肝节段动脉栓塞治疗肝癌的疗效观察

目的 :探讨肝节段动脉栓塞化疗治疗肝癌的疗效。方法 :将 1996年 1月～ 1999年 10月 2 32例肝癌患者根据栓塞方式不同分为 2组 ,其中行肝节段动脉栓塞化疗 6 8例 ,行常规栓塞化疗 16 4例 ,对 2组治疗的疗效进行分析。结果 :节段组 1、2、3年生存率分别为 86 8%、6 1 8%和 4 8 5 % ;常规组则相应为 6 7 1%、4 2 1%和 2 6 2 % ,节段组远期生存率明显高于常规组 (P <0 0 1)。肝功能损害程度节段组明显较常规组轻 (P <0 0 1)。结论 :肝节段动脉栓塞化疗对肝功能损害轻 ,远期疗效明显优于常规栓塞化疗     

原发性肝癌合并门静脉瘤栓的化疗栓塞治疗

将116例合并门静脉主干或左右大分支瘤栓的原发性肝癌分为三组,A组32例,采用单纯肝动脉灌注化疗法;B组66例,采用常规肝动脉化疗加碘油和明胶海绵栓塞法;C组18 例,采用肝段或亚肝段动脉化疗加碘油和明胶海绵栓塞。结果示,A组6、12、18和24个月生存率分别为25 .0%(8/32)、9 .4%(3/32)、3 1%(1/32)和0(0/32),门脉瘤栓消失率为3 .1% (1/32); B 组6、12、18 和24 个月生存率分别为53 .0% (35/66)、25. 8% (17/66)、9 .1%(6/66)和3 0%(2/66),门脉瘤栓消失率为19 .7%(13/66);C组6、12、18 和24 个月生存率分别为72 .2%(13/18)、44 .4%(8/18)、22. 2%(4/18)和11. 1%(2/18),门脉瘤栓消失率为44 .4%(8/18)。各组生存率(P<0 .05)及门脉瘤栓消失率(P<0 .01)差异均有统计学意义。初步观察结果提示,经肝动脉化疗及栓塞法是治疗合并门脉瘤栓原发性肝癌的有效方法,且栓塞法优于单纯灌注化疗法,特别是肝段或亚肝段动脉化疗栓塞法疗效更好。     

肝动脉栓塞和门静脉化疗配合放疗治疗肝癌

将 8 2例不能切除的原发性肝癌 (简称肝癌 )患者随机分为 4组。Ⅰ组 2 0例 ,行肝动脉结扎加化疗栓塞。Ⅱ组 2 3例 ,行全肝移动条放射治疗。Ⅲ组 1 8例 ,在肝动脉结扎加化疗栓塞的同时行门静脉置入全埋入式药物输注装置 (简称化疗泵 ) ,术后行门静脉灌注化疗。Ⅳ组 2 1例 ,在Ⅲ组治疗方法的基础上加用全肝移动条照射治疗。全部病例均随访 1年以上。Ⅰ、Ⅱ、Ⅲ、Ⅳ组的 1年生存率分别为2 5 0 %、1 3 0 %、33 3%、和 6 1 9% ,以Ⅳ组疗效最好。提示肝动脉结扎加化疗栓塞和门静脉灌注化疗配合放疗是不能切除肝癌的较好治疗方法。     

肝癌肝段栓塞与常规栓塞化疗致急性肝功能损害的酶学变化

目的 :探讨肝段化疗栓塞与常规化疗栓塞治疗肝癌对肝功能的影响程度。方法 :通过两组各2 0例肝癌病人分别采用上述两种不同的栓塞后 3d ,对复查肝功能的主要指标进行比较。结果 :两组不同的介入化疗栓塞方法治疗后肝功能指标变化 ,常规组ALT、AST、ALP、TBIL的改变 (P <0 .0 0 1)较节段组变化大 (P >0 .0 5 ) ,GGT两者差异无显著性 ,P均 >0 .0 5。结论 :肝段化疗栓塞与常规化疗栓塞对肝功能的影响 ,后者较之前者变化明显。肝癌的介入化疗栓塞 ,应尽可能行肝段栓塞 ,以减轻肝功能的损害。     

肝动脉化疗栓塞术加经皮肝穿刺射频消融术治疗原发性肝癌56例

目的　观察肝动脉化疗栓塞术加经皮肝穿刺射频消融术对原发性肝癌的治疗效果及术后反应。方法　原发性肝癌患者 5 6例 (男 4 8例 ,女 8例 )。随机分为肝动脉化疗栓塞术加经皮肝穿刺射频消融组(综合组 )及单纯肝动脉化疗栓塞术组 (TACE组 )。综合组行肝动脉化疗栓塞治疗 ,每 4周重复 1次 ,第 2周期后再行经皮肝穿刺射频消融术。结果　综合组缓解率、1年、2年、3年生存率 (6 7.9%、6 7.9%、5 3.5 %、35 .7% )显著高于TACE组相应指标 (46 .4 %、35 .7%、2 5 .0 %、14 .3% ) (P <0 .0 5 )。结论　肝动脉化疗栓塞术加经皮肝穿刺射频消融术对原发性肝癌直径大于 6cm者 ,其疗效优于单纯肝动脉化疗栓塞术。     

胆囊切除在肝癌术后肝动脉栓塞化疗中的临床意义

目的　讨论胆囊切除在肝癌术后经皮肝动脉栓塞化疗中的临床意义。方法　A组 2 0例在初次肝癌切除术中同时切除胆囊 ,B组 5 7例仅作肝癌切除术。比较两组术后经皮肝动脉栓塞化疗术后的副作用。结果　介入术后栓塞综合征 ,两组发生例数分别为发热 ( 7/38)、右上腹痛 ( 2 /19)、腹胀 ( 0 /9)、恶心呕吐 ( 5 /2 6 )、纳差 ( 4 /31)。结论　肝癌切除术中同时切除胆囊 ,有利于降低术后肝动脉栓塞化疗中介入栓塞综合征的发生率 ,减轻其副作用。     

同期化疗合并后程加速超分割放射治疗局部晚期非小细胞肺癌的临床观察

将 5 2例局部晚期非小细胞肺癌 (non smallcelllungcancer,NSCLC)患者随机分为化放组和单放组 ,每组 2 6例。化疗方案为紫杉醇 13 5mg/m2 ,d1、d2 2 ;顺铂 2 0mg/m2 ,d1～d5、d2 2 ～d2 6,化疗同步60 Co体外照射 ,常规分割照射DT40Gy时缩野行加速超分割照射 ,DT1 5Gy/次 ,2次 /d ,2次间隔 >6h ,每周 5d ,照射 9d ,DT2 7Gy ,总剂量DT67Gy/ 6w。化放组CR、PR、NC和PD分别为 3 4 6% ( 9/ 2 6)、 5 3 8% ( 14 / 2 6)、7 7% ( 2 / 2 6)和 3 9% ( 1/ 2 6) ,有效率CR PR为88 4% ( 2 3 / 2 6) ;单放组CR、PR、NC和PD分别为 19 2 % ( 5 / 2 6)、46 2 % ( 12 / 2 6)、2 3 1% ( 6/ 2 6)和 11 5 % ( 3 / 2 6) ,有效率CR PR为 65 4% ( 17/ 2 6) ,P <0 0 5。化放组 1、2年生存率及中位生存时间分别为 69 2 %、3 8 5 %和 19个月 ,单放组分别为 46 1%、19 2 %和 12个月 ,P <0 0 5。化放组白细胞减少发生率 88 5 % ( 2 3 / 2 6) ,脱发发生率 10 0 % ,放射性食管炎 3 4 6% ( 9/ 2 6) ,放射性肺炎 2 3 1% ( 6/ 2 6) ;单放组白细胞减少发生率 3 0 8% ( 8/ 2 6) ,放射性食管炎 3 0 8% ( 8/ 2 6) ,放射性肺炎 19 2 % ( 5 / 2 6)。初步研究结果提示 ,紫杉醇 /顺铂同期化疗合并后程加速超分割放射治疗局部晚期NSCLC能     

中药配合肝动脉化疗栓塞中晚期肝癌58例疗效观察

目的　探讨中药配合肝动脉化疗栓塞中晚期肝癌的预后和影响预后的因素。方法　将病人随机分成 2组 ,经皮肝动脉化疗栓塞 2 9例 ,中药配合经皮肝动脉化疗栓塞 2 9例。全组 5 8例 ,2 5例肝动脉化疗 ,33例化疗栓塞 ;单个肿瘤 2 2例 ,多个肿瘤 36例 ;5 7～ 8 0cm 6例 ,8 1～ 10 0cm 2 7例 ,>10 0cm 2 5例。结果　肿块越小 ,预后越好 (P <0 0 0 1) ;TAI +TAE预后明显优于TAI(P <0 0 5 ) ;中药配合介入 3、5年生存率高于单纯介入治疗 (P <0 0 5 )。结论　中药配合肝动脉化疗栓塞是治疗中晚期肝癌的有效方法 ,影响预后的主要因素为肿块大小及治疗方法     

肝动脉化疗栓塞与肝脾动脉双栓塞治疗肝癌伴肝硬化的比较

目的比较肝动脉化疗栓塞(A组)和肝脾动脉双栓塞(B组)治疗肝癌并肝硬化病人的反应率、生存率、并发症和毒副作用。方法确诊为肝癌并肝硬化的63例病人随机分组，A组31例，B组32例。A组行肝动脉化疗栓塞，B组行肝动脉化疗栓塞加部分脾动脉栓塞。结果A和B组有效率分别为64.5%(20/31)和65.6%(21/32)，腹水吸收好转率分别为33.3%(4/12)和69.2%(9/13)。A组6个月、1、2、3年的累计生存率分别是80.5%(25/31)；41.9%(13/31)，19.4%(6/31)，6.5%(2/31)，B组6个，1、2、3年累计生存率分别是75.0%(24/32)，56.2%(18/32)，34.4%(11/32)，25.0%(8/32)，B组术后并发2例脾脓肿和3例胸积液，并发消化道出血明显减少。结论肝脾动脉双栓塞治疗肝癌并肝硬化能够提高病人对抗癌药的耐受性，提高远期生存率和降低上消化道出血的危险性。     

康莱特注射液对高龄非小细胞肺癌化疗患者生存质量的影响

将 68例高龄 (≥ 70岁 )非小细胞肺癌 (non smallcelllungcancer ,NSCLC)患者随机分为康莱特注射液加化疗(治疗组 3 4例 )与单纯化疗 (对照组 3 4例 )两组。治疗组采用以NVB DDP/CBP(或Taxol DDP/CBP ,Vp 16 DDP/CBP ,VM 2 6 DDP/CBP ,MMC VDS DDP)方案化疗 ,同时应用康莱特注射液 2 0 0mL/d静脉滴入 ,连用 2 0d ;对照组单纯应用相同方案化疗。至少完成 2个周期 ,每周期化疗前后进行疗效对比评价。结果治疗组与对照组比较 ,Karnofsky(KPS)评分改善者分别为 40、13例次 ,两组KPS评分分布上的变化差异有统计学意义 ,χ2 =2 7 14 ,P <0 0 0 1;体重增加者分别为 2 8、8例 ,两组体重变化分布上差异有统计学意义 ,χ2 =3 4 0 5 ,P <0 0 0 1;胸痛、血痰、乏力、食欲不振明显改善比率分别为 79 4%与 5 5 9%、76 5 %与 46 1%、5 2 9%与 8 8%、47 1%与 11 8% ,两组差异均有统计学意义 ,P <0 0 5。     

Transradial approach for transcatheter arterial chemoembolization in patients with unresectable and recurrent hepatocellular carcinoma--a comparison with a conventional transfemoral approach

We evaluated a clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TAE) in patients with unresectable and recurrent hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group; n=385, 1999.7-2007.3, femoral group; n=150, 1997.4-1999.6) of cases were retrospectively compared with regard to the successful rate of angiography, TAE, interventional time, Lipiodol retention pattern and complications. Hepatic angiography and TAE were completed in 379 (98.4%) of 385 cases in the radial group. There was no inter-group difference of interventional time. Minor complications (dull pain or numbness of puncture site) occurred in 29 (7.6%) patients in the radial group. Transradial approach has some advantages as follows: (1) No time will be required to stop breeding after removal of sheath. (2) The patient may freely walk after the examination. TAE by our new transradial approach for HCC was found to have a therapeutic efficacy with lower complications comparable to that of conventional transfemoral approach.     

介入热化疗栓塞对肝癌患者血清细胞因子水平变化的临床研究

目的 探讨介入热化疗栓塞对肝癌患者血清细胞因子的影响及疗效观察.方法 采用ELISA法检测60例原发性肝癌患者(介入热疗组30例,常规介入组30例)治疗前后血清8种细胞因子的变化,并对两组数据进行对比分析.结果 治疗前血清8种细胞因子(IL-17、IL-10、IFN-γ、IL-8、IL-1β、IL-6、IL-1α、TNF-α)在两组间差异无统计学意义(P＞0.05).治疗后1月介入热疗组IL-17水平降低伴有IL-10水平升高,而常规介入组未出现明显变化,血清IL-17和IL-10在两组间差异有统计学意义(P＜0.05).介入热疗组2年生存率明显高于常规介入组(73.3％vs56.7％,P＜0.05).结论 介入热化疗栓塞能使血清IL-17水平降低、IL-10水平升高,能抑制肿瘤生长,提高免疫力,延长生存时间,是治疗中晚期肝癌的一种安全有效的方法.     

肝细胞肝癌经肝动脉化疗栓塞后破裂:2例报告及系统回顾(英文)

Objective: Rupture of hepatocellular carcinoma (HCC) following transarterial embolization/chemoembolization (TAE/TACE) is a rare but life-threatening complication. The aim of the study was to explore the incidence, risk factors, clinical characteristics, treatment, and outcomes of this complication. Methods: We described two cases and reviewed all cases of ruptured HCC after TAE/TACE reported in the literature. Results: Our search yielded 32 cases of ruptured HCC after TAE/TACE. The overall incidences were 0.45% per patient and 0.21% per session. The mean age of the patients was 57.4 years (range 28-90 years, n=26, No. of cases with available information). Males accounted for 81% of cases (21/26). The 50% of the cases had histories of primary hypertension, diabetes or peripheral artery disease (6/12). Mean diameter of the tumors was 11.4 cm (range 3-20 cm, n=27). The 100% of cases had superficial or exophytic tumors (23/23). Portal vein thrombosis was presented in 61.5% of patients (8/13). The median interval between TAE/TACE and rupture was 2 days (range 0 hour-30 days, n=31). Management choices included emergency TAE, surgery, and conservative treatment. The overall median survival time was 7 days (n=19). Conclusion: Rupture of HCC following TAE/TACE is relatively rare but potentially life-threatening. The management is difficult and prognosis is poor. Large tumor size, superficial or exophytic tumors as well as portal vein thrombosis and comorbidities such as primary hypertension, diabetes or peripheral artery disease may be predisposing factors for rupture.     

Transarterial chemoembolization (TAE) with degradable starch microspheres (DSM) in advanced hepatocellular carcinoma]

This study was undertaken to evaluate the clinical utility of chemoembolization using degradable starch microspheres (DSM), which resolve in a short period in patients with advanced hepatocellular carcinoma (HCC). Twenty-one patients underwent DSM chemoembolization 24 times. After a mixture of iodized oil and epirubicin was injected into the hepatic arteries, the patients were embolized with DSM alone 16 times. In the other 8 times, embolization was done in one hepatic lobe with DSM and in the other hepatic lobe with gelatin sponge (GS). There was no major complication related to chemoembolization. Tumor response (complete, partial, and minor responses) was found in 46% of patients after TAE. Tumor recurrence was found in 64% of responders after a mean period of 2.0 months. The response rate was significantly higher when chemoembolization was performed using both DSM and GS than when it was done with DSM alone (63% vs 37%, p < 0.04). Although the response rate after DSM-TAE is low, its anticancer effect is reinforced when used as an adjuvant therapy of GS-TAE.     

Arterial chemoembolization using microencapsulated anticancer drugs]

Selective intra-arterial infusion of ethylcellulose microcapsules containing anticancer drug exerts its therapeutic effects through infarction and sustained drug action (i.e., chemoembolization). Seven hundred and fifty-nine patients with malignant tumors of the liver (310), kidney (177), bladder (100), prostate (41), lung (39), pelvic organs (13), bone (4) and other (75) were treated with single or repeated chemoembolization using microcapsules delivered through percutaneous catheterization as a preoperative or palliative measure. Substantial tumor reduction of 50% was found in 18% of hepatoma, 19% renal cell carcinoma, 54% bladder carcinoma and 54% prostate carcinoma cases. Preoperative chemoembolization facilitated radical surgery for various cancers and significantly improved the survival of patients with locally invasive renal cell carcinoma and bladder carcinoma. Systemic toxic effects were mild, and all patients tolerated the treatment except for one who died of remote embolism to spleen and gallbladder. These results suggested that microcapsule chemoembolization can be successfully applied to a variety of tumors with low morbidity and mortality, and also combined with other treatments in multidisciplinary therapy.     

不能手术的原发性肝癌介入治疗与介入加放疗的疗效比较

目的:观察不能手术的原发性肝癌患者,单纯肝动脉栓塞化疗(TACE)与肝动脉栓塞化疗联合直线加速器放射治疗的疗效及不良反应。方法:116例不能手术的原发性肝癌患者,63例行肝动脉栓塞化疗(介入组),53例行TACE联合放疗(联合组)。TACE灌注化疗药物为:丝裂霉素(MMC)10-20mg,氟尿嘧啶(5-Fu)1000-1500mg,表阿霉素(E-ADM)30-50mg,栓塞剂为40%超液态碘化油5-20ml。直线加速器治疗用10MV-X,95%等剂量线包绕PTV,40-60Gy/8-25F,3-5F/wk。结果:介入组及联合组2年局部控制率分别为30.2%、43.6%,3年局部控制率分别为24.4%、37.9%,两组比较有显著的统计学意义(P<0.05);2年生存率分别为30.1%、42.9%,3年生存率分别为21.5%、32.6%,2年总生存率比较两组差异无统计学意义(P=0.056),3年总生存率比较两组差异有统计学意义(P=0.034)。联合组发现2例放射诱发的肝病。结论:不能手术的原发性肝癌介入治疗加放疗比单纯放疗疗效好。     

经药盒导管系统化疗栓塞治疗肝癌及相关药物监测

目的探讨经药盒导管系统(PCS)化疗栓塞治疗肝癌的临床价值。方法100例患者分成两组,PCS组(56例)经药盒导管系统灌注抗癌药与碘油混合成的乳剂,TACE组(44例)按常规方法栓塞治疗,对每组患者的疗效及药物代谢特征分别进行观察。结果PCS组患者肿瘤内的阿霉素可维持相当持久的较高浓度,7周后平均值7.9ug/克并取得较好治疗效果,其1、3年生存率分别为36/56(64%)及13/56(23%)。TACE组结果则较差,其阿霉素值为4.4ug/克,1、3年生存率分别为19/44(43%)及5/44(11%)。结论经PCS给药方法简便,疗效确切,经药物监测符合药代动力学规律,是治疗肝癌的较好方法。     

Assessment of chemoembolization therapy for primary liver cancer using a stabilized Adriamycin-lipiodol suspension

We formulated a new lipiodol-Adriamycin suspension (ADM/lipiodol, 50 mg/10 ml) that remained stable for 48 h (half-life, 25±3 days). In five cases of hepatocellular carcinoma (HCC) resected after intra-arterial infusion of this agent, the ADM concentration in the tumor was quite high and the tumor necrosis rate was more than 80% on histological examination. Over a 5-year period, 180 patients with unresectable HCC underwent transcatheter arterial embolization therapy (TAE) in the presence or absence of this agent. The regimens consisted of suspension injection alone (A,n=54), suspension injection+TAE using gelatin sponge (B,n=29), TAE followed by suspension injection (C,n=34), and TAE alone (D,n=63). The estimated 1-year survival values determined for patients treated with these regimens were 70%, 73%, 43%, and 39% respectively, and the corresponding 3-year survival values were 27%, 31%, 15%, and 10%. The survival achieved using suspension injection was thus superior to that obtained using conventional TAE, and combined therapy with suspension injection followed by TAE seemed to enhance survival, although there were some biases in tumor size and in the stage of tumor progression. For patients with tumors measuring 5 cm or more in diameter, the survival obtained using regimen A was lower than that achieved using regimen D, but the combination of TAE and suspension injection improved the 1-year survival value obtained using regimen D from 34% to 52%. For patients with tumors measuring less than 5 cm in diameter, the survival achieved using regimen A was markedly better than that obtained using regimen D, although no difference was found between the survival value achieved using regimen A and that obtained using regimens B and C. On the basis of these results, our newly formulated ADM-lipiodol suspension was surmised to be effective by itself against relatively small HCC tumors, whereas it enhanced the efficacy of conventional TAE in large lesions.Presented at the Second International Symposium on Treatment of Liver Cancer, Taipei, 3–4 February 1991     

温阳扶正方联合肝动脉化疗栓塞术治疗脾肾阳虚型肝癌患者的临床研究

目的:探究温阳扶正方联合肝动脉化疗栓塞术治疗脾肾阳虚型肝癌患者的临床效果.方法:从我院2017年12月到2019年12月选取60例脾肾阳虚肝癌患者,将患者随机分成两组,每组30例,一组为对照组,采用肝动脉化疗栓塞术治疗;另一组为观察组,采用温阳扶正方联合肝动脉化疗栓塞术治疗.观察比较两组患者的血管内皮生长因子(vasc...