133例巨大肝癌手术切除疗效分析

1973年至1993年间对133例＞10cm的原冀性肝癌行切除术，根治性切除21例，姑息性切除112例。108例随访满5年以上，5年生存率11．1％，行姑息性切除者，生存1年以上17例，术后平均生存7.7个月，其中10例合并行肝动脉、门静脉双重插管化疗．术后平均生存期15．6个月。对如何提高巨大肝癌的手术疗效作了探讨。     

原发性肝癌肝切除术肝动脉与门静脉灌注化疗的比较

目的评价原发性肝癌根治性切除术后肝动脉灌注化疗与门静脉灌注化疗的疗效，探讨原发性肝癌根治性切除术后复发及转移的预防途径。方法经病理确诊的原发性肝癌７５例，其中４２例行根治性切除及术后选择性肝动脉插管化疗，３３例行根治性切除及术后门静脉灌注化疗。每隔１～３个月重复，定期复查。结果原发性肝癌切除术后肝动脉灌注化疗组的术后复发率（２１．４３％）低于门静脉灌注化疗组（３６．３６％），且生存时间（１１．４个月）明显较门静脉灌注化疗组（７．６个月）长，而门静脉灌注化疗组的转移率（９．０９％）明显低于肝动脉灌注化疗组（３２．１４％）。结论原发性肝癌根治性切除术后行肝动脉灌注化疗较门静脉灌注化疗疗效好，而原发性肝癌切除术后同时结合肝动脉、门静脉灌注化疗对术后预防肿瘤的复发与转移可能更为理想     

原发性肝癌经腹肝动脉栓塞化疗与姑息性切除术的疗效比较

本文对３２例原发性肝癌经腹肝动脉插管，使用碘油抗癌药物乳化液栓塞治疗，与４８例原发性肝癌行姑息性切除术进行比较分析。结果：栓塞化疗组与姑切组的ＡＦＰ转阴率、１年生存率、２年生存率分别为：８２．７％（２４／２９）与０，６２．５％（２０／３２）与２０．１％（１０／４８），３２．０％（８／２５）与０（Ｐ＜０．０５）。且栓塞化疗组３例获Ⅱ期根治性切除术．１例带瘤生存５４个月，至今健在。提示：对不能行根治性切除的肝癌，选用肝动脉插管栓塞化疗为佳。     

原发性肝癌切除术后区域化疗预防复发的临床观察

目的 观察原发性肝癌切除术中经肝动脉、门静脉插管,术后化疗对癌复发预防的疗效。方法 对42例原发性肝癌切除术后随机分成2组,其中一组术中行肝动脉和门静脉插管后皮下植泵化疗,与对照组相比观察术后复发情况。结果 术后行区域化疗组2年内复发率明显低于对照组,(P<0.05)。结论 原发性肝癌切除术后采用区域化疗是防止复发的较为可靠方法。     

肝动脉插管+B超引导下经皮经肝门静脉穿刺化疗栓塞治疗原发性肝癌15例报告

目的 :探讨肝动脉插管联合经皮肝穿刺选择性门静脉化疗栓塞 (TACE SPVE)治疗不能手术的中晚期肝癌的效果。方法 :对不能手术切除的中晚期肝癌 15例在TACE术后 1周 ,行超声引导下经皮经肝穿刺选择性门静脉化疗栓塞。结果 :TACE SPVE 15例共行 4 9次 ,治疗后肿瘤缩小 13例 ,AFP转阴 5例 ,二期手术 3例 ,1例肿瘤缩小 80 % ,AFP转阴。 1年生存率 80 % (8/ 10 )。结论 :TACE SPVE是治疗不能手术切除的中晚期肝癌的有效方法。     

栓塞化疗在肝癌切除术后的价值

为探讨降低肝癌切除术后肝内复发率的方法，从１９８９年１０月至１９９２年１２月，对在院手术切除的２１９例原发性肝癌病人作前瞻性研究，估价术后辅加肝动脉栓塞化疗，对降低术后复发率的疗效。结果表明，根治切除术或姑息性切除后３至４周辅加栓塞化疗，能降低其术后复发率，提高其术后生存率。     

大肝癌切除并用双插管化疗预防手术后复发

「目的」探讨大肝癌切除术后并用双插管化疗对预防术后复发的作用。「方法」１９８９年￣１９９６年，我们对７６例原发性肝部切除术后病例施行了经肝动脉、门静脉双插管化疗，我行单纯手术切除。「结果」插管化疗组的１、２、３年复发率比对照组低１０％以上。「结论」原发性肝癌切除术后行双插管化疗是预防术后复发的有效方法。     

肝癌姑息切除术后辅加肝动脉栓塞化疗的疗效

原发性肝癌容易发生肝内转移，所以能得到根治性切除术的病例不多。而对于姑息性切除的病人其疗效不佳，中位生存期也只有６个月左右。本文报道５５例仅作姑息性切除和３９例作姑息性切除后３至４周辅加栓塞化疗的原发性肝癌病人的疗效。随访结果表明：其术后１、２、３、４年生存率在作姑息性切除的病人和作姑息性切除后３至４周辅加栓塞化疗组病人中，分别为８８．０％、３５．８％、０％、０％和８６．０％、６８．４％、５１．８％、３８．７％（Ｐ＞０．０１），其中位生存期分别为７个月和１６个月。     

双途径介入化疗与单纯肝动脉栓塞化疗治疗晚期肝癌的临床观察

目的研究肝动脉化疗栓塞基础上经皮经肝门静脉灌注化疗治疗晚期肝癌的疗效.方法对49例不能手术切除的晚期原发性肝癌随机分组,行单纯肝动脉化疗栓塞治疗与在肝动脉化疗栓塞基础上加用经肝门静脉灌注化疗,对比分析.结果肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌患者的半年、一年、二年、三年生存率分别为100%、76.5%、35.29%、23.53%,AFP及全身转移的发生率明显降低,与对照组有显著差异.结论肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌疗效优于单纯性经肝动脉化疗栓塞.     

胃和结直肠癌同时伴有肝转移的外科治疗——附48例分析

 本文报导了48例胃和结直肠癌同时伴有肝转移的外科治疗,其中根治性肝切除18例,1、3、5年生存率分别为77.8%、44.4%、33.3%。姑息切除8例,1、3、5年的生存率为37.5%、25%、12.5%。对无法行肝切除,而分别作了单纯肝动脉结扎及肝动脉插管各4例,均在6个月内死亡。肝动脉结扎加插管化疗8例,平均生存期为10.4个月,瘤内无水酒精注射6例,平均生存期为15个月。作者认为转移性肝癌肝切除是目前首选的治疗方式。对无法切除的肝癌采用肝动脉,门静脉双插管化疗和瘤内无水酒精注射等综合治疗,无疑将会提高疗效。     

多结节性肝癌的治疗探讨

总结２９２例多结节性肝癌的治疗。全身化疗１１１例，肝动脉栓塞化疗５８例，多次局切６７例，局切后并用肝动脉、门静脉插管化疗５６例。结果：ＡＦＰ转阴率分别为０、３８．１％、７４．５％、８４．６％；各组１、２、３、５年生存率分别为１８．２％、４５．６％、５２．２％、５３．８％；１．９％、３８．９％、２５．８％、５０．９％；０、７．５％、２０．３％、４６．３％；０、１．９％、５．２％、１７．３％。提示，多结节性肝癌手术切除优于药物治疗，切除后并用肝动脉、门静脉插管化疗优于单纯局切，非手术治疗者。碘油抗癌药物乳化液栓塞治疗优于全身化疗（Ｐ均＜０．０５）。     

直肠癌肝转移的治疗：附45例报告

１９８６年以来，以手术和病理证实的直肠癌肝转移者共４５例，占同期手术的７．７％。其中１６例于切除原发灶后３个月内行根治性切除，占３５．６％。１、３、５年生存率为８４．５％、５０％和３３．３％。１５例同期或分期行肝动脉栓塞化疗、门静脉化疗，１、３、５年生存率为８０％、３３．３％和０．１４例因原发灶未能切除，术后给予静脉或口服化疗，１年生存率仅１１％。     

治疗方案对原发性肝癌预后影响的Cox回归分析

本文应用Cox回归方法研究了影响肝癌患者预后的诸因素。性别,发病年龄,肝癌发生部位等因素对生存期无明显影响。化疗、肝叶切除、分枝动脉结扎和栓塞、固有动脉结扎均可延长生存期。通过Cox回归方法研究诸治疗方案的相互作用,结果表明在14种不同治疗方案组合中有8种有效。其中非插管化疗 肝叶切除的疗效较好,优于其它7种方案,两比较P值均小于0.05。     

Tumor and liver drug uptake following hepatic artery and portal vein infusion

Anatomic dye injection studies of the blood supply of colorectal hepatic metastases suggest that tumors are supplied predominantly by the hepatic artery. Using 13N amino acids with dynamic gamma camera imaging in patients with colorectal hepatic metastases, it has been shown that hepatic artery infusion results in a significantly greater nutrient delivery to tumor compared with portal vein infusion. However, direct measurements of drug levels in tumor following hepatic artery and portal vein infusion in humans have not previously been reported. Patients with metastatic colorectal cancer confined to the liver received fluorodeoxyuridine (FUdR) through the hepatic artery or through the portal vein. All patients had previously failed systemic chemotherapy. Five patients with hepatic artery catheters were matched (by age, serum lactic dehydrogenase levels, percent hepatic replacement, and tumor size) with five patients with portal vein catheters. At operation, 3H-FUdR (1 microCi/kg) and 99mTc-macroaggregated albumin (MAA) (6 mCi) were injected into the hepatic artery or portal vein. Liver and tumor biopsies were obtained two and five minutes later. 3H and 99mTc were measured per gram tissue by scintillation and gamma counting. The mean liver levels following hepatic artery infusion (23.9 +/- 11.4 nmol/g) and portal vein infusion (18.4 +/- 14.5 nmol/g) did not differ. However, the mean tumor FUdR level following hepatic artery infusion was 12.4 +/- 12.2 nmol/g, compared with a mean tumor FUdR level following portal vein infusion of 0.8 +/- 0.7 nmol/g (P less than .01). This low level of tumor drug uptake after portal vein infusion of FUdR predicts minimal tumor response to treatment via this route. Thus, regional chemotherapy for established colorectal hepatic metastases should be administered through the hepatic artery.     

Increased adriamycin levels in hepatic implants of rabbit Vx-2 carcinoma from regional infusion

Regional infusion chemotherapy for the treatment of primary or secondary hepatic cancer should allow delivery of a higher drug concentration to the tumor with decreased systemic exposure when compared with systemic therapy. Fifteen rabbits, each implanted with two hepatic Vx-2 tumors, were treated with infusion of Adriamycin (3 mg/kg and 7.5 muCi of [14C]Adriamycin) through the hepatic artery (n = 5), portal vein (n = 5), and a systemic vein (n = 5) at 20 mg/min. 99Tc-labeled macroaggregated albumin flow images documented specific hepatic perfusion in selected rabbits using this technique. Thirty min after infusion the animals were sacrificed, and multiple specimens of liver, tumor, and heart were taken for liquid scintillation counting and high-performance liquid chromatography. The 14C label remained associated with Adriamycin and metabolites. After systemic infusion 11.5 nmol/g of Adriamycin were found in tumor, and 32.4 nmol/g were found in liver. Infusion of Adriamycin through the hepatic artery produced drug levels of 34.3 nmol/g of tumor and 48.4 nmol/g of liver, while infusion through the portal vein produced drug levels of 6.5 nmol/g of tumor and 54.4 nmol/g of liver. The drug concentration in tumor was significantly higher after hepatic artery infusion compared with systemic (P less than 0.05) or portal vein (P less than 0.01) infusion. The tumor/liver ratio of [14C]Adriamycin tissue levels after hepatic artery infusion was greater than that measured after systemic vein treatment (no overlap of the 90% confidence intervals). Systemic infusion of Adriamycin produced a higher level of Adriamycin in the heart (13.6 nmol/g) than did hepatic artery (10.9 nmol/g) or portal vein (8.9 nmol/g) infusion. Hepatic artery infusion achieved the highest tumor Adriamycin level compared with systemic vein and portal vein infusion. The results suggest that these tumor implants are supplied primarily by the hepatic artery, that clearance of Adriamycin is efficient after regional infusion, and that systemic toxicity may be reduced using intraarterial infusion of Adriamycin for hepatic tumors.     

肝细胞癌伴门静脉癌栓不同治疗方法的比较

目的 比较肝细胞癌合并门静脉癌栓(ｔｕｍｏｒ ｔｈｒｏｍｂｉ ｉｎ ｐｏｒｔａｌ ｖｅｉｎ,ＰＶＴＴ）不同治疗方法的疗效及其意义。方法 １４７例肝细胞癌伴门静脉主干或第１分支癌栓的住院患者,按不同治疗方法分成４组：保守治疗组（Ａ组,１８例）;肝动脉结扎和（或）肝动脉插管化疗组（Ｂ组,１８例）,术后定期栓塞化疗;肝癌联同ＰＶＴＴ切除组（Ｃ组,７９例）;手术切除＋肝动脉化疗栓塞和（或）肝动脉置管或门静脉     

肝动脉灌注栓塞术治疗肝癌的临床分析

目的探讨肝动脉灌注栓塞术治疗肝癌的临床效果与安全性。方法选取50例肝癌患者作为研究组,所有患者行肝动脉灌注化疗后采取肿瘤血管末梢栓塞治疗;另选取经肝动脉灌注化疗的30例肝癌患者作为对照组,比较两组患者治疗后的瘤体客观反应率、甲胎蛋白(AFP)水平和生存率。结果研究组患者的生存率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,研究组患者的AFP下降率和肿瘤缩小率明显高于对照组,差异有统计学意义(P<0.05)。研究组患者发热发生率为58.0%,消化道反应发生率为62.0%;对照组发热发生率为30.0%,消化道反应发生率为33.3%,研究组患者不良反应发生率明显高于对照组(P<0.05)。结论肝动脉灌注栓塞术治疗肝癌的疗效明显优于单纯肝动脉灌注化疗法,且不良反应较轻,值得临床推广应用。     

术中肝动脉合并门静脉插管化疗预防肝癌手术后复发

目的 :研究原发性肝癌根治性切除以后肝动脉和门静脉插管皮下埋置药物泵预防肝癌肝内复发的效果。方法 :回顾性研究 5 4例根治性切除肝癌术后的患者 ,其中切除肿瘤后肝动脉和门静脉插管的患者为 3 1例 ,未做插管的 2 3例。随访 2～ 3年 ,对结果进行比较。结果 :插管组 1、2年以及 3年的复发率均低于未插管组。结论 :原发性肝癌根治性切除手术合并肝动脉和门静脉插管皮下埋置药物泵是预防肝癌复发的有效方法     

A case of Vp4 hepatocellular carcinoma treated with surgical resection and continuous intrahepatic artery infusion chemotherapy of low-dose cisplatin and 5-fluorouracil

A 49-year-old woman was admitted to our hospital because of hepatocellular carcinoma (HCC). She had no hepatitis virus. Serum AFP and PIVKA-II levels were as high as AFP 329.4 ng/ml (AFP-L3% 73.1%) and 281 AU, respectively. Portal venous thrombus was observed from the right portal branch to left portal branch and superior mesenteric vein. An extended right hemihepatectomy with extraction of portal venous thrombus was performed. On postoperative day 8, low-dose cisplatin (10 mg/day for 5 days/week) and 5-fluorouracil (250 mg/day for 5 days/week) were administered through the hepatic artery for 4 weeks. After chemotherapy, one intrahepatic metastasis appeared and RFA was performed for this tumor. At 16 months after surgery, she had multiple lymph node metastases and died at 20 months after the surgery without intrahepatic metastasis. Low-dose CDDP/5-FU intra-hepatic artery infusion chemotherapy was effective for prevention of intrahepatic recurrence after resection of HCC with portal venous thrombus.     

Anticancer effect of UFT in intrahepatic recurrence with tumor embolus in the left portal vein after hepatectomy of hepatoma--a case report

A 65-year-old man was diagnosed as having hepatoma (HCC) in the area of S5 and S8. Anterior segmentectomy was performed on September, 1984. TAE (Sandwich therapy) via r. hepatic artery was performed for the intrahepatic recurrence one and half years after hepatectomy. However, the tumor embolus in the l. portal vein with intrahepatic recurrence occurred, and intraarterial infusion chemotherapy (IAC) using CDDP 150 mg was performed via proper hepatic artery. The decrement of AFP value was observed for a short time after IAC therapy. Therefore, UFT 300 mg daily, was administered. For two and half months after UFT administration, the elevation of AFP value continued from 665 ng/ml to 4150 ng/ml, and decreased rapidly below 20 ng/ml in the following 2 months. The tumor embolus in the l. portal vein was remarkably reduced on computed tomogram examination. This case suggests the usefulness of UFT for the intrahepatic recurrence with tumor embolus in the portal vein after hepatectomy for HCC.