介入治疗在结直肠癌肝转移中的作用

结直肠癌(colorectal cancer,CRC)是我国常见的恶性肿瘤,发病率逐年增高,已跃居第3~5位,在大城市增幅更快[1]。肝脏是CRC的常见转移部位,国外报道约30%的患者伴有同时性CRC肝转移(colorectal liver metastases,CRLM)[2],5年累积异时性CRLM发生率也有14.5%左右,约有76.8%的患者仅发生肝内转移而无其他肝外转移[3],CRLM是     

MRI诊断肝转移瘤的价值探讨

目的探讨脂肪抑制序列在肝脏转移瘤诊断中的价值。方法回顾分析37例有明确原发肿瘤伴有肝脏转移瘤的MRI资料。结果 37例患者T2WI序列发现转移灶201个,脂肪抑制序列发现转移灶236个,不需要增强扫描,仅补充脂肪抑制序列平扫就能发现其他序列未发现的35个病灶。结论在肝脏转移瘤的MRI检查方面,脂肪抑制序列优于T2WI序列。     

消化道肿瘤肝转移介入治疗的临床应用及预后分析

目的探讨介入治疗消化道肿瘤肝转移的治疗疗效。方法回顾性分析96例胃癌、结肠癌和胰腺癌肝转移患者的介入治疗,随访7个月～5年,评价其治疗效果和生存率。结果29例胃癌肝转移患者平均生存期为22.7个月,1年、3年、5年生存率分别为93.1%、31.4%、13.8%;55例结肠癌肝转移患者平均生存期为19.4个月,1年、3年、5年生存率分别为85.5%、34.5%、10.9%;12例胰腺癌肝转移患者平均生存期为13.2个月,1年、3年生存率分别为57.1%、14.2%;本组患者总的平均生存期为17.8个月,1年、3年、5年生存率分别为85.4%、33.3%、10.4%。结论介入治疗是不能根治性切除的肝转移瘤患者的有效治疗方法,鳞癌、胰腺癌肝转移的患者预后较差,而富血供肿瘤、原发肿瘤已切除的患者预后较好、生存期较长。     

小肠平滑肌类肉瘤肝转移的影像学评价和介入治疗

目的 评价小肠平滑肌类肉瘤肝脏转移的影像学表现和介入治疗的短期疗效。方法 回顾性分析7例小肠平滑肌类肉瘤肝脏转移病例,共计46个病灶。病灶直径2-18cm不等。所有患者均行肝脏CT三期扫描和肝动脉造影。介入治疗7例均采用肝动脉化疗栓塞术（TACE）,1例行左锁骨下动脉植入化疗药盒导系统术（肝动脉PCS术）。3例肿瘤中心液化坏死明显的患者还行经皮坏死物引流和肿瘤内无水酒精注射。结果 46个肝脏转移病灶均表现为实质性或囊实性占位,肿瘤较大时囊变成份增加。CT动脉期增强扫描肿瘤明显强化,肝动脉造影肿瘤血管、染色丰富。随访3-10月（平均6.7月）,4例经肝TACE术后肿瘤缩小,1例进行肝动脉PCS要患者肿瘤大小无变化,2例肿瘤增大。3例经皮肿瘤坏互物引流者肿瘤缩小明显。结论 小肠平滑肌类肉瘤肝脏转移以肝动脉供血为主,为富血供肿瘤。肝TACE术、肝动脉PCS术和经皮坏死物引流术是其治疗的有效方法。     

168例肝癌患者CT影像学诊断与介入治疗的疗效观察

目的探讨肝癌患者的CT影像学诊断方法及介入治疗的临床效果。方法对入选的168例肝癌患者采用多层螺旋CT扫描诊断,按照CT诊断选择合适的介入治疗方式,随访6~12个月,观察介入治疗的效果。结果 168例肝癌患者CT扫描图像均可清晰显示肿瘤病灶及周围组织器官情况,病灶的不同诊断图像具有临床典型性;手术切除与介入治疗成功率比较差异无统计学意义(P0.05)。结论多层螺旋CT扫描病灶图像清晰且准确,是目前临床肝癌诊断的重要辅助手段;介入治疗费用低、创口小、临床效果和安全性较好,临床应用价值较高。     

肝脏容积测量指导对门脉高压症介入治疗术式选择的价值

经皮经静脉肝内门体分流术（TIPSS）和经皮经肝食管胃曲张静脉栓塞术（PTVE）联合部分脾栓塞（PSE）是门高压症介入治疗的主要手段。2004年7月～2006年3月，我们采用CT观察了103例门脉高压症患者介入术前后肝脏容积变化，旨在为介入术式的选择提供参考。     

肝脏转移瘤的CT表现与病理分析

探讨肝脏转移瘤的CT表现及病理基础。对28例肝脏转移瘤的CT资料进行回顾性分析。28例肝脏转移瘤中,原发灶来源于消化道肿瘤的较多。瘤灶多发者22例(78．6％),以右叶及全肝弥散分布多见,多数为圆形或类圆形病灶,大部分边界清楚,大小差异较大,直径在(1～3)cm之间居多。低密度病灶21例(75％);单纯低密度者5例,中心见更低密度者4例,出现“瞳孔”征1例,“牛眼”征4例,“圈饼”征2例,“囊样坏死”征2例,“壁结节”征2例,“液-液面”征1例。高密度病灶6例(21．4％);瘤内出血2例,瘤内钙化2例,在脂肪肝基础上呈相对高密度2例。等密度1例(3．6％)。强化方式呈多样性,边缘性强化具有特征性。常伴随其它病变。肝脏转移瘤CT表现多样,但具有一定的特征性,只要我们结合临床,分析其病理特点,大多可明确诊断。     

肺癌患者介入治疗前后血液学肿瘤标志物与CT影像学检测的变化

目的探讨肺癌患者介入治疗前后血液学相关肿瘤标志物与CT影像学检测的变化。方法原发性肺癌患者40例,均采用介入治疗,介入前后进行肿瘤标志物与CT影像学相关指标检测并进行疗效评价。结果经过治疗后,40例患者有效率为32.5%。不同疗效分组治疗前肿瘤标志物水平无显著差异(P>0.05)。治疗后PR组SCC、CEA、NSE及VEGF明显减低(P<0.05),而NC+PD组CEA及VEGF明显升高(P<0.05)。CT影像学检测显示肺动脉AT下降、AC增加明显,EDV流速明显减低,治疗前后有显著性差异(P<0.05)。结论介入治疗具有比较好的临床效果,可以明显改变血液学肿瘤标志物相关指标与CT影像学指标。     

增强CT的动脉早期与动脉晚期扫描对胰腺癌肝脏小转移灶的诊断价值

目的:探讨增强CT动脉早期与动脉晚期扫描对胰腺癌肝脏小转移灶(长径<1cm)的诊断效能。方法:回顾性分析2017年12月至2020年8月间南京医科大学第一附属医院93例经病理证实的胰腺导管腺癌患者增强CT资料,按数字表法随机将患者分为动脉早期组(47例,行动脉早期+门静脉期扫描)和动脉晚期组(46例,行动脉晚期+门静脉...     

超声造影与增强CT对肝脏转移瘤血供情况价值的对比

目的:以增强计算机断层扫描(contrastenhanced computed tomography,CECT)作对比探讨超声造影(contrast-enhanced ultrasonograp,CEUS)在评价肝脏转移瘤(liver metastases,LM)血供方面的价值.方法:研究宁波市鄞州三院55例LM患者(70个病灶)同时采用CECT和CEUS检查,对比分析二者分别在扫描动脉期强化程度的分级、病灶周边滋养血管的出现和病灶血供程度的分类的差异.结果:CEUS在对扫描动脉期强化程度上较CECT更为敏感(1级:59%vs 5%;0级:41%vs 62%;-1级:0%vs 33%),差异具有统计学意义(P<0.05).CEUS动脉期病灶周边滋养血管54%,而CECT为34%,差异具有统计学意义(χ2=5.674,P=0.017).CEUS对动脉期病灶血供程度的分类显示富血供LM所占比率为70%,而CECT为33%,差异具有统计学意义(χ2=19.330,P=0.000).结论:CEUS在评价LM血供方面优于CECT,具有一定的临床应用价值.     

C臂CT在肝恶性肿瘤诊断和微创治疗中的应用与进展

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No treatment option for liver metastases from colorectal adenocarcinoma

After an explanation of alternative treatment modalities, 30 patients with unresectable liver metastases from colorectal adenocarcinoma chose to have no treatment. Fourteen patients (47 percent) had synchronous liver metastases and 16 (53 percent) had metachronous lesions. Thirteen of the 30 patients (43 percent) had histologic documentation of liver metastases, with the remaining 17 patients diagnosed by liver scan, ultrasonography, or computerized axial tomography. Twenty-four of 30 patients (80%) had less than 25 percent liver involvement (Stage I), 23 of 24 patients had alkaline phosphatase levels less than twice normal, and 20 of 24 patients were asymptomatic from their liver metastases. The remaining six patients had liver stages II or III at the time of diagnosis. Overall mean survival of the 30 reported patients with untreated metastatic colorectal cancer to liver is 16 months (range, 2 to 58 months; median survival, 12 months).     

Computed tomographic features of colorectal carcinoma liver metastases predict posthepatectomy patient survival

PURPOSE: The gross appearance of colorectal carcinoma liver metastases reflects the biologic behavior of the tumor, yielding prognostic information. The aims of this retrospective study were to determine whether preoperative computed tomographic features of colorectal carcinoma liver metastases reflect the gross appearance of resected specimens and whether these computed tomographic hepatic features predict survival after hepatectomy. METHODS: Eighty-five patients underwent curative partial hepatectomy for colorectal carcinoma liver metastases. Preoperative computed tomographic features of the largest hepatic deposit were classified by the contour of advancing margin of the tumor into two types: lobular tumors with indentations with an acute angle and nonlobular tumors without such indentations. The correlation between computed tomographic features and 18 other clinicopathologic factors was examined. RESULTS: The overall five-year survival rate was 34.1 percent. Of 85 hepatic tumors examined, 49 were lobular and 36 were nonlobular. Computed tomographic features correlated significantly with gross appearance (P = 0.007). Univariate analysis revealed that computed tomographic features (P < 0.0001), gross appearance (P = 0.0063), size of the largest hepatic deposit (P = 0.0075), age (P = 0.0140), and satellite lesions (P = 0.0443) were significant prognosticators. The five-year survival rates in patients with lobular and nonlobular tumors were 10.4 and 66.1 percent, respectively. By multivariate analysis, computed tomographic features (P < 0.0001) and size of the largest hepatic deposit (P = 0.0419) were independently significant. CONCLUSIONS: Computed tomographic features of colorectal carcinoma liver metastases correlate with their gross appearance. The computed tomographic characterization of liver metastases is the most important independent prognostic factor in patients undergoing curative hepatectomy.     

Usefulness of Y-shaped sheaths in CT angiography for examination of liver tumors

AIM: To conduct a single-stage, combined computed tomography (CT) arterial portography (CTAP) and CT arteriography (CTA) imaging operation, we used Y-shaped sheaths with 2 valves, which allowed the insertion of 2 catheters simultaneously. METHODS: Of 1254 patients who underwent abdominal angiography for transarterial embolization and/or intraarterial chemotherapy in our department from May 2002 to November 2009, 664 patients in whom Y-shaped sheaths with 2 valves were used underwent CT angiography using a c...     

原发性肝癌的介入治疗现状

肝细胞癌（以下简称肝癌）是我国常见的恶性肿瘤之一，每年约有11万人死于肝癌。手术切除、化疗栓塞、各种消融治疗是治疗原发性肝癌的主要方法。尽管几个有关肝癌规范化治疗的指导性建议已经公布^[1]，但就参与本症治疗的各个学科医生和某一具体病人而言，如何选择最佳的治疗方法尚难取得共识。本文结合文献，     

超声介入法治疗代偿期乙型肝炎肝硬化109例疗效分析

目的 探讨超声介入法治疗代偿期乙型肝炎肝硬化患者的疗效。方法 收集本科收治的代偿期乙型肝炎肝硬化患者181例,其中治疗组109例,对照组72例。给予对照组核苷类抗病毒药物联合甘草酸二铵、促肝细胞生长素等治疗,给予治疗组核苷类药物联合超声介入治疗。观察治疗后1年、2年、3年肝功能、凝血功能、血常规、HBV DNA、腹部超声检查指标的变化。两组患者均在超声定位引导下进行肝组织活检,比较治疗前及治疗3年后肝组织病理学改善率及肝组织活动指数（HAI）和肝纤维化指数（HFI）的变化。结果 两组患者基线情况及治疗后HBV DNA阴转率无明显差异。治疗组在治疗3年时血白蛋白为（40.9±4.1）g/L,显著高于对照组[（38.7±3.4） g/L,P＜0.05],凝血酶原活动度为（69.7±11.4） ％,显著高于对照组[（65.9±9.4）％,P＜0.05];治疗组在3年时门静脉内径和脾长分别为（1.18±0.14）cm和（11.74±1.18）cm,显著低于对照组[（1.24±0.14）cm和（12.78±1.43）cm,P＜0.05];３年后治疗组肝组织病理学改善率为54.1%,显著高于对照组的25.0%（P<0.01）;3年时治疗组HAI 和HFI分别为（3.64±0.86）和（3.87±0.84）,显著低于对照组[（8.94±1.42）和（6.83±1.12）,P<0.05]。结论 超声介入治疗可有效改善代偿期乙型肝炎肝硬化患者的肝功能,减轻门脉高压症,减轻肝纤维化程度,肝组织病理学改善率明显提高。     

High-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma: Assessment with liver computed tomography

AIM:To assess the diagnostic performance of followup liver computed tomography(CT) for the detection of high-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma(HCC).METHODS:We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization,radiofrequency ablation or both procedures for HCCs.All patients underwent upper endoscopy and subsequently liver CT.Three radiologists independently evaluated the presence of high-risk esophageal varices with transverse images alone and with three orthogonal multiplanar reformation(MPR) images,respectively.With endoscopic grading as the reference standard,diagnostic performance was assessed by using receiver operating characteristic(ROC) curve analysis.RESULTS:The diagnostic performances(areas under the ROC curve) of three observers with transverse images alone were 0.947 ± 0.031,0.969 ± 0.024,and 0.916 ± 0.038,respectively.The mean sensitivity,specificity,positive predicative value(PPV),and negative predicative value(NPV) with transverse images alone were 90.1%,86.39%,70.9%,and 95.9%,respectively.The diagnostic performances,mean sensitivity,specificity,PPV,and NPV with three orthogonal MPR images(0.965 ± 0.025,0.959 ± 0.027,0.938 ± 0.033,91.4%,89.5%,76.3%,and 96.6%,respectively) were not superior to corresponding values with transverse images alone(P 0.05),except for the mean specificity(P = 0.039).CONCLUSION:Our results showed excellent diagnostic performance,sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after locoregional therapy for HCC.     

The role of 18fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer

BackgroundThe role of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.Methods¹⁸Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.ResultsOverall, 21% of patients had a maximum standardized uptake value ≤3, and 60% of those had undergone neoadjuvant treatment (P = 0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P = 0.112).ConclusionsThe widespread application of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9 > 200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.