只)。13d后再次进行MR检查以测量肿瘤体积(V2),比较肝肿瘤体积生长率(V2/V1)。结果介入治疗后与治疗前肿瘤体积之比(V2/V1)分别为A组628,B组153,C组914。与对照组C相比,采取A、B组的治疗方案均能抑制肝肿瘤的生长(P<005和P<001),A组与B组之间的肿瘤生长率差异亦有统计学意义(P<001)。结论白芨作为肝动脉栓塞剂,结合局部化疗术和肝动脉结扎术能明显抑制大鼠肝细胞癌的生长。     

Factors predicting tumour regression in locally advanced cervical adenocarcinoma treated with balloon-occluded intra-arterial chemotherapy

We retrospectively assessed the factors that may impede tumour reduction of locally advanced cervical adenocarcinoma treated with balloon-occluded arterial infusion chemotherapy (BOAI) as initial therapy. We reviewed the medical records and MRI scans of 31 patients (mean age, 54.7 years; age range, 33-78 years). BOAI was performed via uterine arteries in 21 patients, and via the anterior division or main trunk of the internal iliac artery (when the uterine arteries were obscured) in 10 patients. Tumour reduction rate was calculated from the tumour size on MRI before and after BOAI, and patients given chemotherapy were classified as "non-responders" or "responders". Factors including the patient's age, tumour stage (using the International Federation of Gynecology and Obstetrics classification), the artery used for infusion, infused drug, presence of intravenous systemic chemotherapy, initial tumour size, tumour volume and presence of lymph node metastases were assessed for their ability to predict tumour response to BOAI using univariate and multivariate analyses. Patients who underwent chemotherapy included 10 non-responders and 21 responders. The age of non-responders was significantly higher than that of responders (66 years vs 49 years, p<0.001). Internal iliac arterial infusion significantly correlated with "no response" compared with uterine arterial infusion (p<0.001). In multivariate analyses, internal iliac arterial infusion was an independent predictor for BOAI non-responders (odds ratio, 19.6; 95% confidence interval, 1.4-280.6; p = 0.02). These data suggest that uterine arteries being obscured to arterial infusion may be associated with a poor response to BOAI for cervical adenocarcinoma.     

介入动脉化疗加放射治疗鼻咽癌的近期疗效

目的 探讨经颈动脉灌注化疗药物治疗加放疗对鼻咽癌的疗效.方法 22例患者经临床(包括鼻咽镜检)、影像学(CT、MR)和病理学检查确诊为鼻咽癌,经颈外动脉介入化疗后加放射治疗.化疗药物为阿霉素(ADM)或吡柔比星、5-氟尿嘧啶(5-FU)和顺铂(DDP)或卡铂(CBP).同时随机选择同期单纯放疗的25例作为对照,比较其疗效.结果 介入组总有效率为100.0%,其中CR为90.9%(20/22),对照组总有效率为100.0%,其中CR为68.0%(17/25),两组分别比较差异有统计学意义(P＜0.05).结论 介入动脉化疗后加放射治疗能显著提高鼻咽癌治疗的疗效.     

子宫动脉栓塞术治疗子宫肌瘤的疗效观察和安全性分析

目的分析子宫动脉栓塞术治疗子宫肌瘤的疗效和安全性。方法选择2010年7月~2012年3月我院收治的137例子宫肌瘤患者为研究对象,应用随机数字表法将子宫肌瘤患者分为治疗组和对照组,对照组采用传统激素治疗（61例）,治疗组则在月经来潮干净后1周内采用子宫动脉栓塞术（76例）。随访半年,比较两组患者的临床疗效和安全性。结果治疗组总有效率（89.48%）显著高于对照组（52.46%）,χ2=23.5185,P〈0.01。治疗组失败率与对照组相差不大（χ2=1.5021,P〉0.05）。结论子宫动脉栓塞术与传统激素治疗相比具有高效、微创、恢复时间短等优点。     

Intraarterial chemotherapy for uterine cervical adenocarcinoma: evaluation of its efficacy as neoadjuvant therapy

We performed preoperative intraarterial chemotherapy in twenty cases of uterine cervical adenocarcinoma (stage Ib: 2, II: 15, III: 3) and evaluated the efficacy of this therapy. The dosages used were 75-120 mg of CDDP, 10-20 mg of MMC and 30-60 mg of EPIR. These drugs were administered by intraarterial one-shot infusion twice every three weeks. In five cases, complete response (CR) of the primary lesion was confirmed by histologic examination. There were no cases of CR inpatients with well differentiated adenocarcinoma. Stage reduction was achieved in all cases except three. In all but one case, more than 50% volume reduction was recognized on MR images. These results were not significantly different from those in cases of uterine cervical squamous cell carcinoma in which we performed this therapy. Therefore, we concluded that intraarterial chemotherapy is highly effective and should be carried out as neoadjuvant therapy for advanced uterine cervical adenocarcinoma.     

Multidetector-row computed tomography angiography for planning intra-arterial chemotherapy pump placement in patients with colorectal metastases to the liver

PURPOSE: The purpose of this study was to evaluate the use of multidetector computed tomography (MDCT) in the preoperative arterial evaluation of patients scheduled to undergo intra-arterial chemotherapy pump placement. METHODS: Computed tomography scans of 30 patients with hepatic malignancies who were imaged with multiphase MDCT angiography for intra-arterial chemotherapy pump placement were retrospectively analyzed. Dual-phase helical CT was performed, and the arterial phase images were processed to depict the arterial anatomy and to identify pertinent anomalies. All findings were compared and correlated with surgical findings or catheter angiography if surgery was contraindicated. RESULTS: Arterial anomalies identified on CT angiography in 20 of 30 patients included a replaced right hepatic artery (RHA; n = 6) or left hepatic artery (LHA; n = 8), a replaced common hepatic artery (n = 1), an accessory RHA (n = 2) or LHA (n = 6), a replaced gastroduodenal artery (GDA; n = 2), an extrahepatic connection between the accessory RHA and the replaced RHA (n = 1), and a common origin composed of the GDA and RHA and LHA (n = 2). There were no additional arteries or anomalies identified by catheter angiography, when available, or during surgery. Only 1 variant, an accessory hepatic artery, was not located during surgery. In 2 patients, the surgical team decided that pump placement was not feasible because of overly complex anatomy as determined by CT angiography. Computed tomography angiography showed an overall sensitivity of 100% and specificity of 97%. CONCLUSIONS: Multidetector computed tomography angiography is accurate for the preoperative evaluation of normal and aberrant hepatic vasculature in patients under consideration for intra-arterial chemotherapy pump placement. Axial images alone permit recognition of vascular anomalies, including complex anatomy. Nevertheless, 3-dimensional rendering is useful to evaluate complex vascular anatomy and does not require catheter angiographic confirmation. In addition to aiding in selecting patients ideal for pump placement, MDCT permits noninvasive planning of their surgical approach.