肝癌栓塞化疗后肝脏的形态和功能变化及意义

肝癌栓塞化疗后肝脏的形态和功能变化及意义陈晓明罗鹏飞邵培坚周泽健符力李伟科李勇经导管肝动脉注射碘油抗癌药混悬剂栓塞化疗（简称Ｌｐ－ＴＡＥ）已广泛应用于治疗肝癌。我们通过对一组Ｌｐ－ＴＡＥ治疗后的肝癌患者进行ＣＴ扫描和肝功能检测追踪观察，同时从肝脏形态...     

肝动脉插管治疗晚期肝癌40例分析

对４０例Ⅲ期原发性肝癌进行了６３次肝动脉插管治疗。单纯化疗１０例，化疗（ＴＡＩ）＋碘化油栓塞（ＴＡＥ）３０例，其中１７例加用明胶海绵栓塞。栓塞３０例中，２４例肿瘤缩小，其中５例缩小５０％以上；未栓塞１０例中，仅２例略有缩小．ＡＦＰ增高的３５例中１８例下降（５１．４％）．治后ＴＡＥ３０例中存活＞６个月１４例（４６．７％）．＞１年５例（１６．７％）．ＴＡＩ１０例中仅１例存活＞６个月，无１例超过１年。结果表明：ＴＡＩ和ＴＡＥ是治疗晚期肝癌首选的方法，可以延长生存期，提高生活质量，对门脉癌栓作ＴＡＥ时要尽可能超选择，减少剩余肝组织的误栓。对Ａ－Ｖ分流病例，周围性栓塞与中央型栓塞同时进行，效果会更好。本文对插管治疗晚期肝癌的不足之处作了初步探讨。     

经动脉插管肝段栓塞化疗(TASCE)治疗肝癌

目前经肝动脉插管栓塞化疗（ＴＡＣＥ）已被公认为是肝癌不能手术切除的首选方法。但大多肝癌患者合并肝硬化，肝功能较差，有的同时存在门静脉癌栓。因此，ＴＡＣＥ应用受到限制。我们采用经动脉插管肝段栓塞化疗（Ｔｒａｎｓｃａｔｈｅｔｅｒ Ａｒｔｅｒｉ－ａｌ Ｓｅｇｍｅｎｔａｌ Ｃｈｅｍｐｅｍｂｏｌｉｚａｔｉｏｎ；ＴＡＳＣＥ），将极细导管超选至肝段动脉的靶血管，栓塞化疗所在该段的肿瘤，不影响其他各段肝组织的血供。我们收治的６例肝癌患者，有的伴有门静脉癌栓，术后无明显副作用，并取得满意疗效，现报告如下。１临床资料…     

经股动脉灌注化疗并栓塞治疗晚期肝癌30例分析

报告３０例Ⅲ期原发性肝癌（其中６例合并门静脉癌栓）经股动脉穿刺肝动脉插管灌注化疗并栓塞治疗（ＴＡＣＥ）临床分析。经３８例次治疗后，３０例中１８例肿瘤缩小，其中３例缩小５０％以上；存活期＞６个月者１８例，其中＞１２个月者８例。分析认为，ＴＡＣＥ对不能手术切除的晚期肝癌有良好疗效；对伴有门静脉癌栓形成者也应积极栓塞治疗；正确识别肿瘤的供养动脉对预后有直接影响。     

原发性肝细胞癌单介入治疗与双重介入治疗比较

目的：比较原发性肝细胞癌经皮导管肝动脉栓塞化疗（ＴＡＣＥ）与ＴＡＣＥ联合ＣＴ导向下碘油乙醇注射消融（ＣＴ－ＬＰＥＩ）的疗效。方法：原发性肝细胞癌８６例，分为单介入治疗组，经导管肝动脉栓塞化疗（ＴＡＣＥ）４２例；双重介入治疗组４４例，ＴＡＣＥ联合ＣＴ导向下碘油乙醇消融。结果：ＴＡＣＥ组１、２、３年的生存率分别为６９％，４２％和２０％，组织学检查，仅２０％的病变完全坏死；ＴＡＣＥ联合ＣＴ－ＬＰＥＩ组，１、２、３年生存率分别达１００％、８７％和６７％，组织学检查８５％的病变完全坏死。２组间１、２、３年生存率和肿瘤的完全坏死率均有显著差异。结论：双重介入治疗效果明显优于单介入治疗     

运用螺旋CT观察TACE对门脉癌栓的作用

运用螺旋ＣＴ观察３６例合并门脉癌栓的巨块型肝癌患者经肝动脉化疗栓塞（ＴＡＣＥ）后门脉癌栓的变化。随访３～２０月。结果显示：双螺旋ＣＴ扫描能准确估计门静脉内癌栓的分布范围;经ＴＡＣＥ治疗后１４例门脉癌栓内有碘油存积,２８例癌栓缩小;２０例累计生存率达一年。提示ＴＡＣＥ对门脉癌栓治疗有效     

经股动脉灌注化疗并检塞治疗晚期肝癌30例分析

报告３０例Ⅲ期原发性肝癌经股动脉穿刺肝动脉插管灌注化疗并栓塞治疗临床分析。经３８例次治疗后，３０例中１８例肿瘤缩小，其中３例缩小５０％以上；存活期〉６个月者１８例，其中〉１２个月者８例。分析认为，ＴＡＣＥ对不能手术切除的晚期肝癌有良好疗效；对伴有门静脉癌栓形成者也应积极栓塞治疗；正确识别肿瘤的供养动脉对预后有直接影响。     

肝癌经导管肝动脉化疗栓塞后：Ⅱ期切除的远期疗效分析

中晚期肝癌经皮穿刺肝动脉化疗栓塞术后，为提高术后生存期，提供Ⅱ期切除术最佳指征。方法收集６２例中期肝癌经ＴＡＥ后Ⅱ期手术切除完整随访资料，分为未复发组、复发组、以术前ＴＡＥ次数，间隔时间、ＡＦＰ变化。     

小肝癌及周围肝癌行TACE后肝切除12例报告

目的：探讨小肝癌及周围性肝癌临床治疗的最佳模式。方法：分析近年收治的１２例资料，均粕行肝肿瘤切除的病例。结果：男８例，女４例，小肝癌５例，周围性肝癌７例，术前ＴＡＣＥ１次５例，２次５例，３次２例。ＴＡＣＥ后有肺转移１例，肝局部播散４例，术中出血量略多于同期其它病例。ＴＡＣＥ后肿瘤有１０￣７０％的坏死。结论：对特殊部位的步肝癌可采取ＴＡＣＥ后手术切除的方法，对一般部位的小肝癌和周围性肝癌，在肝功能能     

四生汤减轻肝动脉化疗栓塞毒副反应的疗效

目的：观察四生汤减轻肝动脉化疗栓塞术（ＴＡＥ）毒副反应的临床疗效。方法：将５４例行ＴＡＥ术的肝癌患者分为四生汤组（３４例）与对照组（２０例），将两组ＴＡＥ术后主要临床症状变化和术前及术后２周的外周血象及部分细胞免疫功能进行比较。结果：四生汤组在改善消化道反应方面明显优于对照组（Ｐ〈０．０５），在外周血白细胞及细胞免疫功能（ＮＫ细胞及ＬＡＫ细胞活性）方面，对照组在ＴＡＥ术后呈明显下降，而四生汤组虽略     

股骨头坏死早期 CT 表现分析

目的：分析股骨头坏死的早期CT表现。方法回顾分析23例早期股骨头坏死的CT片,并在6个月～1年内进行回访。结果23例中,双侧股骨头坏死10例,单侧股骨头13例,共33个股骨头,主要表现为局部骨纹理改变及骨密度改变。结论股骨坏死的早期CT表现,具有特征性,对该病诊断是有重要意义。     

Histopathologic study on resected hepatocellular carcinoma after transcatheter hepatic arterial chemo-embolization]

21 cases of hepatocellular carcinoma (HCC) were surgically resected about 14 or 21 days after transcatheter hepatic arterial chemo-embolization (TACE) mostly for histopathologic assessment of effectiveness. Results showed that complete necrosis of all the tumor bulk was seen in one case (case no. 8) in this series. Partial necrosis of the tumor mass was demonstrated in 19 cases. In 6 cases, the necrotic area was over 50%. In 8 cases, it was between 25-49% and in 5 cases it was below 25%. This strongly indicates a certain effectiveness of TACE on HCC. However, the presence of viable residual tumor in 20 cases, including one with complete viability of the tumor (case no. 1), also suggested the necessity of surgical resection. The case of complete necrosis was related to the frequency of the catheter arriving at the tumor, to the types of embolizing drug, and to the morphopathologic features of the tumor.     

Spectrum of renal cortical necrosis in acute renal failure in eastern India.

Renal cortical necrosis is an uncommon cause of acute renal failure. We report 23 cases of biopsy-proven renal cortical necrosis which constituted 6.3% (23/363) of all cases of acute renal failure studied over a period of seven years (1985-92). The patients were divided into two groups: obstetric and non-obstetric. Obstetric complications were responsible for renal cortical necrosis in 15 (65.2%) patients while non-obstetric conditions accounted for the remaining eight (34.8%) cases. The overall incidence of cortical necrosis in obstetric acute renal failure was 15/63 (23.8%) patients, the incidence being nearly equal in early (20.5%) and late (29%) pregnancy. Post-abortum renal failure was the sole cause of cortical necrosis in early pregnancy in the obstetric group. Haemolytic uraemic syndrome (three patients) and septicaemia (two patients) were the main cause of necrosis in the non-obstetric group. The cortical necrosis was diffuse and patchy in 17 and six patients, respectively. The disease had a fatal prognosis in 20 (87%) patients; mortality was due to uraemic complications and infections in the majority of patients. The high frequency of post-abortum renal cortical necrosis in our patients is similar to the experience of other Indian workers.     

肝细胞肝癌预后与病理特征、PCNA和DNA指数的关系

目的　研究肝细胞肝癌 (HCC)患者预后与肿瘤的病理形态特征、PCNA指数及DNA指数的关系。方法　分析 5 1例中等分化HCC患者的临床、随访资料及病理形态特征 ;应用免疫组织化学方法检测其PCNA阳性指数 ;应用图像分析仪进行DNA指数测量。结果　癌灶单个 ,直径≤ 5cm ,无癌栓、无肿瘤旁子灶及癌性坏死患者预相对较好 ;DNA整数倍体预后好于非整倍体 ,非整倍体中DI<1.5者又好于 >1.5者 ;PCNA指数越高 ,患者预后越差 ;DI与PCNA指数有一定的相关 ,且两者与病理形态特征间也有关联。结论　进行病理形态学和PCNA、DNA指数的前瞻性综合分析是评估患者术后是否高危复发及其预后的有效方法     

特发性股骨头缺血坏死的临床病理变化

目的:观察特发性股骨头缺血坏死(ANFH)的病理改变,根据病理特点提出临床治疗方法。方法:对34例特发性ANFH的股骨头,分别采用HE、脂肪、微血栓和弹力纤维染色,股骨头大切片、冰冻切片和石蜡切片方法,观察股骨头内各部位的坏死和修复情况,确定脂肪栓子和微血栓的形态和分布状态。结果:股骨头外上方呈"V"形坏死,与承重区负重力线相一致,坏死区周围有慢性炎细胞及新生骨小梁,脂肪组织增多,脂肪细胞肥大,血管中有大量脂肪栓子和微血栓。结论:脂肪栓塞和微血栓是AHFH重要病理改变,临床治疗中首先要减少或避免负重,并配合抗炎、降血脂和溶栓治疗。     

肝癌患者血清和腹水可溶性肿瘤坏死因子受体-p55的测定

目的 进一步了解肝癌患者的异常免疫状态,探讨血清、腹水中可溶性肿瘤坏死因子受体-p55（sTNFR-p55）检测的临床意义。方法　以双单抗夹心酶免疫吸附法检测了25例肝癌患者和25例肝硬化患者的血清、腹水中血清sTNFR-p55水平并以正常人为对照。结果肝癌病人血清sTNFR-p55浓度[（0.74±0.50）ng/ml]显著高于正常人[（0.37±0.03）ng/ml]和肝硬化患者和[（0.35±0.02）ng/ml],P<0.01。肝癌病人腹水sTNFR-p55浓度[（1.11±1.25）ng/ml]亦显著高于肝硬化患者[（0.33±0.03）ng/ml],P<0.01。肝癌、肝硬化患者血清与腹水的sTNFR-p55水平显著相关。肝癌患者血清sTNFR-p55水平与外周血TBil和AFP呈正相关（r=0.524,P=0.01和r=0.234,P=0.03）。结论　sTNFR-p55的检测对反映肝癌患者的异常免疫状态和肿瘤诊断具有实用价值。     

三联疗法治疗成人早期股骨头坏死的临床疗效

目的 探讨体外冲击波联合高压氧和活血化瘀药物的三联疗法治疗成人早期股骨头坏死的临床疗效。方法 选择骨关节外科股骨头坏死患者30例,ARCO分期分为Ⅰ期17例,Ⅱ期13例,进行体外冲击波联合高压氧和活血化瘀药物的三联疗法治疗,随访时间为3个月,治疗前和3个疗程结束后进行VAS评分、Harris评分、患肢旋股内侧动脉血流阻力指数(RI)、股骨头坏死区域体积占股骨头体积的百分比的计算。结果 同治疗前相比,同一分期治疗后VAS评分和Harris评分降低,P<0.01。而同I期相比,治疗前后II期VAS评分均降低,Harris评分均升高,P<0.05。30例患者中能够探及股骨头旋股内侧动脉血流信号的有20例,其中Ⅰ期13例,Ⅱ期7例。同治疗前相比,同一分期治疗后旋股内侧动脉RI均降低,P<0.05。同治疗前相比,同一分期治疗后股骨头坏死体积所占股骨头体积的百分比降低,P<0.05。而同I期相比,治疗前后II期股骨头坏死体积所占股骨头体积的百分比均升高,P<0.01。结论 三联疗法治疗成人早期股骨头坏死临床疗效显著,Ⅰ期好于Ⅱ期,在临床应用价值巨大。     

血管介入疗法结合依降钙素注射治疗股骨头缺血性坏死的效果

目的 观察血管介入疗法结合依降钙素治疗股骨头缺血性坏死的效果.方法 选取股骨头坏死患者103例,采用血管介入疗法结合依降钙素注射进行治疗.于治疗前和治疗后各时点采用VAS评分评估疼痛程度,Harris评分评估髋关节功能,并观察治疗前后治疗区域血管计数、血管直径及干骺动脉分型变化.结果 与治疗前比较,治疗后血管计数增多,旋股内、外动脉血管直径增大,Harris评分升高,VAS评分降低,差异均有统计学意义（P＜0.05）;总有效率达92.2％（95/103例）.结论 应用血管介入疗法结合依降钙素注射治疗股骨头坏死可有效改善髋关节功能,减轻疼痛,延缓疾病进程.     

肝癌患者血清和腹水可溶性肿瘤坏死因子受体—p55的测定

OBJECTIVE: To examine soluble tumor necrosis factor receptor-p55 (sTNFR-p55) levels in the serum and ascitic fluid and investigate the significance of this examination in assessment of the clinical status of patients with primary hepatocellular carcinoma (HCC). METHODS: Enzyme-linked immunosorbent assay (ELISA) was used to examine sTNFR-p55 levels in the serum and ascitic fluid in 25 patients with HCC and 25 with liver cirrhosis (LC). RESULTS: sTNFR-p55 levels in the serum and ascitic fluid in patients with HCC were significantly higher than those in patients with LC and controls (P=0.001). No significant difference was found between LC and the control in terms of serum sTNFR-p55 levels (P=0.19). Positive correlation was observed between sTNFR-p55 levels in the serum and in ascitic fluid of patients with HCC and LC (r=1.000, P<0.001). Logistic regression revealed that in patients with HCC, serum sTNFR-p55 levels were positively correlated with TBil and AFP in the peripheral blood (r=0.524, P=0.01 and r=0.234, P=0.03, respectively). CONCLUSIONS: Increased sTNFRs-p55 levels in the serum and ascitic fluid reflect abnormal immune status of the patients with HCC and help predict the development of tumor.     

Effect of preoperative transcatheter arterial chemoembolization on tumor cell activity in hepatocellular carcinoma

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