选择性肝动脉栓塞治疗肝海绵状血管瘤

目的 研究使用平阳霉素碘油乳剂经导管超选择插入肝动脉栓塞治疗肝海绵状血管瘤的方法和效果。方法 对32例肝海绵状血管瘤进行平阳霉素碘油乳剂经肝动脉栓塞治疗，将导管超选择插入肝血管瘤的供血动脉，以平阳霉素碘油乳剂栓塞。男14例,女18例，年龄28～62岁,平均44岁，术前均经US、CT、DSA检查确诊。结果 所有病例均成功实施了栓塞治疗;32 例中有30例分别于术后1 ～24个月进行CT或B超随访;瘤体缩小〉50%者25例,〉 30%者5例，其中B超随访肿瘤完全消失1例;1例患者肿瘤缩小不明显.30例临床有症状患者中,临床症状消失28例，明显减轻1例，总有效率96.7 %（29/30）。术中及术后无严重并发症。结论 平阳霉素碘油乳剂经肝动栓塞是治疗肝海绵状血管瘤的安全、有效的首选方法。     

肝血管瘤供血动脉栓塞疗效评价

目的 探讨应用超选择性供血动脉栓塞治疗肝血管瘤的疗效。方法 采用Seldinger改良法经皮穿刺股动脉插管，在DSA引导下将导管超选择性插至最接近肝血管瘤的供血动脉，应用平阳霉素和超液态碘化油及明胶海绵为栓塞剂，栓塞治疗巨大型肝血管瘤7例。结果 7例肝血管瘤供血动脉栓塞均获成功，达到瘤内碘油聚集，瘤体血供截流的理想栓塞效果。无明显不良反应，未出现严重并发症。栓塞治疗后临床症状得到缓解，随访复查瘤体逐渐缩小，未见肿瘤复发。结论 采用供血动脉栓塞治疗肝血管瘤是一简便、安全、有效的方法，适应症广，应成为首选治疗方案。     

经肝动脉栓塞治疗肝海绵状血管瘤(附26例)

目的:观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性.方法:对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应.结果:26例患者介入治疗成功率100%,肿瘤完全消失者6例,瘤体缩小＞50%者17例,瘤体缩小不足50%者2例,瘤体无变化者 1例,无瘤体进展者;总有效率为95.1%;所有患者未出现严重并发症.结论:经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法.     

经肝动脉栓塞治疗肝海绵状血管瘤（附26例）

目的：观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性。方法：对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应。结果：26例患者介入治疗成功率100％,肿瘤完全消失者6例,瘤体缩小〉50％者17例,瘤体缩小不足50％者2例,瘤体无变化者1例,无瘤体进展者;总有效率为95．1％;所有患者未出现严重并发症。结论：经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法。     

碘油乳剂经动脉栓塞治疗16例肝海绵状血管瘤

目的：探讨碘油乳剂经动脉内栓塞治疗肝海绵状血管瘤的临床应用。方法：16例肝海绵状血管瘤患者用动脉栓塞治疗。结果：所有病例均栓塞成功，14例患者栓塞后碘油沉积良好。治疗后14例取得最佳疗效。全部病例临床症状消失，瘤体平均缩小50％，且未见胆囊坏死等并发症。结论：磺油乳剂动脉栓塞治疗肝海绵状血管瘤是安全、简便、并发症少且十分有效的治疗方法。     

肝血管瘤介入性栓塞的治疗

目的寻求非手术治疗肿瘤的方法.方法对68例肝血管瘤施肝动脉插管,选择性肝血管瘤供血动脉内灌注盐酸平阳霉素与超液化碘油的乳化剂及SAP永久性栓塞物质进行栓塞.结果全部病例肝血管瘤病灶均有40%～70%不同程度的缩小.临床上无明显不良反应.结论介入性栓塞治疗肝血管瘤安全、可靠、并发症少,应该成为治疗肝血管瘤的首选方案.     

肝动脉栓塞、硬化治疗肝血管瘤

目的评价肝动脉栓塞,硬化治疗肝血管瘤的临床价值.方法采用Seldinger法行选择性肝动脉栓塞,硬化技术治疗肝血管瘤,其配伍方案:平阳霉素+超液化碘油+鱼肝油酸钠,随访1～7年.结果应用该方法治疗肝血管瘤患者22例,所有瘤灶均明显缩小及纤维化.结论从本组结果显示选择性肝动脉栓塞、硬化技术是肝血管瘤,尤其是多发性或巨大肝血管瘤的理想治疗方法.     

药物微球与化疗栓塞治疗肝癌的临床效果比较

目的　临床验证国内首创的新一代化疗栓塞剂甲氨蝶呤明胶微球 (MTX- m s)对中晚期原发性肝癌 (PHC)的疗效。方法　将 6 3例肝癌病人随机分成两组 ,分别用 MTX-ms和碘油加明胶海绵颗粒结合化疗药物经超选择性肝动脉插管进行化疗栓塞。根据肿瘤的血管造影表现、坏死面积、大小和血清 AFP值的变化比较两种方法的疗效。结果　经 1～ 3次治疗后两组病人的肿瘤血管明显减少 ,肿瘤体积显著缩小 ,AFP值明显下降。各项疗效指标显示 MTX- m s组在某些方面优于常规治疗组 ,但统计学上无显著性差异。结论　MTX- ms具有使用方便、用量小、末梢栓塞作用强和价廉等优点 ,对肝癌的疗效与目前的常规化疗栓塞相当     

肝动脉热栓塞化疗加部分脾栓塞治疗巨块型肝癌伴脾功能亢进23例

目的 探讨超选择性肝动脉热栓塞化疗联合部分脾栓塞在治疗原发性巨块犁肝癌伴脾功能亢进中的应用价值.方法 23例患者采用Seldinger改良技术,导管选择进入脾动脉行明胶海绵颗粒栓塞;再超选择插入肝癌供血动脉内行110℃碘油栓塞联合热化疗药物灌注,使肿瘤达到Ⅳ级栓塞标准.结果 23例患者治疗成功,肿瘤均不同程度缩小.患者不良反应轻.肝功能损害不明显,生存期较长;血常规恢复正常.结论 超选择肝动脉热栓塞化疗治疗原发性巨块型肝癌疗效好,部分脾栓塞可使血常规恢复正常.     

平阳霉素碘油乳剂超选择动脉栓塞治疗肝血管瘤的观察

为了探讨平阳霉素碘油乳剂超选择栓塞化疗治疗肝血管瘤(HCH)的临床疗效和治疗体会,对23例HCH患者采用平阳霉素碘油乳剂超选择性动脉插管动脉栓塞治疗,观察治疗前和治疗后6、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症.23例患者在术后6和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘油聚积征象.术前血管瘤直径为(8.1±2.2)cm,术后6个月血管瘤直径为(5.4±1.3)cm,术后12个月血管瘤直径为(3.4±1.2)cm.治疗前有临床症状者治疗后缓解或消失,术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生.初步研究结果提示,超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大HCH是一种疗效肯定、相对安全较为理想的治疗方法.     

阿霉素不同剂型经肝动脉给药治疗肝癌的体内药动力学研究

观察阿霉素以不同剂型肝动脉给药后的药代动力学和生物学分布。方法：２３例肝癌经肝动脉分别注入单纯阿霉素；阿霉素与碘油混合液，阿霉素与碘混混合并制成乳剂，或Ｃ组之乳剂加用明胶海绵栓塞。用高效液相色谱仪测定阿霉素外周血浓度，对其中１２例，用ＥＣＴ测定肝脏的放射性强度。     

Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA,a mid-term result

Objective： To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol （PVA） particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. Methods： We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. Results： Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients （85.7%） during the mid-term follow-up. Conclusions： Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.     

A correlative study of CT, MR and pathology in rabbit liver after embolization by a China - Formulated lipiodol emulsion

Objective

To explore the MR characteristics following lipiodol retention in rabbit liver and to evaluate the sensitivity of CT (CT value >400 HU) and MR in displaying the hepatic degeneration and necrosis following embolization.

Methods

Thirty-two rabbits were randomly divided into 3 groups. In the control group (n=8), 2 ml of normal saline was injected into the right branch of the portal vein. In the first experimental group(n=12), 4 ml of lipiodol emulsion was injected into the main portal vein. In the second experimental group (n=12), 2 ml of lipiodol emulsion was injected into the right branch of the portal vein. CT and MR images were obtained before and after surgery in each group. The histopathologic condition was determined for all liver tissue specimens.

Results

In the control group, CT and MR did not show any significant changes in the livers after surgery. After the operations in the experimental groups, the regional CT attenuation was 601 ±101 HU in the largest slice, which had no abnormal signals on T₁WI and T₂WI. In the first group, histologic examinations showed there were concentrated lipiodol droplets around the portal areas. In the second group, serious degeneration and necrosis in the right hepatic lobe occurred in 9 rabbits. T₁WI displayed homogenous or non-homogenous low signals and T₂WI mainly displayed a high signal. However, these pathologic changes did not appear on CT scanning due to high attenuation of the lipiodol.

Conclusion

There were no remarkable hepatic changes on MR in rabbits following good retention of the formulated lipiodol emulsion mixture of lipiodol and urografin(CT value > 400 HU). MR displayed serious degeneration and necrosis of the liver following embolization.     

A Correlative Study of CT, MR and Pathology in Rabbit Liver after Embolization by a China-Formulated Lipiodol Emulsion

OBJECTIVE To explore the MR characteristics following lipiodol retention in rabbit liver and to evaluate the sensitivity of CT (CT value ＞400 HU) and MR in displaying the hepatic degeneration and necrosis following embolization.METHODS Thirty-two rabbits were randomly divided into 3 groups. In the control group (n=8), 2 ml of normal saline was injected into the right branch of the portal vein. In the first experimental group(n=12), 4 ml of lipiodol emulsion was injected into the main portal vein. In the second experimental group (n= 12), 2 ml of lipiodol emulsion was injected into the right branch of the portal vein. CT and MR images were obtained before and after surgery in each group. The histopathologic condition was determined for all liver tissue specimens.RESULTS In the control group, CT and MR did not show any significant changes in the livers after surgery. After the operations in the experimental groups, the regional CT attenuation was 601 ±101 HU in the largest slice,which had no abnormal signals on T1WI and T2WI. In the first group, histologic examinations showed there were concentrated lipiodol droplets around the portal areas. In the second group, serious degeneration and necrosis in the right hepatic lobe occurred in 9 rabbits. T1Wl displayed homogenous or non-homogenous low signals and T2Wl mainly displayed a high signal.However, these pathologic changes did not appear on CT scanning due to high attenuation of the lipiodol.CONCLUSION There were no remarkable hepatic changes on MR in rabbits following good retention of the formulated lipiodol emulsion mixture of lipiodol and urografin(CT value ＞ 400 HU). MR displayed serious degeneration and necrosis of the liver following embolization.     

碘油混合乳剂栓塞术治疗晚期肾癌

自１９９１年７月～１９９４年１２月，对１３例中晚期肾癌进行肾动脉插管碘油混合乳剂栓塞化疗术，其中８例肿瘤明显缩小（６１．５４％），３例无明显变化（２３．０８％），２例略增大（１５．３８％）。碘油用以导向治疗肾癌能在肿瘤区聚积，既提高局部化疗浓度又能栓塞肿瘤末稍血管。１３例中晚期肾癌姑息治疗，证明近期疗效满意。     

沙培林联合抗癌药选择性直肠上动脉栓塞治疗进展期直肠癌的临床研究

目的探讨沙培林联合抗癌药在进展期直肠癌治疗中的应用价值。方法将78例进展期直肠癌患者分为试验组38例和对照组40例,分别进行沙培林TAE治疗及传统TAE治疗,对术后反应及疗效进行对比分析。结果试验组在治疗效果、生存率方面优于对照组,两组毒副作用大致相同。结论沙培林联合抗癌药选择性直肠上动脉栓塞治疗进展期直肠癌是一种安全有效的治疗方法。     

子宫肌瘤栓塞治疗后闭经的临床分析

背景与目的:子宫肌瘤的栓塞治疗是子宫肌瘤的治疗方法之一,但存在治疗后闭经的问题.本研究探讨子宫肌瘤栓塞治疗后发生闭经的原因.方法:对在中山大学附属第一医院行子宫肌瘤栓塞治疗的487例患者追踪随访1年观察闭经的发生情况.所有病例均采用双侧子宫动脉插管经导管注入栓塞剂方法,其中104例以超液化碘油加平阳霉素作为栓塞剂,栓塞剂用量超液化碘油8～15 mL(平均10 mL)、平阳霉素6～16 mg(平均8 mg);158例以聚乙烯醇作为栓塞剂,用量80～150 ms(平均100 mg);225例以明胶海绵作为栓塞剂,用量1-2 g(平均1.5g).结果:栓塞后临床有效率为98.97%(482/487):栓塞失败率1.03%(5/487).栓塞后共有6(1.23%)例出现闭经,其中碘油组3例.碘油在卵巢区沉积;聚乙烯醇组1例;明胶海绵组2例.除明胶海绵组1例外.其余5例均出现雌二醇下降,促卵泡生成素上升.另外1例经多次超声检查发现子宫内膜仅3 mm,而雌二醇和促卵泡生成素正常,宫腔镜证实为内膜萎缩.结论:常用的栓塞材料均有可能导致子宫肌瘤柃塞后闭经,子宫肌瘤栓塞后闭经发生率为1.23%,其原凶与卵巢受损和子宫内膜受损萎缩有关.     

动脉血酮体比测定对中晚期肝癌栓塞化疗的临床应用研究

报告３０例中晚期肝癌在导管栓塞化疗前后进行的动脉血酮体比（ＡＫＢＲ）测定研究。结果表明，对肝癌实行明胶海绵和碘油乳剂栓塞化疗是目前行之有效的疗法。利用碘油乳剂适当栓塞对肝脏ＡＫＢＲ无明显影响，而明胶海绵需严格掌握适应证。ＡＫＢＲ的测定对中晚期肝癌的栓塞化疗中选用剂型、剂量及疗法上均有指导意义，对肝脏栓塞化疗前后肝脏能储的推测及肝功能衰竭的预测也颇有临床价值。     

聚乙烯醇栓塞微球可载药微球介入治疗中晚期肝癌的临床疗效及安全性观察

目的 探究聚乙烯醇可载药栓塞微球介入治疗中晚期肝癌的临床疗效及安全性.方法 将60例中晚期肝细胞癌患者,根据患者的疾病实际情况和患者的意愿结合,随机分为对照组,治疗组和实验组,每组20例.对照组采用传统的单纯碘化油乳剂栓塞TACE术,治疗组采用碘化油乳剂+明胶海绵栓塞TACE术,实验组采用碘化油乳剂+Callispheres可载药微球栓塞TACE术,对比3组患者TACE术后的不良反应、1个月后的肿瘤坏死率和术前、术后AFP变化.结果 实验组和对照组术后不良反应较少,均少于治疗组;实验组和治疗组术后1月肿瘤坏死率明显高于对照组,实验组与治疗组术后1月肿瘤坏死率相当;3组患者的术后AFP水平均明显低于术前.结论 应用聚乙烯醇可载药栓塞微球+碘油对中晚期肝癌患者行TACE术,比传统的应用碘化油的TACE术,手术效果好;比明胶海绵+碘化油的TA-CE术,手术效果相当,但是其导致的并发症较少,更利于患者术后恢复.     

碘油乳剂的制作及其对肝脏增强的实验研究

目的将40％碘油乳化成40％碘油乳剂，对其物理性质进行测定和观察，然后探讨其对动物肝脏的增强效应。材料和方法40％碘油10ml、蒸馏水15ml、两种适量的乳化剂及其他物质混合后形成初乳，应用乳均机和超声乳化机将初乳乳化成40％碘油乳剂。11只杂种犬，在不同时期静脉、肝动脉、肠系膜上动脉分别注射稀释为15％碘油乳剂及60％泛影葡胺，然后在不同时期行CT扫描。结果乳剂颗粒平均直径0．63u，95％在1.0u以下，最大不超过5．2u，放置12个月颗粒大小分布不变。静脉乳剂肝脏增强最大平均CT值为75HU，泛影葡胺为21．8HU（P＜0.01）；肝动脉乳剂最大平均CT值为120．5HU，泛影葡胺为50．7HU（P＜0．01）；间接门脉乳剂最大平均CT值为117．8HU，泛影葡胺为41．6HU（P＜0．01）。结论我们制作的碘油乳剂颗粒小、稳定性好、毒性低、显影力强。