中晚期巨块型原发性肝癌的介入热化疗栓塞治疗

目的探讨介入热化疗栓塞（IHC）治疗巨块型原发性肝癌的疗效,并与经肝动脉化疗栓塞（TACE）进行对比。方法IHC治疗的中晚期巨块型原发性肝癌患者68例作为观察组,同期单纯行TACE治疗32例患者作为对照组。比较2组患者的疗效、生存质量、二次手术率、血清AFP下降程度、生存率及毒副作用。结果观察组有效率（79．4％）显著高于对照组（56．3％）,P〈0．05。观察组经治疗后二次手术切除率（70．6％）显著高于对照组（43．8％）,P〈0．01。观察组经治疗后Karnofsky评分增加20分以上者（35．3％）显著高于对照组（12．5％）,P〈0．01;AFP下降程度大于50％者所占比例（52．9％）显著高于对照组（25．0％）,P〈0．01。观察组术后12、18、24个月患者存活率均分别显著高于对照组（P〈0．01）。结论IHC治疗巨块型原发性肝癌疗效显著,可增加患者二次手术的机会,是治疗巨块型肝癌安全有效的治疗方式之一。     

125I粒子联合肝动脉化疗栓塞对原发性肝癌的疗效研究分析

目的 探讨125I粒子联合肝动脉化疗栓塞对原发性肝癌的治疗效果.方法 选取2009年9月至2015年10月在我院收治的70例原发性肝癌患者,按随机分组法将患者分为观察组和对照组,每组各35例.对照组单纯采用TACE法治疗,观察组采用TACE联合125I放射性粒子植入治疗组.治疗后的1、2、3月检测两组患者的血常规、肝功能、肿瘤体积的变化及患者肿瘤标志物(AFP)水平变化情况,并对两组患者进行疗效评价.结果 治疗后,观察组有效率(RR)为85.7％,临床总控制率(CR +PR +SD)为94.3％,对照组有效率(RR)为66.7％,临床总控制率(CR +PR +SD)为71.4％,观察组的疗效明显优于对照组,差异有统计学意义(P＜0.05).在AFP阳性患者中,观察组AFP减小率(转阴率+降低率)显著高于TACE对照组组(P＜0.05),差异有统计学意义.两组患者的术后并发症差异无统计学意义.结论 125I放射性粒子植入联合TACE治疗原发性肝癌疗效确切,安全可靠,不仅改善了患者的生存质量,提高了患者的生存期,还抑制了肿瘤的复发,值得在临床推广和应用.     

射频消融联合经导管肝动脉化疗栓塞术治疗原发性肝癌

目的探讨经导管肝动脉化疗栓塞术(TACE)联合射频消融对原发性肝癌的治疗效果。方法将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共80例,按住院号数的单、双数分成两组:对照组(TACE组)42例,综合治疗组(TACE 射频消融组)38例。对照组只给予TACE治疗,综合治疗组先行TACE后2~3周再予联合射频消融治疗。两组患者行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予相应处理。结果TACE组治疗42例患者,1、2、3年生存率分别为72%、55%和21%,中位生存期1.78年;综合治疗组38例患者1、2、3年生存率分别为89%、78%和53%,中位生存期2.31年。综合治疗组的生存率及生存期均显著高于TACE组(P<0.05)。综合治疗组的综合介入治疗效果与死亡风险率呈显著的负相关(OR=0.570,P<0.05)。结论TACE联合射频消融对原发性肝癌的治疗可显著提高原发性肝癌的生存率,延长生存期。     

肝动脉栓塞化疗治疗原发性肝癌并门静脉癌栓108例

原发性肝癌（下称肝癌）伴门静脉癌栓形成（PTT）属肝癌晚期，易形成肝内播散转移，是影响肝癌预后的重要因素之一，既往采取保守治疗或中医中药治疗，甚或放弃治疗，多数患者于数月内死亡。近10年来，我科对肝癌合并PTT患者采取灌注化疗（TAI）和／或栓塞化疗（TAE—IP），取得满意疗效，现总结报告如下。     

射频消融联合经导管肝动脉化疗栓塞术治疗原发性肝癌

目的 探讨经导管肝动脉化疗栓塞术(TACE)联合射频消融对原发性肝癌的治疗效果.方法 将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共80例,按住院号数的单、双数分成两组:对照组(TACE组)42例,综合治疗组(TACE+射频消融组)38例.对照组只给予TACE治疗,综合治疗组先行TACE后2～3周再予联合射频消融治疗.两组患者行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予相应处理.结果 TACE组治疗42例患者,1、2、3年生存率分别为72%、55%和21%,中位生存期1.78年;综合治疗组38例患者1、2、3年生存率分别为89%、78%和53%,中位生存期2.31年.综合治疗组的生存率及生存期均显著高于TACE组(P＜0.05).综合治疗组的综合介入治疗效果与死亡风险率呈显著的负相关(OR=0.570,P＜0.05).结论 TACE联合射频消融对原发性肝癌的治疗可显著提高原发性肝癌的生存率,延长生存期.     

肝动脉化疗栓塞术治疗肝癌的护理体会

原发性肝癌是常见的恶性肿瘤之一,80%患者发现时已失去手术机会.肝动脉栓塞化疗术(TACE)是近几年来对早、中期肝癌非手术治疗的一种新技术,其特点是损伤小,操作简便易行,治疗效果显著[1].     

腹腔干动脉狭窄患者肝癌的TACE治疗结果分析

目的研究腹腔干动脉狭窄后肝癌患者经侧枝循环行导管肝动脉化疗栓塞（TACE）治疗的方法和疗效。方法对11例腹腔干动脉狭窄后肝癌患者应用RH、Cobra配合微导管技术进行治疗。结果 2例经腹腔干插管至肝段水平行化疗栓塞。7例经肠系膜上动脉插管至肝段水平,并行化疗及栓塞治疗,插管成功率为77.8%（7/9）;4～6周复查,CT显示肿瘤缩小,碘油沉积致密。2例插管至肝固有动脉行灌注化疗。结论腹腔干动脉狭窄后肝脏可形成丰富的侧枝循环,其中肠系膜上动脉供血尤为常见,应用RH、Cobra导管配合微导管技术,多能顺利插管至肝段水平对肝癌行TACE治疗。     

89例巨块型原发性肝癌介入化疗栓塞治疗体会

目的 探索巨块型原发性肝癌介入栓塞治疗的疗效.方法 89例巨块型原发性肝癌患者,经皮股动脉穿刺插管至肝动脉,化疗栓塞治疗肝癌;碘油用量为20～50ml.再注入明胶海绵颗粒栓塞治疗.发现肝外肿瘤供血动脉,超选择插管化疗栓塞后,注入适量明胶海绵栓塞治疗.结果 本组病例中首次DSA造影发现11例存在肝外动脉供血;64例出现肝外供血动脉共计67支.术后甲胎球蛋白下降均>50%.术后4～6周复查CT,肿瘤最大直径缩小3.5～5.9cm.1、2、3年累计生存率分别为73.8%、48.3%和28.5%.结论 巨块型原发性肝癌大剂量碘油栓塞联合肝外肿瘤供血动脉介入治疗,对于提高巨块型原发性肝癌的介入疗效具有重要意义.     

TACE联合三维适形放疗治疗晚期肝癌临床疗效及对患者近远期生存的影响

目的:探讨肝动脉化疗栓塞术(Transcatheter arterial chemoembolization,TACE)联合三维适形放疗(Three-dimensional conformal radiotherapy,3-DCRT)治疗晚期肝癌(Hepatocellular carcinoma,HCC)临床疗效及对患...     

肝动脉化疗栓塞术联合脾栓塞术治疗肝癌脾亢的临床应用价值

目的 探讨肝动脉化疗栓塞术联合脾部分栓塞术治疗原发性肝癌伴脾功能亢进的临床应用价值.方法 确诊为原发性肝癌伴脾功能亢进患者60例,2013年10月至2014年6月就诊于解放军总医院第一附属医院介入科.60例患者被随机分配到A、B两组.A组为对照组,30例患者接受肝动脉化疗栓塞术;B组为实验组,30例患者接受肝动脉化疗栓塞术及脾部分栓塞术.治疗前后检测血常规、血凝四项、肝功能、T细胞亚群,免疫球蛋白及CT扫描.观察两组患者并发症的情况.结果 实验组患者术后外周血象、肝功能、凝血功能及免疫功能较术前有所改善,差异有统计学意义(P＜0.05);两组患者术后并发症间比较无显著地差异性(P＜0.05),并未发生严重并发症.结论 肝动脉化疗栓塞术联合脾部分栓塞术是一种安全且有效的治疗方法,它能有效改善患者血细胞减少状况,改善肝功能,提高免疫力,且术后患者发生严重并发症的概率较低.     

Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.     

A case of necrotizing pancreatitis subsequent to transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

Necrotizing pancreatitis is one of the rare complications of transcatheter arterial chemoembolization (TACE). Necrotizing pancreatitis after TACE may result from the development of ischemia caused by regurgitation of embolic materials into the vessels supplying the pancreas. We report a case of post-TACE necrotizing pancreatitis with abscess formation in a patient with hepatocellular carcinoma. The patient had suffered hepatic artery injury due to repetitive TACE; during his 25th TACE procedure he had submitted to selective catheterization of the feeding vessel from the dorsal pancreatic artery with a cytotoxic agent and Gelfoam particles. The patient complained of abdominal pain after the TACE procedure, and a CT scan led to a diagnosis of necrotizing pancreatitis with abscess formation. The pancreatic abscess progressed despite general management of the pancreatitis, including antibiotics. Percutaneous catheter drainage was performed, and the symptoms of the patient improved.     

Addition of n-butyl cyanoacrylate to classic transarterial chemoembolization may improve the radiological response in patients with hepatocellular carcinoma

OBJECTIVE:

Transarterial chemoembolization is the treatment of choice for intermediate-stage hepatocellular carcinoma. However, there are no clear data supporting transarterial chemoembolization vs. transarterial embolization or regarding the best chemotherapeutic agent, which may suggest a preponderant role of ischemia over chemotherapeutic action. This study sought to evaluate the radiological response and outcome of transarterial chemoembolization modified by n-butyl cyanoacrylate addition compared to conventional transarterial chemoembolization in hepatocellular carcinoma patients.

MATERIALS AND METHODS:

A retrospective review identified forty-seven patients who underwent modified chemoembolization and thirty-three who underwent conventional chemoembolization between June 2006 and December 2011. The radiological response was reassessed using the modified Response Evaluation Criteria in Solid Tumors. The sustained complete response, time to progression and overall survival rates were also analyzed.

RESULTS:

Complete response rates were significantly higher in patients who had undergone modified chemoembolization compared to those who had undergone conventional treatment (61.7% and 24.3%, respectively; p<0.001). The rate of sustained complete response was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 236 and 37 days, respectively; p<0.001). Time to progression was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 424 and 201 days, respectively; p=0.042). Overall survival rates revealed no difference between patients who received modified chemoembolization and conventional chemoembolization (median of 483 and 399 days, respectively; p=0.316).

CONCLUSION:

Transarterial chemoembolization modified by n-butyl cyanoacrylate addition was superior to conventional transarterial chemoembolization in terms of the radiological response in the first imaging control. Although the sustained complete response and time to progression rates were higher for the modified chemoembolization group, no differences in overall survival rates were observed.     

Transarterial chemoembolization using drug eluting beads for the treatment of hepatocellular carcinoma: Now and future

Transarterial chemoembolization (TACE) using doxorubicin-eluting beads (DEBs) have been introduced as a novel device which ensures more sustained and tumor-selective drug delivery and permanent embolization compared to conventional TACE with lipiodol. Studies highlighting the use of TACE with DEBs for the treatment of hepatocellular carcinoma (HCC) have shown similar or better results compared to conventional TACE with lipiodol. TACE with DEBs is increasingly being performed interchangeably with conventional TACE. This review assessed the characteristics, clinical outcomes and future direction of TACE with DEBs compared to conventional TACE.     

Predictive factors of contrast-enhanced ultrasonography for the response to transarterial chemoembolization in hepatocellular carcinoma

Background/Aims

The predictive role of contrast-enhanced ultrasonography (CEUS) before performing transarterial chemoembolization (TACE) has not been determined. We assessed the possible predictive factors of CEUS for the response to TACE.

Methods

Seventeen patients with 18 hepatocellular carcinoma (HCC) underwent TACE. All of the tumors were studied with CEUS before TACE using a second-generation ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy). The tumor response to TACE was classified with a score between 1 and 4 according to the remaining enhancing-tumor percentage based on modified response evaluation criteria in solid tumors (mRECIST): 1, enhancing tumor <25%; 2, 25%≤enhancing tumor<50%; 3, 50%≤enhancing tumor<75%; and 4, enhancing tumor≥75%). A score of 1 was defined as a "good response" to TACE. The predictive factors for the response to TACE were evaluated during CEUS based on the maximum tumor diameter, initial arterial enhancing time, arterial enhancing duration, intensity of arterial enhancement, presence of a hypoenhanced pattern, and the feeding artery to the tumor.

Results

The median tumor size was 3.1 cm. The distribution of tumor response scores after TACE in all tumors was as follows: 1, n=11; 2, n=4; 3, n=2; and 4, n=1. Fifteen tumors showed feeding arteries. The presence of a feeding artery and the tumor size (≤5 cm) were the predictive factors for a good response (P=0.043 and P=0.047, respectively).

Conclusions

The presence of a feeding artery and a tumor size of less than 5 cm were the predictive factors for a good response of HCC to TACE on CEUS.     

经导管动脉栓塞化疗联合射频消融和细胞因子诱导的杀伤细胞输注治疗小肝癌

目的 探讨经导管动脉栓塞化疗(TACE)联合射频消融(RFA)后行自体细胞因子诱导的杀伤细胞(CIK)输注治疗对小肝癌的疗效.评价CIK细胞过继免疫治疗后患者免疫指标的变化.方法 2004年2月至2006年2月本院收治的小肝癌患者43例,分为两组,所有患者均行TACE联合RFA治疗.其中研究组患者21例,均完成4次以上自体CIK细胞输注治疗,每次回输CIK细胞的数量为(1.1～1.5)×1010m,检测研究组患者在CIK治疗前后外周血T淋巴细胞亚群及NK细胞水平的变化;对照组患者22例,未行CIK细胞过继免疫治疗.两组患者均每1～2个月评价肿瘤情况.结果 (1)对照组治疗后第1、2和3年的肝内累积复发率分别为9.1%、22.3%和27.3%;术后1、2和3年的生存率分别为95.5%、81.8%和68.2%.研究组第1、2和3年的肝内累积复发率分别是9.5%、14.3%和19.0%;术后1、2和3年的生存率分别为95.2%、85.7%和76.2%.两组生存率差异无统计学意义(P=0.558).(2)研究组CIK细胞治疗前后外周血T淋巴细胞亚群检测显示CD3+、CD4+、CD56+(NK)效应细胞的比例和CD4+/CD8+比值显著上升(P<0.05),CD8+和CD3+CD56+效应细胞比例下降(P<0.05).结论 TACE序贯联合RFA和CIK细胞过继免疫细胞治疗小肝癌可以提高患者的机体免疫水平,可能对降低肿瘤复发,延长小肝癌患者的生存期有一定作用.     

老年2型糖尿病合并肺部感染患者免疫状态和预后的危险因素分析

目的:探讨影响老年2型糖尿病(type 2 diabetes,T2DM)合并肺部感染患者预后的相关因素。方法:选取2019年8月至2020年6月南京医科大学附属淮安第一医院收治的单纯T2DM患者135例,单纯肺部感染患者128例及T2DM合并肺部感染患者124例,分别记为T2DM组、肺部感染组及T2DM合并肺部感染组。...     

经导管肝动脉化疗栓塞对肝癌患者外周血黑色素瘤抗原1 mRNA的影响

目的 探讨经导管肝动脉化疗栓塞(TACE)对肝癌患者外周血黑色素瘤抗原1(MAGE-1)mRNA表达水平的影响.方法 采用巢式RT-PCR方法 测定18例肝癌患者TACE治疗前后外周血MAGE-1 mRNA的表达.分析其与肝癌临床病理特征间的关系.结果 18例肝癌患者治疗前外周血MAGE-1 mRNA表达10例阳性、8例阴性;TACE治疗后11例阳性、7例阴性.治疗前后外周血MAGE-1mRNA阳性率差异无统计学意义(55.6%比61.1%.P>0.05).治疗前后肝癌患者外周血MAGE-1mRNA阳性率与肿瘤TNM分期((0%比76.9%,20%比76.9%,P<0.05)、远处转移有关(85.7%比36.4%,100%比36.4%,P<0.05),而与肿瘤大小、血清AFP无关(P>0.05).结论 TACE治疗肝癌不会促进肿瘤的血源性转移,MAGE-1 mRNA可作为评估肝癌疗效的一个重要指标.     

Changes in T helper cell-related factors in patients with type 2 diabetes mellitus after empagliflozin therapy

The immune factors related to T helper (Th) 1 (T-bet, STAT1, and IFN-γ), Th17 (ROR-γt, STAT3, and IL-17), and Treg (FOXP3, STAT5, and IL-10) cells, and SOCS1/3 and the proliferation of Th cells were investigated in type 2 diabetes mellitus patients before (baseline) and after empagliflozin therapy.A total of 56 patients on metformin and gliclazide were separated into two groups: Group 1 did not receive empagliflozin (EMPA^?) and the Group 2 received 10 mg/day of empagliflozin for 6 months (EMPA⁺). The expressions of T-bet, ROR-γt, FOXP3, STAT1/3/5 and SOCS1/3 were evaluated in CD4⁺ T cells with real-time PCR. The production of IFN-γ, IL-17, and IL-10 from CD4⁺ T cells was measured using ELISA. The proliferation of Th cells was assessed with flow cytometry.Six months of empagliflozin therapy significantly reduced the expression of ROR-γt and increased FOXP3 and STAT5 expression, compared to baseline. Production of IL-17 decreased after empagliflozin treatment, while IL-10 was enhanced in the EMPA⁺ group. Oral administration of empagliflozin or the addition of empagliflozin to the cell cultures diminished the proliferation of Th cells.Empagliflozin showed anti-inflammatory effects on Th cells by decreasing Th17-related factors, reducing proliferation capacity, and increasing Treg cell properties.     

Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis

Background/Aims:

Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT.

Methods:

Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II).

Results:

The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012).

Conclusions:

Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.