栓塞剂在肝癌介入治疗中的应用

介入治疗对不能手术的中晚期肝癌是最好的选择 ,而栓塞剂的应用对于疗效有重要影响 ,根据被栓血管的粗细可分为周围性和中央性栓塞剂。1　周围性栓塞剂1 1　碘油　为植物油与碘结合的一种有机化合物。为粘稠澄明液体 ,以法国Ｇｕｅｒｂｅｔ药厂生产的超液态碘油 (ＬＵＦ)应用较多 ,粘度较低 ,易于推注。碘油在正常肝脏组织 2 4ｈ消失 ,而在肝癌区滞留可达 16个月。因肝癌血运丰富 ,血管纡曲 ,缺乏基底膜 ,以及癌组织内网状内皮系统功能低下并缺乏淋巴细胞 ,使碘油易于渗入而不易被清除。碘油与水溶性抗癌药可配制成油包水型乳剂和混悬剂 ,其…     

原发性肝癌伴脾亢的介入治疗(附31例报告)

目的　探讨肝动脉化疗栓塞联合部分性脾动脉栓塞 (PSE)治疗原发性肝癌合并脾功能亢进的意义及方法。方法　原发性肝癌合并脾亢 3 1例 ,采用经皮穿刺肝动脉化疗栓塞术 (TACE)和PSE治疗 ,治疗前后测定血细胞数量 ,CT观察肝脏肿瘤及脾脏大小改变。结果　PSE术后 2 4h、1周、4周血白细胞和血小板均较栓塞前明显升高 (Ρ <0 .0 1)。 2 8例脾栓塞面积在 40 %～70 % ,2例 80 % ,1例 <40 %。术后 1月CT复查肝脏肿瘤缩小 2 2例 ,占 70 .97% (2 2 / 3 1)。脾脏有所缩小 ,内可见均一低密度梗死区。结论　肝动脉化疗栓塞及部分性脾动脉栓塞是治疗肝癌合并肝硬化脾功能亢进安全、有效的方法     

肝癌介入治疗后并发股动脉栓塞和胆道支气管瘘1例观察及护理报告

病例阴××,男,45岁。因右上腹胀痛不适4月余入院。经CT、AFP等检查诊断为肝右叶巨块型肝癌,后经病理证实为右肝多灶性肝细胞癌。入院后在介入室经过2次肝动脉     

原发性肝癌合并动静脉瘘的介入治疗(附34例报告)

目的：探讨超选择性明胶海绵瘘口栓塞术对原发性肝癌所致动静脉瘘的治疗方法及疗效。方法：本组对34例经DSA检查确诊为原发性肝癌合并动-静脉瘘（AVS）行超选择性瘘口栓塞，根据瘘口闭塞及肿瘤染色情况确定是否行肿瘤碘化油栓塞治疗。闭塞瘘口材料主要为明胶海绵辅以弹簧圈。结果：34例中33例一次性瘘口闭塞成功，其中28例成功地行肿瘤栓塞治疗，1例因瘘口闭塞早期即发生肺栓塞症状，1月后行弹簧圈瘘口闭塞成功。结论：超选择性明胶海绵瘘口栓塞术对原发性肝癌所致的动静脉瘘的治疗是一种安全、有效、并发症少的治疗方法，能为肿瘤碘化油栓塞提供良好治疗环境。     

脂肪栓塞综合征早期诊断与治疗(附10例临床报告)

目的　总结脂肪栓塞综合征 (FES)早期诊断及治疗经验。方法　根据 1 0例 FES患者早期体征、临床表现及实验室检查改变 ,进行有效的治疗 ,并对结果进行评价。结果　 1 0例 FES均痊愈。结论　早期识别 FES是治疗的关键 ,对于 FES,防重于治     

介入治疗癌性上腔静脉综合征(附7例报告)

目的：评价选择性支气管动脉灌注化疗（BAIC）治疗癌性上腔静脉综合征（SVCS）的效果。方法：对7例诊断明确的中晚期肺癌及淋巴瘤患者，并发严重的SVCS行BAIC治疗9次，其中5例各治疗1次，2例各治疗2次。结果：7例SVCS患者经BAIC治疗后，全部病人的主要症状与体征得到有效控制和／或明显改善，未发生与该技术操作有关的严重并发症。结论：BAIC治疗中晚期肺癌的严重并发症SVCS，近期疗效确切，且在技术上是成功的。     

肝癌介入治疗后肝肾综合征抢救成功一例

重症肝癌介入治疗后非常容易并发肝肾综合征，介入医师面对无尿和肝功能衰竭办法不多，现将我们抢救成功的一例报道如下。     

膈下动脉栓塞治疗肝癌13例分析

2006年5月-2007年3月，我们对肝右叶巨块型肝癌13例行肝动脉-右膈下动脉联合化疗栓塞术，疗效满意。现分析报告如下。     

化疗加栓塞治疗原发性肝癌的疗效观察

目的：探讨化疗加栓塞对原发性肝癌的疗效。方法：70例原发性肝癌患 随机分为治疗组（n＝45）和对照组（n＝25）。全部病人均经导管灌注化疗药物，治疗组追加肿瘤供血动脉栓塞。治疗后，全部病人经随访观察1－3年。结果：治疗组疗效明显优于对照组，患生存期明显延长，且两组间有统计学上的显差（P＜0．05）。结论：化疗加栓塞是原发性肝癌非手术治疗的首选方法。     

肝癌化疗栓塞术后综合征临床分析

本文分析报告192例各型肝癌化疗栓塞术后综合征发生情况:总发生率为89.1%,转氨酶升高发生率为77.2%,肝区疼痛64.1%,发热54.2%,恶心呕吐35.4%,腹胀38.0%,腹水形成19.8%,黄疸18. 8%,呃逆5.7%.结合我们的研究和经验讨论了肝癌化疗栓塞的病理生理改变,化疗栓塞术后综合征发生机理及临床对症处理方法.     

甘草酸二铵联合槐耳颗粒治疗肝癌TACE术后栓塞综合征临床观察

目的：探讨甘草酸二铵联合中药槐耳颗粒治疗肝癌肝动脉化疗栓塞(TACE)术后栓塞综合征的临床疗效。 方法：选择90例肝癌行常规TACE治疗后的患者,按随机数字表法分为观察组和对照组各45例。对照组单纯给予甘草酸二铵注射治疗;观察组在对照组治疗基础上给予中药槐耳颗粒口服治疗。比较2组治疗后1个月内转氨酶和栓塞综合征缓解情况,并评价临床疗效。 结果：观察组栓塞综合征（发热、腹痛）缓解程度、生活质量评分显著高于对照组（P<0.05）,观察组转氨酶复常有效率、临床总效率、术后恶心呕吐患者比例与对照组无明显差异（P>0.05）。 结论：甘草酸二铵注射联合中药槐耳颗粒治疗TACE术后栓塞综合征疗效显著,提高了患者生活质量,安全可靠,值得临床推广应用。     

Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications

The current review provides an overview on the palliative, combined, neoadjuvant, bridging, and symptomatic indications of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). It is based on an analysis of the current literature and the experience of the authors on the topic. Chemoembolization combines the infusion of chemotherapeutic drugs with particle embolization. Tumor ischemia raises the drug concentration compared to infusion alone, extends the retention of the chemotherapeutic agent and reduces systemic toxicity. Palliatively, TACE is performed to control symptoms and prolong survival in HCC patients; in some indications TACE allows a local tumor control of 18-63%. For combined indications, excellent results were achieved by combined therapies, such as percutaneous ethanol injection (PEI)/TACE, radiofrequency ablation (RF)/TACE, and laser-induced thermotherapy (LITT)/TACE. As a neoadjuvant therapy prior to liver resection TACE showed 70% tumor control. Though debatable, TACE still plays a role as a bridging tool before liver transplantation. Symptomatic indication of TACE in ruptured HCC showed 83-100% control of bleeding but survival was poor. Thus, TACE represents an important therapeutic tool against HCC in general in addition to its special role in cases of unresectable HCC.     

肝癌介入治疗现状与进展

本文就肝癌介入治疗的方法、相关基础研究及仍然存在的问题对近几年的文献进行了复习。各种介入治疗方法(TACE、热灌注化疗、热栓塞、中药栓塞剂、经皮注射无水乙醇、射频消融、经皮微波凝固、氩氦刀冷冻)均存在不足,双重化疗栓塞术,TACE联合消融,TACE联合基因治疗等综合治疗手段的应用使疗效进一步提高;TACE后肝癌残存灶生物学行为影响方面的研究仅开始涉及,诸多问题尚待解决。以p53抑癌基因治疗、溶瘤病毒治疗为代表的基因治疗、抗血管生成等新的治疗方法的出现,使肝癌的介入治疗进入了新阶段;术中及围手术期处理关系着肝癌介入疗效及并发症防治,有待进一步规范。     

脾动脉栓塞在肝癌介入治疗中的应用

目的：探讨脾动脉栓塞在肝癌介入治疗中的应用价值。方法：对11例中晚期肝癌病人在进行肝动脉化疗栓塞的同时进行脾动脉栓塞治疗，观察病人血液白细胞、血小板计数及肝功能的变化情况和术后反应，判断治疗效果。结果：所有病人治疗后血液白细胞和血小板计数升高，肝功能恢复快，无严重并发症发生。结论：脾动脉栓塞应用于治疗肝癌可改善病人肝功能，控制脾功能亢进，促进血液白细胞、血小板升高，有助于病人的恢复。     

介入治疗在防治肝癌术后复发中的作用及进展

随着介入治疗方法(肝动脉化疗栓塞、经皮注射无水乙醇、射频消融、经皮微波凝固、氩氦刀冷冻、高强度聚焦超声及放射性核素介入治疗等)的不断丰富,以肝动脉化疗栓塞为主的综合介入治疗在肝癌术后复发中的应用逐渐得到人们的共识,但有待进一步规范.经介入途径抗肿瘤血管生成治疗、基因治疗以及针对肝癌转移复发特异性环节中的靶向治疗等新技术的出现、成熟,将使肝癌的综合治疗疗效得到进一步的提高,相信介入治疗今后在预防和治疗肝癌术后复发中将会发挥更重要的作用.     

Selective and sequential transarterial chemoembolization: survival in patients with hepatocellular carcinoma

Purpose

To assess the survival time of patients with HCC following transarterial chemoembolization performed in a highly selective and sequential way.

Patients and methods

124 HCC patients (102 male, 22 female; mean age 63 ± 11 years) treated with selective and sequential chemoembolization at a single center were included. Selective chemoembolization was performed through a coaxially introduced microcatheter in a segmental or subsegmental hepatic artery. Treatment was stopped after complete stasis of the blood flow in the tumor-feeding vessel. The primary endpoint of the study was overall survival.

Results

The median overall survival of the entire patient population was 27.2 months (mo) (±8.9 mo, 95% CI 9.8 mo, 44.6 mo). When stratified according to liver function the median survival was 46.1 mo (±9.0 mo; 95% CI 28.5 mo, 63.7 mo) for Child-Pugh A and 11.1 mo (±4.3 mo; 95% CI 2.7 mo, 19.5 mo) for Child-Pugh B (p < .001). The median survival was 46.1 mo (±16.6 mo; 95% CI 13.5 mo, 78.7 mo) for BCLC stage A, 19.7 mo (±2.6 mo; 95% CI 14.6 mo, 24.8 mo) for BCLC stage B, and 14.4 mo (±5.0 mo; 95% CI 4.5 mo, 24.3 mo) for BCLC stage C (p < .01).

Conclusion

Selective and sequential chemoembolization offers long survival times in patients with HCC. Those patients with preserved liver function benefit more than patients with limited liver reserve.     

肝癌介入治疗后心脏并发症的预防及治疗

目的：探讨肝癌介入治疗后心脏并发症发生的原因及预防,处理措施,方法：原发性肝癌病人4例,年龄36－65岁,所有病人接受经导管肝动脉化疗栓塞（TAE）治疗,术后进行心电监护,心电图检查和心肌酶谱（HEA）检查。结果：4例病人均有心前区不适感,T波轻度改变,心型肌酸激酶（CK－MB）升高,提示有心肌受损现象,经治疗后,3例治愈出院,1例因多器官功能衰竭死亡,结论：肝癌介入治疗后心脏并发症是一种少见的并发症,如能早期发现,并及时处理,病人一般能康复。     

外生性肝癌的血供特点及介入治疗

目的探讨外生性肝癌血供特点及经肿瘤供血动脉化疗栓塞术的疗效。方法5例外生性肝癌经股动脉插管,肿瘤供血动脉造影、化疗栓塞治疗,用榄香烯350 mg肿瘤血管内热灌注化疗和顺铂60～80 mg加碘油8～15 ml乳剂及明胶海绵化疗栓塞。结果5例患者共行10次经血管途径的化疗栓塞术。造影显示肿瘤供血动脉以肝外血管为主,肝动脉部分参与供血。5例患者术后瘤体缩小30%～50%,4例AFP下降。结论外生性肝癌有不同于肝内肝癌的血供特点,经肿瘤供血动脉化疗栓塞术对外生性肝癌同样有效,是可供选择的治疗方法之一。     

Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC)

The treatment of unresectable “non-early” (according to the BCLC classification) hepatocellular carcinoma (HCC) in cirrhotic patients with transcatheter arterial chemoembolization (TACE) followed by radiofrequency ablation (RFA) is retrospectively evaluated and possible prognostic factors of this combined therapy are investigated. Forty-six consecutive cirrhotic patients (Child-Pugh class A or B) with solitary or oligonodular HCC underwent RFA after TACE. The treated lesions were 51 overall (size 30–80 mm, mean 48.9). RFA was performed by a multitined expandable electrodes device after one TACE administration. Local efficacy was evaluated with multiphasic computed tomography (CT) performed an average of 2 months after treatment and then during follow-up. Patient survival rate was also evaluated (follow-up time 1–51 months, mean 15 months). Technical success (defined as complete devascularization during the arterial phase) was achieved in 34/51 lesions (66.7%) at the first CT check and in 29/51 (56.9%) during the succeeding follow-up. Among the considered prognostic factors, only lesion diameter (< or >=50 mm) was statistically significant in the Fisher's exact test in terms of local control (85.2 vs. 45.8% at first CT, p=.0065; 70.4 vs. 41.7% during follow-up, p=.051). There were two major complications (6.5%): one hepatic failure and one death. A Kaplan-Meier analysis showed survival rates of 89.7% at 12 months and 67.1% at 24 months. Combined therapy for non-early HCC shows a relatively high complete local response (especially in lesions less than 5 cm in diameter) and promising mid-term clinical success. Its overall usefulness has yet to be established by a larger series and risk-benefit analysis.     

中晚期原发性肝癌合并症的介入治疗研究

目的探讨中晚期原发性肝癌合并症的综合介入治疗方法。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62例,按住院号数的单、双数随机分成两组:对照组(单纯TACE组)32例,综合治疗组(TACE 合并症处理组)30例。综合治疗组行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综合处理。结果TACE组治疗32例患者,1、2和3年生存率分别为68%、50%和19%,中位生存期1.5年;综合治疗组30例患者1、2和3年生存率分别为87%、75%和48%,中位生存期2.0年。综合治疗组的生存率及生存期均显著高于对照组(P<0.05)。与对照组相比综合治疗组疗效与死亡风险率差异有统计学意义(P<0.05)。结论原发性肝癌合并症的控制可增加TACE的疗效,显著提高原发性肝癌患者生存率,延长生存期。