单中心11例肝内胆管细胞癌肝移植疗效分析

Objective To evaluate the effect of liver transplantation(LT)on the prognosis in patients with intrahepatic cholangiocarcinoma(ICC).Methods A retrospective analysis was performed on 11 consecutive patients with ICC who underwent LT between October 2003 and November 2008 at our institution.The overall and disease-free survival rates were calculated by the Kaplan-Mayer method.Results The median survival time Was 9.0 months(2.5-53 months).The 1-,2-,3-and 4-year disease-free survival rate and overall survival rate of all the patients were 51.9%、51.9%、51.9%、51.9%and 50.5%、50.5%、50.5%、50.5%,respectively.The perioperative mortality and the recurrence rate were 0 and 43.5%,respectively.The survival rate and disease-free survival time of patients with recurrence were 2.5-10 months(mean 7.5 months)and 1-8 months(mean 3.8 months).Conclusions The prognosis of LT for ICC is rather poor.ICC patients with lymph node metastasis.vascular or bile duct invasion is contraindicated for LT.     

单中心11例肝内胆管细胞癌肝移植疗效分析

Objective To evaluate the effect of liver transplantation(LT)on the prognosis in patients with intrahepatic cholangiocarcinoma(ICC).Methods A retrospective analysis was performed on 11 consecutive patients with ICC who underwent LT between October 2003 and November 2008 at our institution.The overall and disease-free survival rates were calculated by the Kaplan-Mayer method.Results The median survival time Was 9.0 months(2.5-53 months).The 1-,2-,3-and 4-year disease-free survival rate and overall survival rate of all the patients were 51.9%、51.9%、51.9%、51.9%and 50.5%、50.5%、50.5%、50.5%,respectively.The perioperative mortality and the recurrence rate were 0 and 43.5%,respectively.The survival rate and disease-free survival time of patients with recurrence were 2.5-10 months(mean 7.5 months)and 1-8 months(mean 3.8 months).Conclusions The prognosis of LT for ICC is rather poor.ICC patients with lymph node metastasis.vascular or bile duct invasion is contraindicated for LT.     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

肝内胆管癌分型分期与治疗

Objective To investigate the typing, staging and therapeutic outcome of intrahepatic cholan-giocarcinoma (ICC). Methods The clinical data of 60 ICC patients who were admitted to the Renji Hospital of Shanghai Jiaotong University from January 2000 to December 2008 were retrospectively analyzed. ICC was classi-fied according to the type and TNM staging proposed by the Liver Cancer Study Group of Japan (LCSGJ). The relationships between typing, staging, surgical procedures and therapeutic outcome were investigated, as well as the relationship between the LCSGJ staging system and UICC staging system. Results The 1-, 3-, and 5-year survivals of the 60 ICC patients were 44% (23/52), 19% (10/52) and 10% (5/52), respectively. The median survival time for patients with radical resection (n =30) , liver transplantation (n = 10), palliative surgery (n = 11) and exploratory laparotomy (n=9) were 13, 3, 3 and 1 months, respectively. The radical resection rates for mass-forming type, periductal-infiltrating type, intraductal growth type and mixed type were 23/31, 9/15, 5/6 and 3/8, respectively. There were significant relationships between tumor type, degree of differentiation and prog-nosis (χ2 = 8. 308, 10. 009, P < 0. 05), and between tumor type and lymph node metastasis (χ2 = 13. 261, 5.702, P <0.05). There was no significant difference in survival time between patients with different pathological types, but the prognosis of patients with mucinous adenocarcinoma was better than that in the other types, with a median survival time of 20months. The median survival time of patients in LCSGJ stage Ⅳ was 3. 0 months, which was significantly longer than that in UICC stage Ⅳ (χ2 =3. 877, P <0. 05). Tumor staging was intimately related to the macroscopic type χ2 =8.288, P <0. 05). Conclusions The prognosis of ICC is poor. The typing and staging of LCSGJ is concise and practical, which is helpful in guiding treatment and evaluating progno-sis. Surgical treatment should be applied to mucinous ICC, and liver transplantation is not recommended for the treatment of ICC.     

肝内胆管癌分型分期与治疗

Objective To investigate the typing, staging and therapeutic outcome of intrahepatic cholan-giocarcinoma (ICC). Methods The clinical data of 60 ICC patients who were admitted to the Renji Hospital of Shanghai Jiaotong University from January 2000 to December 2008 were retrospectively analyzed. ICC was classi-fied according to the type and TNM staging proposed by the Liver Cancer Study Group of Japan (LCSGJ). The relationships between typing, staging, surgical procedures and therapeutic outcome were investigated, as well as the relationship between the LCSGJ staging system and UICC staging system. Results The 1-, 3-, and 5-year survivals of the 60 ICC patients were 44% (23/52), 19% (10/52) and 10% (5/52), respectively. The median survival time for patients with radical resection (n =30) , liver transplantation (n = 10), palliative surgery (n = 11) and exploratory laparotomy (n=9) were 13, 3, 3 and 1 months, respectively. The radical resection rates for mass-forming type, periductal-infiltrating type, intraductal growth type and mixed type were 23/31, 9/15, 5/6 and 3/8, respectively. There were significant relationships between tumor type, degree of differentiation and prog-nosis (χ2 = 8. 308, 10. 009, P < 0. 05), and between tumor type and lymph node metastasis (χ2 = 13. 261, 5.702, P <0.05). There was no significant difference in survival time between patients with different pathological types, but the prognosis of patients with mucinous adenocarcinoma was better than that in the other types, with a median survival time of 20months. The median survival time of patients in LCSGJ stage Ⅳ was 3. 0 months, which was significantly longer than that in UICC stage Ⅳ (χ2 =3. 877, P <0. 05). Tumor staging was intimately related to the macroscopic type χ2 =8.288, P <0. 05). Conclusions The prognosis of ICC is poor. The typing and staging of LCSGJ is concise and practical, which is helpful in guiding treatment and evaluating progno-sis. Surgical treatment should be applied to mucinous ICC, and liver transplantation is not recommended for the treatment of ICC.     

巩固性重复射频消融对甲胎蛋白阴性肝细胞癌射频消融后局部肿瘤进展的疗效

目的 探讨甲胎蛋白(AFP)阴性肝细胞癌(HCC)患者在射频消融(RFA)获得影像学完全消融后,以安全边界(SM)≥1 cm为目标的巩同性重复RFA(CRRFA)对于局部肿瘤进展的影响.方法 课题组在2002年7月至2009年7月间,共收治152例完全消融的AFP阴性HCC.其中,影像学分析显示肿瘤周边部分区域SM＜1 cm者110例,所有区域SM≥1 cm者42例.在SM＜1 cm的110例患者中,59例在首次RFA后6个月内接受了CRRFA,其余51例选择了临床观察随访.然后,据此将符合纳入标准的病例分为窄SM-CRRFA组(n=41)和窄SM-单次RFA组(n=37).此外,还从42例SM≥1.0 cm者,选择符合纳入标准的病例纳入宽SM-单次RFA组(n=30).对三组患者的局部无瘤生存率进行了比较.结果 窄SM-CRRFA组1年、2年、3年、4年和5年局部无瘤生存率分别为97.1%、90.9%、69.6%、47.2%和33.0%;窄SM-单次RFA组分别为85.9%、66.5%、43.5%、15.8%和0.0%;宽SM-单次RFA组分别为92.7%、83.7%、59.3%、36.9%和9.2%.三组间局部无瘤生存率差异有统计学意义(χ2=14.789,P=0.001).两两比较结果 显示,窄SM-CRRFA组和宽SM-单次RFA组的累积局部无瘤生存率均明显高于窄SM-单次RFA组(χ2分别为9.353和5.375,P值分别为0.002和0.020);窄SM-CRRFA组与宽SM-单次RFA组局部无瘤生存率差异无统计学意义(χ2=1.785,P=0.182).结论 对于直径3～5 cm的AFP阴性HCC,RFA治疗后SM≥1 cm是影响局部肿瘤控制效果的重要因素;对于SM＜1 cm者,CRRFA可显著提高局部无瘤生存率.

Abstract：

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.     

肝肾联合移植13例临床分析

目的 探讨肝肾联合移植的适应证、手术并发症及生存情况.方法 回顾性分析2003年10月至2008年12月施行的13例肝肾联合移植患者的临床资料,分析围手术期死亡率、并发症情况及生存情况.结果 13例肝肾联合移植患者围手术期死亡率30.8%(4/13).术中、术后腹腔出血4例(30.8%);肺部感染7例(53.8%);移植肾急性排斥反应1例(7.7%).本组随访4.4～60个月,中位数40个月.存活1年以上8例,2年以上6例,3年以上5例,4年以上3例,5年以上1例.肝肾联合移植前有1例患者经历肝移植(例2)和2例患者经历肾移植(例3、例4),例4患者于肝肾联合移植术后第29天死于肺部感染、多器官功能衰竭,例2和例3肝肾联合移植术后分别存活40 m、48 m.结论 肝肾联合移植是治疗终未期肝肾疾病的有效方法.肝/肾移植术后再行肝肾联合移植是可行的.

Abstract：

Objective To investigate the indications, complications and survival results of combined liver-kidney transplantation. Methods From Oct 2003 to Dec 2008, the clinical data of 13 patients who underwent combined liver-kidney transplantation (CLKTs) were retrosptiverly analyzed in our institution. The perioperative mortality rate, complications and the result of follow-up were analyzed.Results The perioperative mortality rate (within 30 days) was 30.8% (4/13). Postoperative complications included intrabdominal bleeding in 4 patients ( 30. 8% ); pulmonary infection in 7 patients (53.8%); acute renal rejection in one (7. 7% ). Survivors were followed up from 4.4 to 60 months, with the median time of 40 months. Eight patients have survived more than 1 year; six patients have survived more than 2 years; five of them have survived for more than 3 years; and three of them have survived for more than 4 years, with one surviving for more than 5 years. One patient had undergone liver transplantation ( case 2 ) and two patients had had kidney transplantations ( case 3 and case 4 ) before this CLKTs.Postoperatively case 4 died of pulmonary infection and multiple organ failure at day 29, while case 2 and case 4 survived respectively 40 m, 48 m after CLKTs. Conclusions CLKTs is an effective therapy for end-stage liver and kidney disease. CLKTs for patients with irreversible liver and renal insufficiency after initial liver transplantation or kidney transplantation was feasible.     

碳酸酐酶IX表达在肾透明细胞癌预后评估中的价值

目的 评估肾透明细胞癌组织中碳酸酐酶IX(CA IX)表达在患者预后判断中的价值.方法 应用免疫组织化学P-V方法检测 120例肾透明细胞癌和25例正常肾组织石蜡标本中CA IX的表达.以肿瘤特异性生存率作为最终和主要的评估目标.运用Cox回归模型行CA IX表达与预后关系的单因素和多因素分析,以P＜0.05为差异有统计学意义.结果 112例(93.3%)获随访,随访6～94个月,中位时间45个月,无瘤生存75例,带瘤生存3例,死亡34例,其中死于肿瘤28例.正常肾组织均不表达CA IX.120例肾透明细胞癌组织中CA IX高表达89例(74.2%),高表达者中获随访82例,无瘤生存62例(75.6%),带瘤生存2例(2.4%),死亡18例(22.0%),死于肿瘤13例(15.9%),复发和(或)转移9例(11.0%),中位生存期为92个月.肾透明细胞癌CA IX低表达31例(25.8%),其中获随访30例,无瘤生存13例(43.3%),带瘤生存1例(3.3%),死亡16例(53.3%),死于肿瘤15例(50.0%),中位生存期为53个月,复发和(或)转移8例(26.7%).2组肿瘤特异性生存率比较经log-rank检验,差异有统计学意义(P=0.000,χ2=15.950),CA IX高表达组1、3、5、7年肿瘤特异性生存率分别为95.2%、83.9%、81.2%、78.2%,CA IX低表达组分别为89.5%、63.9%、46.8%、40.1%.2组术后肿瘤复发和(或)转移率比较差异有统计学意义(P=0.040,χ2=4.200).多因素Cox 回归模型分析显示CA IX表达是影响肾透明细胞癌预后的指标(RR=0.186).结论 CA IX高表达与肾透明细胞癌患者术后死亡率及肿瘤复发和(或)转移率呈负相关,CA IX可作为判断肾透明细胞癌预后的指标.

Abstract：

Objective To evaluate the prognostic significance of carbonic anhydrase IX (CA IX) expression in patients with clear cell renal cell carcinoma (ccRCC). Methods CA IX expression in a cohort of 120 patients with ccRCC was evaluated by P-V immunohistochemistry with a rabbit CA IX polyclonal antibody. Twenty-five normal kidney tissues were used as a control. The relationship between CA IX expression and prognosis was analyzed by univariate and multiple-factor analysis (Cox regression model). The primary end point was cancer specific survival. Results One hundred and twelve (93.3%) patients were followed up with the median follow-up time of 45 months (range, 6 to 94 months). Seventy-five patients survived without evidence of tumor recurrence, 3 patients survived with tumor recurrence, and 34 patients died, 28 of the 34 died of cancer. CA IX expression was negative in all normal renal tissue. High CA IX expression was observed in 89 (74.2%) patients, among which 82 patients were followed up, and the disease free survival was 75.6% (62/82). Two (2.4%) patients survived with tumor recurrence, and 18 (22.0%) patients died, of which 13 (15.9%) died of cancer. Tumor recurrence and (or) metastasis occurred in 9 (11.0%) patients, with a median survival of 92 months in this high expression group. Low CA IX expression was observed in 31 (25.8%) patients, among which 30 patients were followed up, and the disease free survival was 43.3% (13/30). One (3.3%) patient survived with tumor recurrence, and 16 (53.3%) patients died, of which 15 (50.0%) died of cancer. Tumor recurrence and (or) metastasis occurred in 8 (26.7%) patients with a median survival of 53 months in this low expression group. Cancer specific survival between CA IX high expression group and low expression group was significantly different (P=0.000, χ2=15.950), and tumor relapse and (or) metastasis rates were significantly different (P=0.040, χ2=4.200). The 1, 3, 5 and 7 year cancer specific survival rates were 95.2%, 83.9%, 81.2% and 78.2% respectively in the high CA IX expression group, and 89.5%, 63.9%, 46.8% and 40.1% respectively in the low expression group. Multivariate analysis with Cox regression model showed that CA IX expression was a prognostic factor (RR=0.186). Conclusions High CA IX expression is negatively correlated with postoperative mortality, relapse and (or) metastasis in ccRCC. CA IX expression could be used as a prognostic biomarker in ccRCC.     

普萘洛尔作为严重婴幼儿血管瘤一线治疗的前瞻性研究

目的 前瞻性评价普萘洛尔作为一线方案治疗严重婴幼儿血管瘤的疗效和安全性.方法 2009年3月至2010年2月对78例严重婴幼儿血管瘤患儿口服普萘洛进行治疗,用药剂量为每天2 mg/kg.患儿性别、年龄、肿物部位、并发症以及患儿入选该治疗的指征、不良反应、停药后有无复发等均被详细记录.针对服药后1周、1个月和停药时疗效分别评价.平均随访时间为16.7个月(12.1～23.6个月).结果 初始服药平均年龄为3.7个月(1.1～9.2个月),停止服药的平均年龄为11.2个月(5.2～22.3个月).疗程平均7.6个月(2.1～18.3个月).所有患儿口服普萘洛尔1周后肿物生长有效控制,其中88.5%(69/78)的患儿表现为促进消退.服药1个月和停药时,表现为促进消退的患儿达98.7%(77/78).14例伴发溃疡的血管瘤患儿,溃疡在服药后2个月内均愈合.15.4%(12/78)患儿有轻微不良反应.35.9%(28/78)患儿停药后有复发倾向.结论 普萘洛尔治疗婴幼儿血管瘤疗效明显,不良反应小,可作为严重婴幼儿血管瘤的一线治疗.

Abstract：

Objective To prospectively assess the efficacy and safety of propranolol as a first-line treatment for problematic infantile haemangioma in China. Methods From Mar. 2009 to Feb. 2010, 78 patients with problematic infantile hemangioma were included in the prospective study. The characteristics of the tumor, including sex, age, site, complications, were recorded. The response to treatment at 1 week, at 1 month and at the end of treatment was evaluated. The efficacy of treatment was graded as no response, stabilization, or accelerated regression. The indications for treatment, side effects and relapse after treatment were documented. The mean follow-up period was 16.7 months (range, 12.1-23.6 months). Results Oral therapy was initiated at mean age of 3. 7 months (range, 1.1-9.2 months) as first-line therapy. The mean age at the end of treatment was 11.2 months ( range, 5. 2-22. 3 months) . The treatment was lasted for 7. 6 months (range, 2. 1-18. 3 months). One week after treatment beginning, the hemangioma growth was controlled in all the patients. The accelerated regression was achieved in 88. 5% (69/78) of patients after one week of treatment, and 98.7% (77/78) of patients after 1 month of treatment and at the end of treatment. Ulceration was occurred in 14 cases before treatment, which was healed after treatment for 2 months. Minor side effects were happened in 15.4% ( 12/78) of patients.Rebound growth of lesion was noticed in 35. 9% (28/78 ) of patients. Conclusions Propranolol is effective in the treatment of infantile hemangioma with minor side effect. We suggest it should be used as the first-line treatment.     

Effects of α1-adrenergic receptor on the proliferation of cholangiocarcinoma cells

Objective To investigate the correlation between α1-adrenergic receptor and the pathological behavior of cholangiocarcinoma, and the effects of norepinephrine (NE) on the proliferation of cholangiocarcinoma cell line QBC939. Methods Thirty-six samples of cholangiocarcinoma were resected in Southwest Hospital from August 2002 to March 2008. The expression of α1-adrenergic receptor in the 36 samples of cholangiocarcinoma tissue and 4 samples of normal bile duct tissue were detected by SABC technique. The proliferation of cholangio-carcinoma cell line QBC939 was detected after processing the cells with NE, phentolamine and prazosin. All the data were analyzed by chi-square test. Results The high positive expression rate of α1-adrenergic receptor was 68% (17/25) in patients with lymph node metastasis, which was significantly higher than 9% (1/11) in patients without lymph node metastasis (χ2=10.604, P<0.05). The high positive expression rate of α1-adrenergic receptor was 85% (11/13) in patients with middle and low positioned cholangiocarcinoma, which was significantly higher than 30% (7/23) in patients with hilar cholangiocarcinoma (χ2=9.753, P<0.05). NE promoted the proliferation of cholangiocarcinoma cell line QBC939 by stimulating the expression of α1-adrenergic receptor, and in a concentration-dependent manner. The proliferative effect was weakened as time passed by, and it was eliminated by phentolamine and prazosin. Conclusions The expression of α1-adrenergic receptor is diverse due to lymph node metastasis and the location of the tumor, α1-adrenergic receptor with high expression may play an important role in the proliferation and metastasis of cholangiocarcinoma.     

超声引导经皮复合热消融技术治疗中、大肝细胞癌

目的　评估超声引导复合热消融技术治疗中、大肝细胞癌 (HCC)的应用价值。方法在超声引导下经皮采用多针插入、多点能量输出的射频消融 (RFA)或微波消融 (MWA)技术 ,治疗 6 8例HCC患者共 73个肿瘤结节 ,平均直径 (4 5± 1 7)cm (3 1～ 13 0cm) ,经 1 9～ 6 7 6个月 [平均(16 0± 14 8)个月 ]随访 ,检测局部及远期治疗效果。结果　治疗后合并肝包膜下血肿及皮肤烧伤的患者各 1例。肿瘤完全消融率 78 1% (5 7/73) ,2 4 6 % (14 /5 7)的病灶出现局部肿瘤进展 ,远处复发率 5 6 7% (38/6 7) ,1、3、5年生存率分别为 6 2 3%、2 9 6 %、2 1 6 % ,中位生存时间为 18 6个月 (95 %可信区间为 10 9～ 2 6 3个月 )。RFA与MWA在完全消融率、局部肿瘤进展率与远处复发率、生存率方面差异均无显著意义。结论　经皮复合热消融技术治疗不能手术切除的中、大肝细胞癌创伤小 ,可获得良好的局部控制和远期疗效 ,RFA与MWA疗效无明显差异     

纳米刀消融治疗不可切除肝门部胆管癌的初步探索

目的:分析纳米刀消融治疗不可切除肝门部胆管癌的疗效与难点。方法:回顾性分析2016年1月—2018年6月郑州大学第五附属医院采用纳米刀消融技术治疗的26例不可切除肝门部胆管癌的临床资料。结果:全部患者顺利实施开腹纳米刀消融治疗。4例患者术中放置T管引流,11例术中放置胆道支架,4例术中放置胆道支架+放射性粒子链。8例手术前、后CA19-9均无明显升高;其余18例患者术前CA19-9明显升高,术后第1、3天进一步升高,后逐步下降。术后胆道出血1例,心房颤动2例,上消化道出血死亡1例,胆道感染3例,肝脓肿、腹腔脓肿、淋巴漏各1例,PTCD管脱落4例。22例(84.6%)患者术后胆管再通。26例患者总生存时间平均为(9.8±5.6)个月。结论:纳米刀消融治疗不可切除肝门部胆管癌安全、有效,联合胆道支架治疗可使患者获得更好疗效。     

Resection of intrahepatic cholangiocarcinoma: a Western experience

We analyzed the results of an aggressive surgical approach to intrahepatic cholangiocarcinoma. Between 1990 and 1997, 30 of 42 patients with intrahepatic cholangiocarcinoma underwent resection with curative intent. Mean tumor size was 10 ± 5 cm, and the tumors were classified as TNM type III, IVa, and IVb in 63%, 34%, and 3% of the patients, respectively. All patients underwent hepaticoduodenal lymphadenectomy. Fifteen patients received adjuvant radio- and chemotherapy. The overall survival rates at 1, 2, and 3 years were 86%, 63%, and 22%, respectively, and the median survival time was 28 months. Tumor recurrence was the main cause of death. Three patients survived for more than 5 years, including 2 patients with no evidence of recurrence. Factors influencing survival were: presence of satellite nodules (P = 0.007) and lymph node invasion (P = 0.05). The width of the resection margin and the use of an adjuvant therapy had no impact on survival. Complete surgical resection may offer a chance for long-term survival in selected patients and may improve the quality of life of patients with more advanced disease. Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998     

Intrahepatic cholangiojejunostomy for unresectable malignant biliary tumors with obstructive jaundice

We reviewed our experience with intrahepatic cholangiojejunostomy as a palliative therapy for patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Fifteen patients with malignant biliary obstruction were treated by cholangiojejunostomy at our hospital. Two patients had intrahepatic cholangiocarcinoma, 7 had gallbladder carcinoma, 5 had bile duct carcionoma, and 1 had pancreatic carcinoma. Segment III cholangiojejunostomies were performed in 14 patients and segment V cholangiojejunostomy in 1. Contraindications for surgical resection were locoregional invasion of tumors involving the proper and/or common hepatic artery and portal vein in 15 patients and the presence of hepatic metastases in 6 patients. Liver metastases were detected in 5 of the 7 patients with gallbladder carcinoma. Postoperative complications occurred in 2 patients (13%), but there was no leakage of the cholangioenteric anastomosis in our series. There was no operative mortality after cholangiojejunostomy. Of the 9 patients who survived for more than 6 months after surgery, 7 showed a significant improvement in performance status (PS) (82 ± 10%) 3 months after the surgery compared with the preoperative PS (70 ± 7%). Four of the 9 patients had recurrent cholangitis as a late complication, but 4 were completely free from jaundice. Median survival after cholangioenteric bypass was 9 months (range, 2–25 months). With respect to tumor location, the median survival time was 4 months (range, 2–25 months) in patients with gallbladder carcinoma and 15.5 months (range, 12–22 months) in those with bile duct carcinoma. While the median survival period after surgery was only 3 months (range, 2 to 8 months) in the 5 patients with hepatic metastases from gallbladder carcinoma, 2 patients without liver metastasis survived for 9 and 25 months after segment III cholangioenteric bypass. In conclusion, cholangiojejunostomy can provide useful palliation for malignant biliary obstruction when combined with careful patient selection. Received: September 5, 2000 / Accepted: November 8, 2000     

原发性胆管细胞性肝癌42例的外科治疗

目的　评价原发性胆管细胞性肝癌外科诊治的效果。方法　回顾性分析 1996 年 1 月至2001年12月间经手术治疗的42例原发性胆管细胞性肝癌的临床与病理资料。结果　42 例患者以上腹痛、黄疸、上腹包块为主要临床表现,合并胆石症6例;CA19 9检查25例,16例升高;形成单个包块者20例,腹腔淋巴结转移19例。手术切除16例,其中根治性切除13例,同种异体原位肝移植1例。根治性切除生存超过1年者7例,超过3年者4例,超过5年者2例。姑息性切除及肿瘤未切除者无2年生存者。结论　增强对原发性胆管细胞性肝癌的认识,提高早期诊断水平,采用手术切除及肝移植治疗,可提高治疗效果。     

CT引导下肺结节热消融联合术中即时活检的可行性

目的 观察CT引导下热消融肺结节联合术中即时活检的可行性。方法 回顾性分析331例接受CT引导下经皮肺穿刺活检和/或热消融肺结节患者的资料,共373个病灶。其中102例（102个病灶）仅接受CT引导下经皮肺穿刺活检（单纯活检组）,132例（174个病灶）仅接受CT引导下热消融（单纯消融组）,97例（97个病灶）接受CT引导下热消融联合术中即时活检（消融联合活检组）。计算技术成功率,记录并发症;评价活检标本病理诊断阳性率（所取组织标本可获得明确病理诊断判定为阳性）及基因检测标本质量。结果 对331例均顺利完成操作,技术成功率为100%（331/331）。单纯活检组术后6例（6/102,5.88%）咯血,单纯消融组及消融联合活检组术中及术后均未见咯血。单纯活检组5例、单纯消融组11例、消融联合活检组13例发生气胸,3组间差异无统计学意义（P=0.10）;均予CT引导下经皮置管引流。单纯活检组活检组织病理诊断阳性率为73.53%（75/102）,消融联合活检组为82.47%（80/97）,组间差异无统计学意义（P=0.13）。消融联合活检组共16例接受基因检测分析,活检组织标本均达到质控合格标准。结论 CT引导下热消融肺结节联合术中活检可行,可降低出血发生风险,且能满足病理检查及基因检测要求。     

Percutaneous transhepatic endoprostheses for hilar cholangiocarcinoma

In patients with unresectable hilar cholangiocarcinoma, percutaneous transhepatic endoprosthesis insertion is one of the available methods of palliation. We reviewed our experience with it in 35 consecutive patients with hilar cholangiocarcinoma who were judged on clinical or radiologic evidence to be unsuitable for resective or palliative surgery. The 30-day mortality rate was 14 percent (5 of 35 patients). Of the remaining 30 patients, endoprosthesis placement was successful in 28, with 2 patients discharged with a permanent external drainage catheter. Twenty-four patients survived a median of 3 months (range 1 to 17 months), and 2 were lost to follow-up. Good or fair palliation of symptoms was achieved in 50 percent of the discharged patients and in 66 percent of those living longer than 3 months. We believe that percutaneous transhepatic endoprostheses can provide useful palliation in patients with hilar cholangiocarcinoma, even in the presence of advanced disease.     

经皮微波和射频消融治疗肝细胞性肝癌的临床比较研究

目的探讨经皮微波和射频消融治疗肝癌临床效果的差异。方法以相同的纳入标准,回顾性比较了肝细胞性肝癌经超声引导经皮微波消融49例98个结节和射频消融53例72结节的局部疗效、并发症和远期生存率。结果微波组与射频组比较,肿瘤完全消融率分别为94.9%(93/98)和93.1%(67/72)(P=0.75),局部复发率为11.8%(11/93)和20.9%(14/67)(P=0.12)。主要并发症发生率分别为8.2%(4/49)和5.7%(3/53)(P=0.71)。1、2、3年无瘤生存率微波组分别为45.9%、26.9%和26.9%,射频组为37.2%、20.7%和15.5%(P=0.53)。1、2、3、4年累积生存率微波组分别为81.6%、61.2%、50.5%和36.8%,射频组为71.7%、47.2%、37.6%和24.2%(P= 0.12)。结论经皮微波和射频消融治疗肝癌的局部疗效、并发症和远期生存率无显著差别,均为安全有效的肝癌治疗手段。     

超声引导高强度聚焦超声治疗肌壁间子宫肌瘤的效果

目的探讨超声引导高强度聚焦超声(HIFU)治疗肌壁间子宫肌瘤的效果及其对前、后壁子宫肌瘤疗效的差异。方法对54例症状性肌壁间子宫肌瘤患者行超声引导下HIFU治疗;消融后当日或次日及术后3个月时行增强MR检查,评估肌瘤消融范围并计算消融率:消融率≥50%为显效,0<消融率<50%为有效,增强信号无减低为消融无效。结果共消融治疗肌壁间子宫肌瘤57个,其中前壁肌瘤32个,后壁肌瘤25个;消融前肌瘤体积为16.27～502.12cm3,消融后增强MRI显示无灌注区域体积为5.75～292.42cm3,平均消融率为(68.14±16.19)%,显效率为89.47%(51/57),有效率为100%(57/57)。3个月后消融肌瘤无灌注区域体积较术后1天或次日进一步缩小(t=6.365,P<0.05)。前壁肌瘤平均消融率为(74.35±12.24)%,后壁肌瘤平均消融率为(60.93±17.62)%,差异有统计学意义(t=2.366,P<0.05)。结论超声引导HIFU治疗肌壁间子宫肌瘤安全、有效,对前壁肌瘤的消融率高于后壁肌瘤。     

射频消融治疗初发小肝癌的疗效及预后因素分析

目的 分析射频消融治疗初发小于5 cm 肝细胞癌的疗效和预后因素,探索射频消融治疗小肝癌的适应证及进一步提高疗效的方法 .方法 采用回顾性队列研究方法 ,分析2001年10月至2006年12月期间,124例在中山医院肝癌研究所行射频消融治疗初发小于5 cm肝细胞癌135个病灶,随访期至2008年3月.结果 中位随访期22个月,中位、平均总体生存期为46个月、(42.7± 2.7)个月;1、2、3、4、5年的总体生存率为86.8%、66.5%、56.5%、45.6%、36.5%.与总体生存相关的独立危险因素有:白蛋白(P=0.007,r=2.227)和凝血酶原时间(P=0.035,r=2.010).白蛋白≤35 g/L且凝血酶原时间＞13 s(45例)和白蛋白＞35 g/L且凝血酶原时间≤13 s(42例)两组病人5年生存率和中位生存时间分别为25%、21个月和67%、63个月.结论 白蛋白和凝血酶原时间正常的初发小肝癌病人接受射频消融治疗能获得较高的5年生存率.