超声导向注射无水酒精治疗肝癌50例报告

超声导向注射无水酒精治疗肝癌５０例报告江苏省海门市人民医院（海门市２２６１００）孙铁近年来，采用超声导向注射无水酒精治疗肝癌（Ｐｅｒｃｕｔａｎ－ｃｏｕｓｅｔｈａｎａｌｉｎｊｅｃｔｉｏｎ，ＰＥＩ）的方法受到广泛重视和推崇。我院自１９９３年１月至１９９６...     

B超引导下瘤内注射无水酒精治疗肝癌

本文报道采用酒精瘤内注射治疗经病理证实的14例中晚期肝癌患者。经随访3～15个月,其中1例肝内病灶明显缩小(由12×12cm～2.1×2.0cm),随访超过15个月仍健在。2例治疗中瘤体缩小一半,但1个月后又增大。4例治疗后,AFP下降一半。其余7例无效。瘤内注射,尽管是一姑息性疗法,但在B超引导下既能显示瘤体与相邻组织的关系,又能看到进针的运动过程,针尖位置及酒精在瘤内弥散呈现强光团的动态情景。它与肝动脉的各种栓塞疗法相比,作者认为本方法简便、安全、准确及并发症少,是值得推广的新疗法。     

无水酒精注射治疗肝癌

目的 观察经皮酒精注射治疗原发性肝癌的效果。方法 超声或CT引导下对87例原发性肝癌行经皮肝肿瘤内无水乙醇注射治疗，共注射治疗573次。结果 6个月、1年、2年绝对生存率分别为95.4%、78.3%、47.7%。临床症状的改善以疼痛缓解与食欲好转较为明显。AFP明显下降者占66.1%。肿块缩小率为78%。结论 酒精注射治疗小肝癌效果明显好于大肝癌；该疗法无针道转移及其它严重并发症，酒精注射联合栓塞治疗对大肝癌可能具有更好的疗效。     

超声引导下无水酒精瘤体内注射治疗不宜手术的原发性肝癌

肝脏恶性肿瘤最佳的治疗方法是以根治性手术切除为主的综合治疗.但是临床目前约有80%的患者不宜行手术治疗,而超声引导下经皮穿刺肝内肿瘤注射无水酒精(percutaneous ethanol injection,PEI)是非手术治疗的一个重要手段.本研究对2003-2006年间应用经皮无水酒精瘤体内注射的方法治疗原发性肝癌40例进行回顾性分析,以评价疗效及实用性.     

超声介入瘤内注射无水酒精治疗原发性肝癌近期复发危险因素

目的 探讨超声介入瘤内注射无水酒精治疗原发性肝癌后近期复发的危险因素。方法 前瞻性收集我院2007年1月-2011年12月73例超声介入瘤内注射无水酒精治疗原发性肝癌患者的临床资料,利用单因素回归分析超声介入瘤内注射无水酒精治疗原发性肝癌的相关因素,然后用多元回归分析法对相关因素进行分析,确定其近期复发危险因素。结果 单因素分析发现:患者的性别、年龄、血清乙肝HBsAg阳性阴性、肿瘤部位、肿瘤数目组间的生存率差异无统计学意义。肿瘤大小、血清AFP水平、有无门脉癌栓形成、肝功能(Child)分级、肿瘤分化程度、肿瘤不同转移部位之间生存率差异有统计学差异。经多因素分析及逐步回归结果显示,肝功能(Child)分级、肿瘤分化程度、肿瘤转移、门脉癌栓是预后显著相关的因素(卡方检验,χ²=47.763,P＜0.01;似然比检验,χ²=450.546,P＜0.01)。结论 肝功能(Child)分级、肿瘤分化程度、肿瘤转移和门脉癌栓是超声介入后近期复发的危险因素。     

高强度聚焦超声与超声引导穿刺无水酒精 注射治疗门静脉癌栓的比较

 摘要：目的对比观察高强度聚焦超声(HIFU) 与超声引导穿刺无水酒精注射治疗门静脉癌栓(PVTT)的疗效 和不良反应。方法回顾性分析我院原发性肝癌(PLC)合并PVTT患者86例的治疗情况,在肝癌肿块行TACE治 疗的基础上,对于癌栓的治疗,52例（A组）为HIFU治疗,34例（B组）为超声引导穿刺无水酒精注射治疗 ,对比评价两组PVTT治疗的近期有效率 (CR+PR)%、临床受益率(CBR)、生存期及不良反应。结果A组近期 有效率40.38%,B组41.18%,两组比较差异无统计学意义(P=0.1493)。A组CBR为48.08%,B组为23.53%,两 组比较差异有统计学意义(P=0.0102)。两组的生存期和中位生存期分别为3.6～23.5月和12.3月、4.2～ 21.3月和11.5月,两组比较差异无统计学意义(P=0.1504)。主要不良反应为：A、B两组少数病例有上消化 道出血,B组多数病例有肝区胀痛、发热、肝包膜下出血,B组的不良反应发生率明显高于A组,两组差异 有统计学意义（P=0.0051）。结论HIFU与无水酒精注射治疗的近期疗效与远期疗效相似,在改善患者临床 状态等方面优于无水酒精注射治疗,治疗的不良反应明显低于无水酒精注射,HIFU比无水酒精注射有更高 的安全性,应用范围广,能适合肝功能异常、伴有腹水、病情较重不能耐受其他方法治疗的肝癌伴门静脉 癌栓患者。     

肝动脉栓塞化疗联合B超引导下无水酒精注射治疗33例肝癌疗效观察

经皮经导管肝动脉栓塞化疗术（ＴＡＣＥ）目前被认为是不能手术切除的肝癌的首选治疗方法之一,然而仍有许多病例疗效不理想。我所采用ＴＡＣＥ联合Ｂ超引导下瘤内注射无水酒精（ＰＥＩ）治疗３３例原发性肝细胞癌。现将结果报告如下。１材料与方法１．１研究对象６４例原...     

超声引导下药物联合治疗左肝癌

１９９０年１０月至１９９４年６月，采用超声引导，门静脉分支栓塞化疗及无水酒精注射（ＰＨＰＣＥ）加癌周、癌内无水酒精注射（ＰＥＩＴ）治疗左叶原发性肝癌１３例；经治２疗程后的１１例，表现为肿瘤缩小或消失、ＡＦＰ下降或转阴；经治６疗程的３例，已存活３年，另１例已存活２３个月，其余７例已存活４～２０个月。根据治疗经验及结果，认为本法操作简单、疗效确实、并发症少，可作为年迈体弱或伴有其他器官疾病、术后复发及不接受手术治疗患者的一种补救方法。     

肝癌无水酒精注射术的疗效及影响因素

原发性肝癌（ＨＣＣ）目前的治疗效果尚不尽人意。手术切除是ＨＣＣ首选的治疗方法 ,但我国大多数ＨＣＣ病例均伴有肝硬化或（和）慢性肝炎 ,由于肝功能不佳而不能接受手术切除。对于不能手术切除的ＨＣＣ病人 ,Ｂ超引导下的经皮无水酒精注射术（Ｐｅｒｃｕｔａｎｅｏｕｓｅｔｈａｎｏｌｉｎｊｅｃｔｉｏｎ，ＰＥＩ）是目前疗效较为肯定的疗法之一。本文重点概述ＰＥＩ的指征、疗效及影响疗效的因素。１ＰＥＩ治疗ＨＣＣ的指征ＰＥＩ在应用的早期主要用于治疗直径＜３ｃｍ的小肝癌 ,因为较大的肿瘤无水酒精无法完全弥漫浸润而易于局部复发。…     

超声引导无水酒精注射术对肝癌患者乙醇代谢酶活性影响的临床研究

目的：探讨超声引导无水酒精注射（PEI）治疗对原发性肝癌患者乙醇代谢酶活性的影响。方法：原发性肝癌行PEI治疗30例为治疗组,以同期门诊体检30例健康成人为对照组,比较治疗前治疗组转氨酶及乙醇代谢酶水平与对照组的差异,观察比较PEI治疗前及治疗3、6、8次后转氨酶和乙醇代谢酶的变化。结果：治疗组PEI治疗前转氨酶及乙醇代谢酶活性明显高于对照组（P〈0.001）;治疗组治疗3、6、8次后均显著高于治疗前（P〈0.001）;第3次治疗后升高最明显,第6次后逐渐趋缓,第8次后下降但仍高于术前,两两比较有显著性差异（P〈0.001）。结论：原发性肝癌患者PEI治疗前就存在一定程度肝细胞损害,PEI治疗可造成癌旁肝细胞损害,致患者血清乙醇代谢酶活性升高,多次PEI治疗并未无限度地加重肝损害。检测乙醇代谢酶活性可作为临床评价PEI对癌旁肝组织损害程度的指标。     

超声引导无水酒精注射术对肝癌患者乙醇代谢酶活性影响的临床研究

目的:探讨超声引导无水酒精注射(PEI)治疗对原发性肝癌患者乙醇代谢酶活性的影响。方法:原发性肝癌行PEI治疗30例为治疗组,以同期门诊体检30例健康成人为对照组,比较治疗前治疗组转氨酶及乙醇代谢酶水平与对照组的差异,观察比较PEI治疗前及治疗3、6、8次后转氨酶和乙醇代谢酶的变化。结果:治疗组PEI治疗前转氨酶及乙醇代谢酶活性明显高于对照组(P<0.001);治疗组治疗3、6、8次后均显著高于治疗前(P<0.001);第3次治疗后升高最明显,第6次后逐渐趋缓,第8次后下降但仍高于术前,两两比较有显著性差异(P<0.001)。结论:原发性肝癌患者PEI治疗前就存在一定程度肝细胞损害,PEI治疗可造成癌旁肝细胞损害,致患者血清乙醇代谢酶活性升高,多次PEI治疗并未无限度地加重肝损害。检测乙醇代谢酶活性可作为临床评价PEI对癌旁肝组织损害程度的指标。     

Androgen deprivation therapy prevents bladder cancer recurrence

Although accumulating preclinical evidence indicates the involvement of androgen receptor signals in bladder cancer (BC) development, its clinical relevance remains unclear. We aimed to evaluate the predictive role of androgen deprivation therapy (ADT) in BC recurrence in prostate cancer (PC) patients.We retrospectively reviewed 20,328 patients with PC diagnosed during 1991–2013 and identified 239 (1.2%) men having primary BC. After excluding ineligible patients, 162 patients made up a final cohort.With a median follow-up of 62 months, 38 (50%) of 76 control patients without ADT experienced BC recurrence, while 19 (22%) of 86 did in ADT group. Thus, patients having received ADT for their PC showed a significantly lower risk of BC recurrence (5-year actuarial recurrence-free survival: 76% v 40%; P < 0.001) and also had a significantly smaller number of recurrence episodes (5-year cumulative recurrence: 0.44 v 1.54; P < 0.001), compared to the control patients. A multivariable analysis revealed ADT as an independent prognosticator (hazard ratio, 0.29; 95% confidence interval, 0.17–0.49) for BC recurrence.This is the first clinical study showing that ADT significantly reduces the risk of BC recurrence.     

无水酒精注射治疗肝癌

目的观察经皮酒精注射治疗原发性肝癌的效果。方法超声或CT引导下对87例原发性肝癌行经皮肝肿瘤内无水乙醇注射治疗,共注射治疗573次。结果6个月、1年、2年绝对生存率分别为95.4%、78.3%、47.7%。临床症状的改善以疼痛缓解与食欲好转较为明显。AFP明显下降者占66.1%。肿块缩小率为78%。结论酒精注射治疗小肝癌效果明显好于大肝癌;该疗法无针道转移及其它严重并发症;酒精注射联合栓塞治疗对大肝癌可能具有更好的疗效。     

Local recurrence rate in patients with colorectal cancer liver metastasis after wedge resection or percutaneous radiofrequency ablation

Purpose: To compare local recurrence (LR) rate in patients with colorectal cancer liver metastasis (CRCLM) after surgical wedge resection (WR) or radiofrequency ablation (RFA) and to investigate predictive factors of LR.

Materials and methods: This single-centre, retrospective, institutional review board-approved study including 43 consecutive patients with 121 metastases treated by WR and 60 patients with 110 metastases treated by RFA between 2007 and 2014 with 23 and 18.5?months of follow-up, respectively. Demographics and tumour characteristics were compared using the unpaired t-test and chi-square test. Predictive factors for LR (lesion size, depth, relation to hepatic vessels, intervention, margin status) were investigated in uni- and multivariate analyses.

Results: Patient and CRCLM characteristics were similar in both groups. Mean lesion size and depth in the WR and RFA groups were 18?mm and 15?mm (p?=?0.03), and 19?mm and 26?mm (p?p?=?0.06). Positive margins and lesion depth were predictive factors of LR in the WR group (p?=?0.03 and p?=?0.02, respectively, on uni- and multivariable analyses). Lesion depth and proximity to a vein increased the risk of positive margins on pathology after WR (p?=?0.04 and p?Conclusion: Our study showed a trend towards a lower LR rate with RFA compared to WR. Lesions located deep in the liver and/or close to large vessels are at high risk of LR following WR, while curative treatment can be obtained with RFA.     

三维适形放疗治疗直肠癌术后复发病例临床观察

目的：观察三维适形放疗治疗直肠癌术后复发病例的疗效。方法：选择直肠癌术后复发患者54例接受三维适形放疗，其中低分化腺癌4例，中分化腺癌37例，高分化腺癌7例，粘液腺癌6例。放疗总剂量在60－72GY／22－24F／每周4－5次，其毒性作用用血液学、生化试验、胃肠道和泌尿系统反应进行评价。观察有无放射性肠淡症状，监测血细胞。每3月复查MRCT1次，二年生每6月复查MR或CT1次。结果：迄2000年12月25日止共随访54例，随访到53例（98.1%），失访1例（1.9%）；中位随访时间为15.4个月，平均访时间为14.3个月（3－30个月）。疗效判定标准：按WHO制订标准，完全缓解5例，占9.3%；部分缓解27例，占50.0%。稳定15例，占27.8%；进展6例占11.1%。有效率为59.3%。一年生存率61.1%（33/54），症状缓解率92.6%（50／54）。放射性肠炎发生率约为5.6%。均未出现白细胞减少和肝、肾功能降低与尿频、尿急、尿痛和血尿。结论：三维适形放射治疗直肠癌术后复发患者具有明显的剂量分布优势，局部控制率和症状缓解率高，放射性肠炎发生率低。     

Clinical significance and treatment of biochemical recurrence after definitive therapy for localized prostate cancer

Following definitive therapy, once biochemical recurrence is diagnosed, it is critical to perform an early risk assessment. Successful salvage largely relies on the prompt initiation of therapy. Consideration should be given to the overall health status of the individual, as prostate cancer tends to progress relatively slowly, and each of the salvage options confer risk that may well outweigh potential benefits.Biochemical recurrence following radical prostatectomy, as evidenced by detectable PSA, may ultimately lead to metastasis and cancer-specific mortality. Decisions regarding local versus systemic (or combined) therapy can then be made using clinicopathological predictors such as PSA-DT, Gleason score, time interval between RP and BR, and pathologic stage.After EBRT, the definition of biochemical recurrence has largely been a moving target with consensus groups attempting to define significance based on PSA changes which are likely to reflect cancer progression. PSA-DT, PSA nadir after EBRT, and Gleason score may be used to estimate the likelihood of MP and therefore the need for systemic therapy in addition to local therapy.

Conflict of interest statement

None.     

经皮肝穿刺无水酒精瘤内注射治疗原发性小肝癌的意义

Objective To evaluate the therapeutic effects of percutaneous ethanol intratumoral injection (PEIT) for treatment of small primary liver cancer (SPLC). Methods 240 patients with surgically or pathologically proved SPLC (<3 cm in diameter) were treated by PEIT (under the guidance of B-ultrasound). Of the 240 patients, 163 had recurrent liver cancer, 55 had inoperable liver cancer because of cardiac, pulmonary, hepatic and renal dysfunctions or due to the close proximity of tumor to the major vessels, and 22 refused to receive surgical resection. In 40 patients who received surgical resection after PEIT treatment, the resected tumors were pathologically evaluated for necrotic status and the patients were followed up postoperatively. Results Postoperative 1-, 2- and 3-year survival rate of the 240 patients was 94.9%, 84.2% and 66.3% respectively. Conclusion PEIT can be used as a non-invasive treatment for SPLC, and preoperative PEIT appears to be helpful in reducing recurrence of postoperative liver cancer.