介入治疗大肠癌肝转移72例体会

目的：探讨介入化疗和栓塞治疗大肠癌肝转移的临床应用价值，分析肝脏转移肿瘤的DSA表现。方法：对72例大肠癌肝转移病人采用选择性肝动脉插管灌注化疗药物和碘化油栓塞为主的综合治疗。结果：CR＋PR68％（49／62），6个月、1年、2年和3年生存率分别为95．3％、78．9％、43．3％和16．7％。结论：采用介入化疗栓塞是治疗大肠癌盱转移的一种安全有效的治疗方法。     

热疗结合介入化疗栓塞术治疗中晚期肝癌的疗效观察

目的 观察热疗与介入化疗栓塞术联合治疗中晚期肝癌的临床疗效和毒副反应。方法 选取原发性中晚期肝癌患者40例，分为两组，每组20例。治疗组行介入化疗栓塞加局部区域热疗。对照组仅行常规介入化疗加栓塞治疗。化疗方案采用阿霉素（ADM）50～60mg、丝裂霉素（MMC）6～8mg、顺铂（DDP）60—80mg、5-氟尿嘧啶（5-Fu）500mg。栓塞剂采用超液态碘化油及明胶海绵。结果 治疗组总有效率75％（15／20），对照组40％（8／20）（P〈0．05）。两组0．5、1、1．5、2年生存率分别为100％，95％；90％，75％；65％，45％；60％，25％；治疗组0．5、1、1．5生存率较对照组无明显提高（P〉0．05），2年生存率较对照组明显提高（P〈0．05）。毒副反应无差异。结论 热疗联合介入化疗栓塞术治疗中晚期肝癌疗效优于单纯介入化疗栓塞术，且不增加毒副作用，是治疗中晚期肝癌的一种安全有效的综合治疗方法。     

大肠癌肝转移的介入治疗

目的：探讨采用介入化疗并栓塞方法治疗大肠癌肝转移的疗效,并发症及生存期。材料与方法：治疗组３８例采用介入法肝动脉栓塞化疗,对照组２４例采用常规全身静脉化疗。结果：介入栓塞化疗组ＣＲ＋ＰＲ为８４．２％,全身静脉化疗组ＣＲ＋ＰＲ为３７．５％,两组比较,介入栓塞化疗组３８例中６、１２和２４个月的生存率分别为９４．７％、６４．５％和４１．７％,而单纯静脉人 组２４例中６、１２和２４个月的生存率分别为５９．     

大肠癌肝转移的介入治疗

目的 探讨采用介篱化疗并栓塞方法治疗大肠癌肝转移的疗效、并发症及生存期。方法 治疗组３８例采用介入法肝动脉栓塞化疗,对照组２４例采用常规全身静脉化。结果 介入栓经疗组ＣＲ＋ＰＲ为８４．２％,全身静脉化疗组ＣＲ＋ＰＲ为３７．５％,两组比较Ｐ〈０．０１,介入栓塞化疗组３８例中６、１２和２４个月的生存率分别为９４．７％、６４．５％、４１．７％,而单纯静沦疗组２４例中６、１２和２４个月的生存率分别为５８．     

术中温热低渗灌洗化疗及术后动脉插管化疗在胃癌中的应用

探讨胃癌手术切除后腹腔及肝转移的防治方法，对218例胃癌切除术后病人随机分成术中腹腔温热低渗灌洗化疗及术后动脉灌注化疗126例（简称治疗组）和单纯术后静脉化疗92例（简称对照组），并对其腹腔转移率，肝转率为3年生存率进行对照研究。结果治疗组腹腔转移率27％，肝脏转移率12．7％，3年生存率69．5％，对照组腹腔转移率44．5％，肝脏转移率26．1％，3年生存率47．8％，本结果表明，术中温热低渗灌洗化疗及术后动脉化疗对进展期胃癌术后腹腔复发和肝转移有良好的防治作用。     

胃肠道肿瘤肝转移介入治疗的临床研究

目的：探讨胃肠道肿瘤肝转移数字减影血管造影术（DSA）表现和介入治疗效果。材料和方法：回顾分析61例胃癌、大肠癌肝转移瘤DSA表现和介入治疗方案，随访10个月-5年，评价其治疗效果和生存率。结果：胃癌、大肠癌肝转移的DSA表现可分为肿瘤边缘环状染色、较均匀染色和不染色3种，其中以边缘环状染色最常见。61例患者的有效率（CR＋PR）为86．7％，平均生存期为19．2个月，1年、3年、5年生存率分别为91．8％、32．8％、13．1％。结论：介入治疗是胃肠道肿瘤肝转移的有效治疗方法，正确地运用介入治疗技术，合理地使用化疗药物是提高疗效的关键。     

老年胃癌行介入化疗泵留置热灌注化疗的护理观察

胃癌是我国常见的消化道恶性肿瘤之一，晚期胃癌的治疗以外科手术切除为主。随着介入放射学技术的发展，介入治疗与外科切除联合的综合治疗越来越显示出其优越性，介入术温热疗法后可使肿瘤内药物浓度区域曲线比单纯药物灌注提高约1．6倍，更加有效杀灭癌细胞。因此，胃癌行化疗泵留置热灌注化疗成为目前较为有效的方法。     

不能手术切除胃癌介入治疗的进展与临床应用

胃癌是我国最常见的恶性肿瘤，近年来采用外科手术治疗早期胃癌，已取得十分满意的效果，然而，晚期不能手术切除的胃癌占胃癌就诊患者的５０％左右，对这些病例虽采用常规化疗加放疗等多种方法，其临床效果不佳。８０年代开始采用介入放射学治疗胃癌经胃动脉大剂量化疗（ＧＡＩ）再加上胃肿瘤血管栓塞（ＧＡＥ），可使肿瘤区域的化疗药物浓度比口服或静脉给药提高数十倍，并延长药物对肿瘤细胞的直接作用时间，经动物实验研究和临床     

成人脑恶性胶质瘤术后放疗同步替尼泊甙联合 司莫司汀化疗疗效分析

目的前瞻性研究成人脑恶性胶质瘤患者术后同步放化疗的疗效。方法1999年9月至2003年5月收治50例成人脑恶性胶质瘤术后患者，随机分成两组，各25例。①单纯放疗组，给予术后单纯放疗，DT54～60Gy；②同步放化疗组，给予单纯放疗组相同的放疗方法，同时于DT20Gy后行同步替尼泊甙（VM-26）联合司莫司汀（Me-CCNU）化疗。结果成人恶性胶质瘤术后单纯放疗组1、3、5年生存率分别为56％、24％、6％，中位生存期为16个月；术后同步放化疗组1、3、5年生存率分别为72％、48％、20．11％，中位生存期为36个月。同步放化疗组生存率明显优于单纯放疗组（χ^2=4．05，P=0．044）。结论成人恶性胶质瘤患者在手术后适当时机进行同步放化疗可以提高生存率；VM-26联合Me-CCNU是有效的化疗方案。     

动脉灌注化疗药物和免疫制剂在治疗晚期胃肠道肿瘤中的应用

为评价动脉内灌注化疗药物和免疫制剂对治疗晚期胃肠道肿瘤的临床疗效，将86例不能切除的胃肠道肿瘤随机分成两组，A组46例，行动脉灌注化疗同时进行免疫治疗，B组40例，单纯动脉灌注化疗。结果肿瘤治疗有效率（CR＋PR）A组82．6％，B组52．5％；0．5、1和2年生存率，A组分别为100％、82．6％和56．5％，B组分别为100％、65％和42．5％。表明动脉内灌注化疗药物和免疫制剂治疗能有效提高晚期胃道肿瘤的治疗效果。     

骨肉瘤侵袭骺板的影像学与BMP-2表达的研究

目的比较不同影像学检查方法显示骨肉瘤骺板侵袭的阳性率,并从分子生物学水平探讨骨形成蛋白-2(bone morpho-genetic prote in-2,BMP-2)对骨肉瘤侵袭可能的发生机制。方法分析36例经病理证实的骨肉瘤患者的X线片和MR I图像中骺板侵袭征象阳性率并做统计分析;对其标本的不同部位取材并做BMP-2的免疫组织化学染色。结果X线、MR I检查对骨肉瘤侵袭骺板的显示率分别为44.44%、100.00%(P<0.05)。BMP-2在瘤体、骺板浸润区、正常骺板、瘤周正常组织的阳性表达率分别为88.89%、94.44%、10.00%和20.00%(P<40.05)。瘤体、骺板浸润区的表达显著高于正常骺板、瘤周正常组织。结论MR对骨肉瘤骺板侵袭的显示率具有明显的优势。BMP-2与骨肉瘤侵袭骺板具有一定的关系。     

Adrenergic stimulation of Rb+ uptake in pig hearts in vivo assessed by 87Rb MRS.

It was previously shown that the adrenergic agonist dobutamine stimulates Rb(+) uptake in isolated pig hearts. In the present work we examined whether dobutamine can increase Rb(+) uptake rate in vivo. Open-chest domestic pigs (N = 14) were used under general anesthesia. The surface coil was placed against the anterior left ventricular wall to obtain (87)Rb spectra using a spectrometer interfaced with the 7T, 30-cm horizontal bore magnet. RbCl was infused at the rate of 1.35 +/- 0.14 mmol/kg/hr without or with dobutamine (0.6 mg/kg/hr) over a 60-min period, and then the infusions were terminated. The rate constant (k x 10(3), from 13 +/- 2.4 to 36 +/- 12 min(-1)) and Rb(+) influx rate (from 2.5% to 4.8%/min) were increased by dobutamine despite lower plasma [Rb(+)] (0.59 +/- 0.16 vs. 0.84 +/- 0.24 mM in control), while the tissue/plasma Rb ratios were identical (38 +/- 9). Heart rate (HR) and systolic blood pressure (SBP) were increased from 106 +/- 9 to 161 +/- 15 bpm (+52%) and from 78 +/- 7 to 93 +/- 11 mmHg (+19%), respectively. The stimulation of Rb(+) uptake by dobutamine is consistent with the activation of Na(+)/K(+) ATPase previously observed in isolated hearts. However, the 50% increase in HR and the double coronary flow caused by the SBP increase and vasodilatation may also contribute to this effect.     

高频乳腺X线立体定位穿刺活检术的操作技术

目的　阐述乳腺X线立体定位穿刺活检术 (SCNB)的操作步骤并探讨技术操作过程中的注意事项。方法　对 36处 ( 32例 )乳腺可疑病灶进行了SCNB检查。主要操作过程包括机器校正、选择及固定体位、依次进行扫描及预定穿刺点坐标后进行穿刺活检。结果　 2 9处病灶SCNB病理与手术病理结果相同 ,SCNB诊断符合率和穿刺失败率分别为 80 .6 % ( 2 9/36 )和 8.3% ( 3/36 )。结论　SCNB具有技术先进、定位准确、诊断准确率高 ,损伤小、安全性高 ,病人易于接受等优点。在实施该技术过程中 ,注意机器校正、病人体位固定和穿刺点位置及深度的选择等步骤技术操作 ,是确保SCNB的准确率和可靠性的关键     

Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

Purpose To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods Sixty-seven consecutive patients (mean age 67.3 years, range 25–93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2–22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10–285 days). Conclusion Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.     

经桡动脉路径椎动脉支架成形术的临床研究

目的评价经桡动脉行椎动脉支架成形术的安全性及有效性,主要优缺点及适应证、禁忌证,并探讨其技术要点。方法对36例不适合经股动脉路径行椎动脉支架成形术或不愿意术后卧床的患者进行经桡动脉椎动脉支架成形术(桡动脉组),统计其穿刺成功率、手术成功率及并发症发生率;并与同期52例经股动脉椎动脉支架成形术(股动脉组)结果进行比较。结果穿刺成功率、手术成功率及并发症发生率在桡动脉组分别为97.2%(35/36)、88.9%(32/36)、5.6%(2/36),股动脉组分别为98.1%(51/52)、96.2%(50/52)、26.9%(14/52)。两组间穿刺成功率、手术成功率差异无统计学意义(χ2=0.09378,0.8087,P值均>0.05);但并发症发生率两组间差异有统计学意义(χ2=5.17,P<0.05)。桡动脉组患者发生穿刺部位轻微淤血2例,无血肿、假性动脉瘤和动静脉瘘等严重并发症发生。结论经桡动脉椎动脉支架成形术安全有效,并发症发生率低,可作为椎动脉支架成形术的选择途径之一。     

经皮经肝胆管引流支架植入联合三维适形放射治疗恶性梗阻性黄疸48例分析

目的观察经皮肝胆管穿刺引流(PTCD)及胆管内支架置入术(PTBS)联合三维适形放疗(3D-CRT)治疗恶性梗阻性黄疸的疗效及应用价值。方法对48例恶性梗阻性黄疸患者行经皮肝胆管穿刺置管引流及胆管内支架植入,术后予3D-CRT,常规分割,总剂量DT 40～60 Gy/4～6周,观察近期疗效及生存率。结果 48例均引流成功,术前血清总胆红素(221.85±54.73)μmol/L,术后1、2及3周总胆红素分别下降为(129.68±23.58)、(88.29±15.70)和(48.58±11.61)μmol/L;经3D-CRT后肿瘤完全缓解3例,部分缓解36例,稳定9例,肿瘤总有效率81.3%;1、2年累积生存率分别是77.1%、37.5%;中位生存期18.5个月;无治疗相关的严重并发症。结论 PTBD+支架植入联合3D-CRT治疗恶性梗阻性黄疸是一种安全、有效的姑息性治疗方法,可以改善恶性肿瘤伴黄疸患者的临床症状,提高生存质量并延长生存时间。     

Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy

A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P?=?0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P?<?0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P?=?0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.     

胃镜引导插管小肠双对比造影方法研究

目的：探讨小肠双对比造影检查的有效方法。方法：72例受检者被随机分成2组；试验组(36例)应用研制的小肠造影导管，在胃镜直视下钳夹导管头端并送达十二指肠水平部，头端气囊充气固定导管，退出胃镜后，经导管灌注适量稀钡胶浆及空气行小肠双对比造影。对照组(36例)采用改进的F9心导管在透视下插管。结果：实验组插管成功35例(成功率97．1％)，对照组插管成功27例(成功率75％)。结论：研制专用的小肠造影导管并经胃镜引导插管行小肠双对比造影检查，其成功率明显高于普通插管方法。     

Reirradiation for Recurrent Neck Metastases of Head-and-Neck Tumors Using CT-Guided Interstitial 192Ir HDR Brachytherapy

PURPOSE: To report the therapeutic results obtained with CT-guided interstitial high-dose-rate brachytherapy (HDR-BRT) as exclusive treatment for recurrent neck metastases of head-and-neck tumors. PATIENTS AND METHODS: Between 1995 and 1999, 49 patients with prior radiation therapy (RT) with or without surgery for primary head-and-neck tumors were treated for recurrent neck metastases located within previously irradiated volumes. All patients had fixed lymphadenopathy with a mean tumor volume of 96 cm(3) (range, 15-452 cm(3)). There were 38 males and eleven females with a mean age of 60 years (range, 28-79 years). All patients had previously received RT as primary or adjuvant treatment with a mean dose of 54 Gy (range, 45-80 Gy). 36 patients (73%) underwent surgery, and 26 (53%) received adjuvant or palliative chemotherapy. The accelerated hyperfractionated interstitial HDR-BRT (2 x 3.0 Gy/day) delivered 30 Gy in 37/49 (75%) and 36 Gy in 12/49 implants (25%). RESULTS: At a minimum 6-week follow-up, the response rate was 83% (41/49) with complete remission in 20% (10/49) and partial remission in 63% (31/49) of the implanted tumor sites. 8/49 patients (17%) did not respond to the treatment. After 19 months of median follow-up, the local control rate was 69% and a total of 15/49 patients (30%) experienced local disease progression. Of these, nine (18%) had locoregional progression and six (12%) progression within the treated volume. The median post-BRT survival was 14 months. The overall survival rate was 52% at 1 year, 31% at 2 years, and 6% at 3 years. CONCLUSION: In patients with recurrent cervical lymphadenopathy of head-and-neck tumors, exclusive interstitial HDR-BRT can provide palliation and tumor control.     

微波联合5-氨基酮戊酸及光动力疗法治疗肛管内尖锐湿疣

目的评价微波联合5-氨基酮戊酸及光动力疗法(ALA-PDT)治疗尖锐湿疣的疗效。方法将86例尖锐湿疣患者分为两组,每组43例。治疗组采用微波、5-氨基酮戊酸与ALA-PDT联合治疗,对照组单用微波治疗。结果治疗组患者痊愈率为83.7%(36/43),复发率为4.7%(2/43);对照组痊愈率为67.4%(29/43),复发率为18.6%(8/43)。两组痊愈率及复发率比较,差异有显著统计学意义(P<0.01)。结论微波联合5-氨基酮戊酸及光动力疗法治疗尖锐湿疣在疗效及复发率方面均明显优于微波治疗。