中晚期肝癌的综合介入治疗

目的　探讨肝动脉栓塞化疗术 (TAE)、经皮穿刺注射无水酒精 (PEI)和肝动脉灌注化疗药物术 (TAI) 3种方法联合治疗中晚期肝细胞癌的临床效果。方法　常规肝动脉栓塞化疗术、肝动脉灌注化疗药物术 ,透视或CT定位经皮穿刺多点注射无水酒精。结果　随访 1～ 3年 ,1、2、3年生存率分别为6 0 .3% ,2 8.6 % ,17.3%。结论　运用 3种介入方法治疗中晚期肝癌有明显临床效果     

CT导引经皮穿刺热化疗治疗肺、肝恶性肿瘤

目的评价CT导引下,经皮穿刺热化疗治疗肺、肝恶性肿瘤的价值.方法21例肝癌、肺癌和肝、肺转移癌患者行肿块热化疗.将化疗药物加热至55～60℃,在CT引导下注入肿块内,注入量根据V=4/3π(r+0.5)cm3t适当增减.重复治疗2～5次,并依治疗前后CT扫描密度和大小的变化以及生化指标、生存期作为疗效观察标准,治疗效果分为五级效佳、显效、有效、效差、无效.结果效佳6例,显效9例,有效3例,效差2例,无效1例,随访观察时间为36个月20例,病员生存时间8～22个月,平均生存时间16个月,1例病员结合肝动脉栓塞治疗,存活28个月仍健在.治疗总有效率为95.2%.结论CT导引下经皮穿刺热化疗是治疗肺、肝恶性肿瘤的有效方法,尤其适合于不能手术切除的病人,结合肝动脉栓塞可提高疗效.     

原发性肝癌伴脾亢的介入治疗(附31例报告)

目的　探讨肝动脉化疗栓塞联合部分性脾动脉栓塞 (PSE)治疗原发性肝癌合并脾功能亢进的意义及方法。方法　原发性肝癌合并脾亢 3 1例 ,采用经皮穿刺肝动脉化疗栓塞术 (TACE)和PSE治疗 ,治疗前后测定血细胞数量 ,CT观察肝脏肿瘤及脾脏大小改变。结果　PSE术后 2 4h、1周、4周血白细胞和血小板均较栓塞前明显升高 (Ρ <0 .0 1)。 2 8例脾栓塞面积在 40 %～70 % ,2例 80 % ,1例 <40 %。术后 1月CT复查肝脏肿瘤缩小 2 2例 ,占 70 .97% (2 2 / 3 1)。脾脏有所缩小 ,内可见均一低密度梗死区。结论　肝动脉化疗栓塞及部分性脾动脉栓塞是治疗肝癌合并肝硬化脾功能亢进安全、有效的方法     

CT导向下经皮穿刺冰醋酸治疗肝脏转移性肿瘤

目的 总结经皮穿刺刺冰醋酸注射治疗（PAI）肝脏转移性肿瘤的效果。方法 搜集1997年1月至1999年6月在CT导向下经皮穿刺冰醋酸注射治疗（PAI）的肝脏转移性肿瘤患者35例（病灶40个），病灶直径2－4cm。经CT定位后穿刺，注入4－10ml的30％冰醋酸，且冰醋酸内中加入1ml对比剂，每个病灶1周注射2次，一般持续2－3周。结果 本组35例共40个病灶，其中肿瘤缩小者为23个，占57.5%；肿瘤大小无变化者12个，占30％；肿瘤增大者5个，占12.5%；决有效率为87.5%。所有患者随访3个月至3年及以上，1年生存22例，生存率达62.9%；2年14例，生存率为40.0%；3年及以上者8例，生存率为22.9%。结论 经皮穿刺冰醋酸注射治疗肝脏转移性肿瘤是1种有效的治疗方法。     

肝动脉化疗栓塞治疗肝转移性平滑肌肉瘤的临床体会

目的探讨经肝动脉化疗栓塞治疗肝脏转移性平滑肌肉瘤（MLL）的临床价值。方法对8例经穿刺活检及免疫组化证实的MLL行肝脏CT三期增强扫描及肝动脉灌注化疗栓塞,随访1～3年,依据动脉化疗栓塞前后肝内病灶强化程度、DSA表现及生存期评估疗效。结果单发转移瘤3例、多发5例。治疗后临床症评价,显效6例,有效2例 影像学疗效评价显效3例,有效4例,无效1例。1、2、3年生存率分别为7/8、4/8和3/8。结论肝动脉灌注化疗栓塞是一种安全有效治疗肝脏转移性平滑肌肉瘤的方法。     

肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

目的 探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的疗效和安全性.方法 前瞻性研究9例少血供性肝海绵状血管瘤患者经肝动脉栓塞结合经皮经肝瘤体内药物注射治疗情况.对于CT/MRI明确诊断的肝海绵状血管瘤(直径＞5 cm),且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此表现的9例患者,先行肝动脉插管栓塞术,栓塞剂为超液化碘油(10 m1)与博莱霉素(8 mg)混悬剂,实际用量为5～10 ml.栓塞后4 d开始行经皮经肝瘤体内穿刺多点注射博莱霉素8～16 mg,间隔3～4 d再次注射,连续2～3次,1个月后复查CT,以后3、6个月及1年不定期复查CT.结果 9例患者DSA上所见血管瘤染色与CT增强扫描表现一致,碘油沉积呈散在点状分布,治疗后1个月瘤体均明显缩小,以后继续缩小,1年后复查基本稳定不再缩小.2例患者出现急性胆囊炎,对症处理后痊愈.1例出现栓塞后胆汁瘤,随访观察未进一步进展,未作特殊处理.结论 经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法 .     

CT引导下射频消融术在肝脏恶性肿瘤治疗中的临床应用

目的评价肝动脉化疗栓塞(TACE)联合全麻下CT引导下经皮穿刺射频消融(RFA)治疗肝脏恶性肿瘤的疗效。资料与方法原发性肝癌患者20例,肿瘤切除术后复发6例,肝转移瘤5例,男23例,女8例,年龄40～74岁。所有患者均先行TACE术(1～2次),然后在全麻CT引导下经皮穿刺行RFA治疗,其中2例联合手术行RFA治疗,2例做了2次RFA治疗。随诊2～36个月,观察并发症和疗效。结果 31例患者共进行43次RFA治疗,未出现任何严重并发症。23个肿瘤完全坏死,11个部分坏死。结论 TACE联合全麻下CT引导下RFA治疗肝脏恶性肿瘤是一种有效的微创治疗方法。     

经肝动脉小剂量栓塞化疗联合经皮乙酸灭活对巨块型肝癌疗效的评价(附28例报道)

目的评价经肝动脉小剂量栓塞化疗(TACE)联合经皮乙酸注射(PAI)治疗巨块型肝癌的疗效。方法28例巨块型肝癌患者,首次行常规剂量TACE治疗,重复TACE治疗采用小剂量(10mg丝裂霉素与碘油乳化栓塞),术后1周CT复查,依据碘油的充盈状况,对碘油稀疏和缺损区域进行PAI治疗。观察其治疗后的生存率,肿块的变化及术后肝功能、α-FP、副反应情况。结果28例患者术后1a,2a,3a累积生存率分别为96.4%,78.6%,32.1%,全部患者的肿块缩小。结论小剂量TACE联合PAI治疗巨块型肝癌能明显提高患者的生存率,术后肝功能损伤小,副反应少。     

CT引导下臭氧及胶原酶治疗极外侧型腰椎间盘突出症

 目的 探讨在CT引导下经皮穿刺注入臭氧及胶原酶治疗极外侧型腰椎间盘突出症的临床疗效.方法 72例经临床诊断为极外侧型腰椎间盘突出症患者,在CT引导下经皮穿刺进入椎间盘内,注入浓度为60μg/ml的臭氧10～40ml,再退针至突出物内注入胶原酶600～1 200 U.结果 随访3～6个月,疗效根据改良的Macnab方法评价,其疗效优、良、差率分别为44.5%、45.8%、9.7%.结论 CT引导下经皮穿刺注射臭氧及胶原酶治疗极外侧型腰椎间盘突出症是安全、有效的方法.     

动脉灌注化疗并栓塞治疗中晚期恶性肿瘤935例临床疗效及并发症分析

目的:为总结动脉灌注化疗合并栓塞术治疗各种中晚期恶性肿瘤的临床疗效以及并发症发生的原因。材料与方法:采用回顾性临床总结过去6年中935例各种中晚期肿瘤.共进行动脉插管化疔药物灌注2715例次,肿瘤供血动脉栓塞675例次,所用化疗药物一般2～3联.所用栓塞剂为40%碘化油5～20ml 以及明胶海绵碎屑。结果:935例病人CR113例,PR201例,MR288例,SD241例,PD92例,总有效率(CR+PR+MR)为63.2%。栓塞后综合征发生率为6.6%。结论:经皮穿刺肿瘤供血动脉插管化疗药物灌注及栓塞术对中晚期恶性肿瘤的疗效肯定。     

Granular cell tumor presenting as an intradural extramedullary tumor

Granular cell tumor (GCT) is an uncommon benign tumor, which is thought to originate from a Schwann cell. GCT may involve any part of the body, but in our knowledge, there has been only one previous report of GCT, which arose in the intradural extramedullary space of the spine. We report a case of GCT, which occurred in the intradural extramedullary space.     

Granular-cell tumor: a rare variant of mammary tumor

BACKGROUND: Granular cell tumor (GCT) is a rare variant of mammary tumor beset with diagnostic dilemmas that may be resolved by using numerous, very complex, enzymohistochemical and immunohistochemical methods. CASE REPORTS: We reported three female patients 16, 21 and 65 years old, operated on for mammary tumor at the Surgical Clinic of the School of Medicine in Nis, over the period of thirty years, 1977 to 2007. During this period 14.022 mammary tumors were diagnosed, including these three cases. These tumors had benign characteristics, without associated tumors in other localizations. A typical histological feature of GCT was a granular cytoplasm in large ovoid cells, organized like nests or like a trabecular arrangement. The tumors were analyzed by sets of histochemical, enzymohistochemical, immunohistochemical methods as well as ultrastructural examination. Protein, S-100 neuron-specific enolase and vimentin expressed a diffuse and intensive immunohistochemical activity, while expression of estrogen and progesterone receptors, as well as HER-2 oncoprotein was negative. The ultrastructural analysis confirmed that the tumor cells were enriched by lysosomes and consequential disorganization of cytoplasm. CONCLUSION: The reported enzymo- and immunohistochemical combined methods provide a precise diagnosis and confirm the GCT's neural origin, which has been disputed for years.     

Extrarenal rhabdoid tumor mimicking a sacral peripheral nerve sheath tumor

Extrarenal rhabdoid tumor is a rare, highly aggressive tumor of childhood with a poor prognosis. It represents <1% of pediatric soft tissue malignancies, typically involving infants . Frequently involved extrarenal sites include deep locations of the neck, abdomen, and paraspinal regions. The presence of “rhabdoid” cells is the characteristic histologic feature. Recent discovery of a specific genetic mutation enables a more accurate diagnosis. We present a case in an adolescent of extrarenal rhabdoid tumor arising within the sacral canal. This appears to be the first reported case of an extrarenal rhabdoid tumor arising within the sacral canal and mimicking a peripheral nerve sheath tumor. While rare, this tumor can be included in the radiologic differential diagnosis of peripheral nerve sheath tumors in children.     

Metastatic liver tumor with tumor thrombi of the portal vein

Tumor thrombi of the portal vein are an important prognostic indicator for primary hepatocellular carcinoma (hepatoma), and their presence is a major criterion in differentiating intrahepatic tumors. We report four cases of metastatic liver tumors with tumor thrombi, one a gastric tumor and the others colorectal cancers, two of which were difficult to differentiate from hepatoma. The angiographic features of hepatoma are reviewed and differentiation between the two is discussed. Angiography showed the vessels of metastatic liver tumors to be of fine to mixed types. Chaotic vessels and pooling are characteristic of hepatomas, and dense tumor stains are observed only in hepatomas. The mean survival period after angiography was 3.8 months, and the prognosis was not favorable in patients having "thread-and-streak" sign on angiography.