肝动脉导管栓塞化疗治疗肝癌的护理

目的:探讨肝动脉栓塞化疗治疗肝癌的术前、术后的护理措施。方法:对36例行TACE的患者在术前充分准备、术后精心护理。结果:肝动脉栓塞化疗治疗有效率82 % ,术后出现不良反应的患者,经对症治疗、护理均痊愈。结论:肝动脉栓塞化疗治疗肝癌是手术不能切除或术后复发HCC的首选方法,细致、周到的护理是治疗成功的重要保证     

肝细胞癌TACE治疗进展

肝细胞癌(HCC)是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括:经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞(TACE)是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

肝细胞癌TACE治疗进展

肝细胞癌（HCC）是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括：经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞（TACE）是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma

Cone-beam computed tomography (CBCT) using a flat-panel detector is an alternative method of obtaining cross-sectional images. This technique is now being used during transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC). Several CBCT techniques are performed to detect HCC lesions: CBCT during portography (CBCTAP), CBCT during hepatic arteriography (CBCTHA), CBCT after iodized oil injection (LipCBCT), CBCT during arteriography (CBCTA) of extrahepatic collaterals. Almost all HCC lesions can be detected using these CBCT images. Three-dimensional arteriography using maximum intensity projection from CBCTHA images can identify the tumor-feeding branch. In particular, this technique is useful when the tumor stain cannot be demonstrated on arteriography. In addition, dual-phase CBCTHA can improve the diagnostic accuracy for hypervascular HCCs because corona enhancement can be detected around the tumor. To monitor the embolized area during TACE, selective CBCTHA or LipCBCT at the embolization point is useful. Two sequential CBCT scans without and with contrast material injection is also useful to confirm each embolized area of two vessels. Furthermore, CBCTA can prevent nontarget embolization. Although the image quality of CBCT is low compared to that of conventional CT, CBCT provides useful information that helps perform TACE for HCCs safely and effectively.     

Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma

A dilated hepatic falciform artery (HFA) arising from the left hepatic artery was demonstrated on arteriography prior to chemoembolization of an unresectable hepatocellular carcinoma (HCC) located predominantly in the left lobe of the liver. The HFA was occluded by microcoils to prevent a possible toxic supraumbilical skin rash following chemoembolization of the HCC via the left hepatic artery. There were no postprocedure complications. We consider this procedure useful for improving the safety of chemoembolization.     

Cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma

A case of cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is presented. A 76-year-old man underwent TACE for advanced hepatocellular carcinoma. Immediately after chemoembolization, his level of consciousness deteriorated. Computed tomography revealed deposition of iodized oil in the cerebral cortex, basal ganglia, and thalami. Magnetic resonance imaging showed restricted diffusion within the thalami and basal ganglia. The patient's level of consciousness gradually improved, and all neurologic symptoms disappeared over 6 weeks.     

不可切除性肝细胞癌经肝动脉化疗栓塞后的MRI监测

原发性肝细胞癌是临床最常见的恶性肿瘤之一。治疗原发性肝细胞癌最有效的方法是手术。但是由于肝癌患者多伴有肝硬化、肝炎,及其它器官转移等不适合手术治疗。目前临床治疗肝细胞癌（HCC）的主要非手术方式介入治疗方法．     

Feasibility of transcatheter arterial chemoembolization for hepatic adenoma

PURPOSE: To assess the efficacy of transcatheter arterial chemoembolization (TACE) for hepatic adenoma (HA). MATERIALS AND METHODS: Between July 1989 and June 2006, TACE was performed in seven patients with HA (five male and two female patients; mean age, 25 years). The therapeutic results were evaluated by reviewing the clinical records and radiologic studies. The causes of HA were hormonal therapy for aplastic anemia (n = 4) and glycogen storage disease type I (n = 2); in one patient, the cause was unknown. The presenting symptoms were abdominal pain (n = 4) and lower-extremity edema (n = 1). Two patients had no symptoms at presentation. Rupture (n = 1) or impending rupture (n = 3) of the tumors was detected on computed tomographic (CT) scans obtained before TACE. Clinical results were assessed at subsequent TACE sessions and follow-up CT. The mean follow-up duration after the first TACE session was 88 months (range, 16-200 months). The change in tumor size at CT was measured to evaluate the therapeutic results. RESULTS: The preexisting symptoms were relieved and no procedural-related complications were observed in all patients. Hemostasis and no further bleeding episodes were achieved in patients with rupture or impending rupture with intratumoral hemorrhage. The treatment results were complete remission (n = 2), tumor regression in size by more than 50% (n = 4), and progression (n = 1) at follow-up CT. CONCLUSION: TACE is a feasible therapeutic modality for HA.     

Postoperative recurrence of hepatocellular carcinoma: Results of transcatheter arterial chemoembolization

A retrospective analysis was made of the effect of transcatheter arterial chemoembolization (TACE) in 87 patients with recurrent hepatocellular carcinoma (HCC). In contrast to the predominantly single nodular HCC (60.2%) on preoperative angiography, recurrent HCC showed a multinodular pattern in 54.2%. Preoperative TACE had significantly prolonged the interval between surgery and recurrence. One- and 2-year survival rates after TACE of the 87 recurrent HCCs were 74.7% and 55.%, respectively, which were not significantlydifferent from those of a control group of 206 patients with HCC in Child's class A, who were treated with TACE only. We believe that TACE is an effective measure in the management of preoperative and recurrent HCC.     

中国肝细胞癌经动脉化疗栓塞治疗临床实践指南

肝细胞癌（HCC）是起源于肝细胞的恶性肿瘤,中国HCC患者80%发生于乙型肝炎病毒（HBV）感染后。HCC通常是一种富血供肿瘤,经动脉化疗栓塞（TACE）治疗一方面阻断肿瘤血供,同时在肿瘤局部聚集高浓度的化疗药物,对肿瘤细胞发挥最大限度的杀伤作用,被公认为HCC非手术治疗最常用方法之一,但TACE本身目前尚缺乏标准。为此,中国医师协会介入医师分会专家们共同编写了《中国肝细胞癌经动脉化疗栓塞治疗临床实践指南》,内容包括概述、适应证与禁忌证、围手术期处理、设备器械与药物准备、伦理与知情同意、患者术前准备、围手术期治疗、手术操作、并发症与处理、疗效评价与随访、综合治疗等,本指南旨在促进我国肝癌TACE技术的规范化、专业化和个体化整体水平的提高,促进并推动我国肝癌诊疗研究的发展。     

经导管化疗栓塞治疗肝癌的应用及进展

介绍了肝癌TACE的发展历史，以及治疗时临床疗效的提高，化疗药物的作用及用量，伴有静脉癌栓和动静脉瘘时的处理，治疗后肝功能、肿瘤恶性程度和患者生存质量的改变等方面的研究进展。     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

球囊辅助TACE术治疗肝癌1例

临床资料 患者男,28岁.因“腹胀、腹泻1个月余,血便1d”入院.既往有慢性乙型肝炎病史.入院体检:T 37.1℃,HR 90次/min,R 20次/min,BP 112/66 mmHg.门诊CT提示:①考虑肝左叶原发性肝癌并肝内转移或多中心型肝癌;②腹膜后淋巴结转移,并肝动脉-门静脉瘘;③疑左侧肾上腺转移,建议结合临床;④肝硬化,脾肿大,腹水.入院后予以抑酸、止血、降门脉压等对症支持治疗,并完善胃镜检查.     

Carbon dioxide-enhanced sonographically guided radiofrequency ablation plus transcatheter arterial chemoembolization for hepatocellular carcinoma

A 78-year-old man had a history of blood transfusion and hepatitis C virus-related liver cirrhosis. He was admitted to the authors' hospital with a hepatocellular carcinoma just below the right hemidiaphragm. Although the lesion was not well visualized with standard sonography, it was clearly defined by performance of sonography with intraarterial injection of carbon dioxide, allowing safe and accurate radiofrequency ablation. To increase the extent of tumor ablation, transcatheter arterial chemoembolization was performed immediately before radiofrequency ablation. By concomitant application of these two techniques, complete tumor necrosis was achieved without the need to perform additional ablation.     

中期肝癌TACE之争论与研究现状

【摘要】 TACE长期以来一直是中期肝癌的标准治疗。但是,近2年来,TACE受到了来自系统治疗和经导管肝动脉灌注化疗（HAIC）的影响。在如何面对靶向治疗和免疫治疗时代,中期肝癌治疗决策的定位,TACE在中期肝癌治疗中的重要作用,以及面对系统治疗和HAIC的机遇,本文从循证医学的角度,阐述上述问题。     

原发性肝癌肝动脉化疗碘油栓塞后的MRI诊断价值

目的 研究MRI检查技术，尤其是FSET2WI和多时相快速动态增强扫描评价原发性肝癌动脉化疗碘油栓塞后（TACE）的影像学表现，探讨其临床应用价值。方法收集2000年9月至2004年7月肝癌病例30例（共37个病灶），于TACE后2～6个月行GE1．5TMRI检查，并于MRI检查后2～6d行DSA检查。研究肝癌TACE后肿瘤的坏死或存活的MRI信号特点，以及MRI和DSA在显示肿瘤存活结果的符合情况。结果37个肝癌TACE术后病灶中，MRI明确判断21个病灶有肿瘤残存，16个病灶凝固坏死明显。MRI判断病灶残存的敏感性为91．3％，特异性100％，准确性94．6％。与DSA相比无明显统计学差异（P〉0．05）。结论FSET2WI和多时相快速动态增强扫描序列相结合，同时观察病灶周围的完整与否，可以准确地判断肝癌TACE后肿瘤的坏死或残存。作为一种无创伤性检查。可以作为评价肝癌TACE术后疗效的首选检查。     

Imaging features of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation

OBJECTIVE: The purpose of this pictorial essay is to show the imaging features of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and radiofrequency thermal ablation on CT, MRI, and contrast-enhanced sonography and to describe the advantages and limitations of each imaging technique in evaluating the therapeutic effect on HCC. CONCLUSION: CT is the standard imaging technique for monitoring the effectiveness of TACE and radiofrequency ablation. Contrast-enhanced sonography and MRI can complement CT in evaluating the therapeutic response.     

术前经动脉化疗栓塞对肝癌细胞增殖的影响

目的　评价术前经导管动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)对肝细胞癌细胞增殖的影响。方法　经手术病理证实的肝细胞癌 136例 ,其中行 1～ 5次TACE后Ⅱ期手术切除 79例 (TACE组 ) ,按治疗方式不同分 4组 ,A组 11例 ,仅灌注化疗药物 ,治疗 1～ 4次 ;B组 33例 ,化疗药加碘化油栓塞 ,治疗 1～ 5次 ;C组 2 3例 ,化疗药加碘化油加明胶海绵颗粒栓塞 ,治疗 1～ 3次 ;D组 12例 ,化疗药加碘化油、无水乙醇、明胶海绵颗粒栓塞 ,治疗 1～ 3次。单纯手术 5 7例 (非TACE组 ) ,用免疫组化检测各标本Ki 6 7和增殖细胞核抗原 (PCNA)蛋白表达。结果　TACE组的C组和D组较非TACE组Ki 6 7和PCNA蛋白表达显著降低 (P <0 .0 5 )。A组和B组较非TACE组Ki 6 7和PC NA蛋白表达显著增高 (P <0 .0 5 )。结论　多材料联合栓塞TACE后肝癌细胞的增殖活性受抑制 ,而单材料栓塞、单纯化疗后肝癌细胞的增殖活性得到增强。     

肝动脉化疗栓塞对肝癌生物学特性的影响

经导管肝动脉化疗栓塞术(transcatheter arte-rial chemoembolization,TACE)是目前肝细胞癌(hepatocellular carcinoma,HCC)非手术疗法中应用最广泛的方法之一,但其远期疗效仍不能令人满意。多项病理研究表明,TACE虽能使HCC肿瘤病灶大部分发生凝固坏死,但发生完全坏死者少见,多数病灶内仍可见残存的肿瘤细胞,从而成为肿瘤复发转移的根源,也严重影响了TACE远期疗效[1,2]。HCC的残存及复发是十分复杂的过程,其影响因素包括肿瘤增殖的活性增加、抗凋亡基因表达、促血管生成因子表达及新生血管生成、黏附因子、多药耐药基因及端粒酶异…