肝癌介入治疗方法的回顾与展望

介入治疗被认为是肝癌非手术疗法中的首选方法。肝癌介入治疗方法可分为经皮经血管治疗技术和经皮非血管治疗技术。单纯动脉内灌注抗癌药效果差，各种肝动脉栓塞术尤其是使用同轴导管作超选节段性治疗是介入治疗的主流；一些非血管介入方法如经皮无水乙醇注射治疗、经皮射频消融治疗等以及合理的综合治疗也是治疗肝癌的有效武器。     

CT检查对判断原发性肝癌肝动脉化疗栓塞疗效与预后的意义

目的 探讨CT检查对判断原发性肝癌介入化疗栓塞治疗效果的意义。方法 93例原发性肝癌病人介入治疗采用经皮股动脉插管肝动脉化疗栓塞术，治疗前后进行CT扫描及增强扫描，根据碘油在肿瘤中沉积分布的特点，可将肿瘤形态分为完全型，部分型，多灶型及稀少型。结果 介入治疗后CT检查显示，疗效达PR30例（30／93），占32．2％。肝癌治疗后CT表现与预后有关系，12个月、24个月及36个月以上生存病例在完全型和部分型分别为38例（82．6％）、25例（54．3％）、3例（6．5％）和15例（58．8％）、9例（34．6％）、0例。结论 原发性肝癌介入治疗后CT检查是疗效判定的有效手段；肝癌病灶内碘油沉积分布特点与病人预后有关。     

双介入治疗中晚期原发性肝癌

双介入治疗中晚期原发性肝癌魏法才侯守玺王力李学华姜桂生常爱林我院自１９９０年３月～１９９５年１２月，联合应用经股动脉插管肝动脉化疗栓塞术和经超声引导下经皮肝穿刺瘤内注射无水酒精治疗中晚期原发性肝癌７２例（简称双介入治疗），疗效满意，现报道如下。资料与...     

超声造影在肝癌介入治疗中的应用价值

目的探讨超声造影技术在肝癌介入治疗中的应用价值。方法应用超声造影技术(CEUS),对56例经过介入治疗的肝癌患者的65个病灶治疗前后进行诊断,并与常规彩超进行对比研究。结果比较常规彩超和CEUS对肝癌的诊断,发现CEUS对原发性肝癌和<10 mm肝癌病灶的诊断阳性率明显高于常规彩超,差异有明显的统计学意义(P<0.05),CEUS对肝癌介入的诊断情况与增强CT的诊断结果比较,有一致性,Kappa>0.72,P<0.05,而与常规彩超检查结果不一致,Kappa>0.45,P<0.05。结论 CEUS是一种判定肝癌介入治疗疗效并及时指导治疗的有效方法。     

原发性肝细胞癌局部介入治疗新进展

原发性肝细胞癌是全球第6大常见恶性肿瘤，肿瘤相关性死亡中排名第三。我国肝癌发病率和病死率在男性和女性中均位列前五，且呈逐年上升趋势，而就诊时可手术切除的患者不到30%。随着医学技术的不断发展，介入治疗已在肝癌治疗中发挥着关键性作用。本文将重点对经动脉化疗栓塞、经动脉放射栓塞、经皮射频消融、微波消融等介入治疗方式，以及介入治疗与分子靶向、免疫联合治疗方面的最新进展作一综述。     

肝动脉化疗栓塞与微波热凝固疗法联合治疗原发性肝癌的临床研究

肝动脉栓塞(TACE)是治疗原发性肝癌的有效方法,但是单独应用很难达到根治肿瘤的目的,只有综合治疗才能提高疗效。本研究采用经皮穿刺微波热凝固治疗(PMCT)结合TACE治疗原发性肝癌,分析两者结合的原理并评价其治疗效果。1资料与方法1．1一般资料2003年9月—2004年9月在我院住院治疗的18例原发性肝癌患者共28个结节,诊断均由活检病理证     

原发性肝癌介入治疗对尿激酶型纤溶酶原激活剂及其受体表达的影响

  目的 探索原发性肝癌介入治疗前后尿激酶型纤溶酶原激活剂（urokinase plasminogen activator, uPA）及其受体（urokinase plasminogen activator receptor, uPAR）表达的变化，分析uPA及uPAR在人类原发性肝癌发生发展中的作用，并为uPA及uPAR表达水平对介入治疗原发性肝癌的效果评价价值提供可靠的理论依据。方法 对48例已确诊的原发性肝癌患者在介入治疗前后分别取静脉血、癌组织和肝正常区组织标本，应用ELISA、RT-PCR方法，分别检测介入治疗前后uPA／uPAR在血清、肝癌组织与正常肝组织中的表达变化。结果 介入治疗前uPA／uPAR 在血清内的表达量明显高于对照组，两组间的差异有统计学意义（P＜0.01）；肝癌组织中uPA／uPAR mRNA明显高于正常区肝组织，两组间的差异有统计学意义（P＜0.01），且介入治疗后肝癌组织中uPA／uPAR mRNA的表达量较治疗前明显降低，两组间的差异有统计学意义（P＜0.05），但未降至正常。结论 uPA／uPAR 的过量表达与原发性肝癌的发生有关，uPA／uPAR的mRNA表达水平对介入治疗原发性肝癌的效果评价有一定的参考价值。     

护理干预对原发性肝癌患者介入治疗后医院感染的预防作用分析

目的探讨原发性肝癌患者介入治疗后医院感染的临床特征和采取护理干预的预防效果。方法选取2006年9月至2010年4月进行介入治疗的142例原发性肝癌患者随机分为观察组和对照组,每组71例。观察组患者接受全面护理干预,对照组患者接受常规护理,对比两组患者院内感染的发生率及临床特征。结果观察组患者进行介入治疗后15例出现感染,感染率为21．1％,对照组出现52例感染,感染率为73．2％,观察组感染率显著低于对照组（P〈0．05）。结论护理干预能够有效预防原发性肝癌患者介入治疗后医院感染。应重视心理护理、院内消毒、口腔护理等多种护理方式,并针对医院病原菌分布合理应用预防性抗生素,降低患者感染风险,改善生活质量。     

131碘标记肝癌单抗片段介入治疗原发性肝癌的临床毒副作用观察

目的 观察^131碘标记肝癌单抗片段介入治疗原发性肝癌的临床毒副作用。方法采用股动脉插管介入治疗方法对25例原发性肝癌患者进行42人次的^131碘标记肝癌单抗片段的导向治疗，分别于治疗前以及治疗后7天、28天、36天、57天观察血常规、尿常规、肝功、肾功、甲功，并进行统计分析。结果治疗前后各项指标变化较小。结论通过介入方法临床应用^131碘标记肝癌单抗片段治疗原发性肝癌，方法安全无明显毒副作用。     

经皮微波固化联合无水酒精注射治疗原发性肝癌

经皮微波固化与瘤内无水酒精交替注射治疗25例原发性肝癌。结果随访6－15个月，中位生存期12．3个月；甲胎蛋白阳性13例，治疗后降至正常10例；组织学检查病变完全坏死率76％（19／25）；3例＜5cm的小肝癌完全缓解，22例＞5cm的大肝癌治疗后病情好转达16例，无效6例。联合治疗副作用不大，未见严重并发症。初步研究的结果提示：经皮微波固化联合无水酒精注射是治疗原发性肝癌的有效方法之一。     

血浆前列腺素E_2测定对原发性肝癌的诊断价值

为探讨前列腺素Ｅ＿２（ＰＧＥ＿２）在原发性肝癌（ＰＨＣ）中的应用价值，作者共检测３０例ＰＨＣ（包括转移者２２例、未转移者８例）、１０例酒精性肝病、３９例肝硬化、３０例正常人的血浆ＰＧＥ＿２浓水平。结果表明：ＰＨＣ患者血浆ＰＧＥ＿２水平明显升高（Ｐ＜０．００１），且转移者比未转移者亦明显升高（Ｐ＜０．０１），而两种良性肝病则无明显升高（Ｐ＞０．０５）。提示血浆ＰＧＥ＿２测定对早期发现肝硬化向ＰＨＣ转化，监测ＰＨＣ的扩散及转移有一定意义。     

血清高尔基体蛋白73联合甲胎蛋白检测在原发性肝癌患者中的诊断价值

目的:探讨高尔基体蛋白73（golgiprotein 73,GP73）联合甲胎蛋白检测用于原发性肝癌诊断的临床意义。方法:收集2013年6 月至9 月天津医科大学肿瘤医院160 例血清,其中原发性肝癌患者46例,单纯肝硬化患者30例,其他消化系统肿瘤患者44例,健康者40例。应用酶联免疫吸附实验定量检测血清GP73水平,电化学发光免疫分析检测血清甲胎蛋白（alpha-fetoprotein ,AFP）水平。结果:GP73诊断原发性肝癌的敏感性达到73.9% ,与本研究中AFP 敏感性（56.5%）相比,前者有显著增高,差异有统计学意义（P<0.01）。 GP73和AFP 联合检测敏感性有显著提高,可以达到86.9% ,与单独一种相比敏感性有显著性差异（P<0.01）。 结论:GP73有可能作为原发性肝癌诊断的血清标志物之一,而GP73和AFP 的联合检测对原发性肝癌的诊断也有较好的应用价值。      

Front Cover Image,Volume 121, Number 6, May 1, 2020

The treatment for perihilar cholangiocarcinoma (PHC) is a challenge for the surgeon requiring complex resections with a reported perioperative mortality rate between 15% and 48%. In PHC patients with future liver remnant (FLR) less than 30%, it is advised that hepatectomy can be safely performed after the FLR is modified. Associating Liver Partition and Portal vein ligation for Staged Hepatectomy (ALPPS) procedure is criticized heavily due to its high morbidity and mortality rate in this setting. Hereby, we are reporting a modification of ALPPS procedure for PHC. Clinical presentation, preoperative work-up as well as operation and postoperative course of two cases were described in detail. Both patients were jaundiced preoperatively, stage 1 partial-ALPPS procedures were performed laparoscopically, there was sufficient remnant hypertrophy during the interval stage and there was no posthepatectomy liver failure after the second stage (Supporting Information Video). We have followed patients with a mean follow up of 35 months without any recurrence. Here we describe the key technical aspects of this approach that are discussed in three parts: minimally invasive first stage, biliary drainage of both FLR, and deportalized liver at first stage and biliary reconstruction at the second stage. This technique, in selected patients, can extend the indication of ALPPS procedure for PHC with preoperative jaundice.     

原发性肝癌患者可溶性IL—2受体水平,IL—2和NK活性的变化及意义

采用双抗体夹心ELlSA法检测43例原发性肝细胞癌(PHC)病人血清可溶性白细胞介素2受体(sIL-2R)水平,及其外周血单个核细胞(PBMC_s)的白细胞介素2(IL—2)活性和自然杀伤(NK)细胞活性.另将51例慢性乙型活动性肝炎和肝硬化病人做为对照.结果,上述病人血清sIL—2R水平明显升高,IL—2和 NK活性低于正常人,其中PHC的IL—2和NK活性的降低又为显著(P<0.001< O.001).表明PHC病人的细胞免疫功能受损程度最重.检测sIL_2R水平和IL—2活性,可望做为对PHC患者病情分析及判断预后的指标.     

晚期原发性肝癌腹腔化疗的近期疗效观察

本文报告了我科从1992年10月以来采用以顺铂为主的腹腔化疗治疗35例晚期原发性肝癌的近期疗效观察。结果：部分缓解12例，有效率34．3％（12／35），稳定16例，进展7例。毒性反应轻，有轻度恶心、呕吐，对造血机能影响小，对肝肾等没有重大损害。结果表明以顺铂为主的腹腔化疗是有效而毒副反应小的治疗手段。     

Simultaneous over-expression of insulin-like growth factor-II (IGF II) and IGF-II receptor (IGF-II R) genes in human primary cancer-implication of autocrine and paracrine mechanism in autonomous growth of hepatic cancer

This is first report about the simultaneous over-expression of both Insulin-like growth factor (IGF-II) and its receptor (IGF-II R) at mRNA level in human primary hepatic Cancer (PHC). In 10 PHC samples from China, IGF-II and IGF-II R were both over-expressed, whereas only a background signal was detected in normal liver. In 5 pairs of PHC and its non-tumorous adjacent liver tissues from South Africa, IGF-II and IGF-II R were also over-expressed in PHC. mRNA expression of IGF-II in all 5 cases and IGF-II R in 4 of 5 cases were higher in cancer than non-tumorous adjacent liver tissues. These results strongly implicate that an autocrine and/or paracrine mechanism might be involved in formation and progression of PHC.     

A case-control study of primary hepatocellular carcinoma in Taiwan

A case-control study was carried out to explore possible risk factors of primary hepatocellular carcinoma (PHC) in Taiwan. One hundred thirty-one PHC patients and 207 hospital control patients were interviewed and blood samples were collected for blood type and hepatitis B virus (HBV) infection marker tests. Eighty-three percent of the PHC patients were found to be hepatitis B surface antigen (HBsAg) positive as compared with 21.0% of the control patients with an odds ratio (OR) of 21.5. Hepatitis B e antigen (HBeAg) positive status increased the risk of PHC. No significant association was observed between erythrocyte genetic markers and PHC, except c of the Rh system, which was significantly lower in the PHC cases. As compared with the control patients, the PHC patients had a higher proportion with a history of liver diseases and more siblings affected with liver diseases. However, the variables such as cigarette smoking, alcohol drinking, peanut consumption, frequent intake of raw fish, heart diseases, peptic ulcer, malaria, hypertension, diabetes, color blindness, G-6-PD deficiency, surgical operation, blood transfusion, and liver diseases of parents and children were not found to be associated with PHC.     

脾动脉部分栓塞联合肝动脉化疗栓塞治疗原发性肝细胞癌合并脾亢的临床研究

背景与目的：原发性肝细胞癌（primary hepatocellular carcinoma,PHC）患者70％-90%有肝硬化、脾功能亢进以致患者术前外周血象偏低或术后外周血象恢复缓慢常影响经肝动脉化疗栓塞（transcatheter hepatic arterial chemoembolization,TACE）的正常进行。本研究探讨脾动脉部分栓塞（partial splenic embolization,PSE）联合经TACE治疗合并脾功能亢进的PHC的方法和意义。方法：对26例PHC患者采用PSE联合TACE治疗的方法,26例PHC患者单用TACE治疗。结果：PSE联合TACE较单用TACE治疗明显改善PHC患者外周血象,PSE术后3天、1周、2周及4周外周血白细胞、红细胞、血小板较栓塞前明显提高。结论：PSE联合TACE是PHC合并脾亢的安全、有效治疗方法。     

原发性肝癌超声造影特征及其与病理相关性的研究

Objective  

The aim of this study was to evaluate the value of contrast-enhanced ultrasound (CEUS) for blood perfusion of primary liver cancer (PHC) and investigate the correlation between microvascular architecture of PHC and pathological differentiation.