肝癌介入治疗后肝细胞凋亡和再生的研究

目的　研究肝癌介入治疗后 ,周围正常肝脏细胞是否存在肝细胞凋亡及再生及其特点。方法　VX2肝癌动物模型兔 50只 ,分别行肝叶切除术 (PH)与经动脉化疗栓塞术 (TACE) ,流式细胞术检测术后 2 4、72h的周围正常肝细胞周期 ,测定S期细胞比率 (SPF) ,增殖指数 (PI)的变化并测定是否有肝细胞凋亡。结果　TACE术后 2 4hSPF、PI较对照组均明显升高 (P <0 .0 0 1 ) ,并且术后第 1天 ,TACE术后肝细胞增殖弱于肝叶切除术 ,各项指标差异有显著性 (P <0 .0 5) ,术后 72h ,两组出现较小的亚二倍体峰 (Sub G1 ) ,较对照组有所升高 (P <0 .0 5) ,但它们之间差异无显著性 (P >0 .0 5)。结论　TACE术后肝组织存在一定程度的再生和肝细胞凋亡 ,这可能与碘油的选择性栓塞 ,化疗药物的诱导和自由基的损伤有关     

Treatment of hepatocellular carcinomas by thermal ablation and hepatic transarterial chemoembolization

Local tumor recurrence after thermal ablation of hepatocellular carcinoma (HCC) can impact on overall survival and are very closely linked to partial treatment of the primary lesion or to potential microvascular invasion or satellite micronodules located close to the main lesion. The diagnosis of these liver metastases close to the primary lesion on CT and MRI is difficult and their incidence, number and spread throughout the liver correlates with diameter of primary tumor. Tumor diameter is currently the key factor to predict whether or not thermal ablation of HCC will be complete or not. It has now been shown for monopolar radiofrequency ablation that this therapy alone is sufficient to effectively treat single HCCs < 3 cm in diameter provided that liver micrometastases are not present. If the HCC is >3 cm in size, multifocal or in the case of tumor recurrence, overall survival and recurrence-free survival results are better if monopolar radiofrequency ablation is combined with hepatic trans-arterial chemoembolization. The timing of this combination of treatments probably influences its effectiveness on tumor and tolerability and remains to be assessed.     

超声引导微波联合肝动脉化疗栓塞术治疗大肝癌的疗效评价

目的探讨超声引导微波联合肝动脉化疗栓塞术(transarterial chemoembolization,TACE)治疗大肝癌的疗效.方法 35例大肝癌采用超声引导微波联合TACE介入治疗(微波联合TACE组),并选择同期40例大肝癌采用单纯微波治疗(单纯微波治疗组)和31例采用单纯TACE治疗(单纯TACE治疗组)作为对照. 结果微波联合TACE治疗后30例AFP降至正常,3例明显下降;超声检查:80.0%(28/35)肿块缩小 ,20.0%(7/35)无变化, 肿块中心回声增强 , 周边呈低回声, 境界清晰, 其中可见钙化回声, 肿瘤内血流消失或减少.12例超声引导下活检,病理组织学结果显示: 肿瘤完全坏死9例,不完全坏死3例.30例CT检查, 76.7%(23/30)肿块缩小.微波联合TACE组缓解率(CR PR)88.6%(31/35),1、2、3、5年生存率分别为88.6%(31/35)、71.4%(25/35)、60.0%(21/35)、42.9%(15/35),均高于单纯微波组及单纯TACE组.无严重并发症发生. 结论超声引导微波联合TACE介入治疗大肝癌安全、有效、实用, 比单纯微波或TACE治疗效果好,为不能手术切除或其它治疗效果不佳的大肝癌提供了一种可行和有效的治疗方法.     

当归对兔肝纤维化肝癌介入治疗后肝纤维化的作用

目的 建立兔肝纤维化肝癌模型,观察当归对其行化疗栓塞(TACE)术后加重肝纤维化的预防作用,探讨当归预防肝纤维化的作用机制.方法 将55只新西兰大白兔随机表法分为对照组(n=10)、模型组(n=15)、介入组(n=15)和预防组(n=15).造模时给予腹腔注射纯CCl4剂量0.1 ml/kg,每周1次,共注射10周,同时给予5%的乙醇饮水,在第10周末于肝左叶种植VX2瘤.其中模型组:在第12周末经肝动脉注入生理盐水2ml;介入组:在行TACE术时注入平阳霉素1mg+碘油0.2ml;预防组:在行TACE术时注入平阳霉素1mg+碘油0.2ml+当归注射液6ml/kg.对照组:以相同剂量生理盐水注射.各组于第16周末检测透明质酸酶(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(CⅣ),并进行肝组织苏木素咿红(HE)染色、胶原纤维(VG)染色和转化生长因子(TGF)-β1免疫组织化学染色.结果 模型组(7/10)和预防组(6/10)的肝纤维化病理分期主要处于肝纤维化Ⅱ期(P>0.05),介入组(7/9)主要处于肝纤维化Ⅲ期,与模型组(3/10)和预防组(4/10)分期比较差异有统计学意义(P<0.05);模型组、介入组和预防组血清HA、LN、PCⅢ和CⅣ明显高于对照组(P<0.05),预防组低于介入组(P<0.05),与模型组比较差异无统计学意义(P>0.05);对照组肝组织TGF-β1呈阴性表达,介入组肝组织TGF-β1表达明显增强,模型组和预防组TGF-β1表达较介入组减少.结论 用CCl4诱发兔肝纤维化后并种植VX2瘤,可以建立兔肝纤维化肝癌模型,行TACE术后可加重其肝纤维化的程度,当归对其有延缓作用,TGF-β1参与其调控机制.     

Local recurrence following complete radiologic response in patients treated with transarterial chemoembolization for hepatocellular carcinoma

PurposeThe purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsOne-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4–86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression.ResultsA total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51–2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P <0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57–2.67]; P<0.001), INR (HR: 0.13 [95% CI: 0.03–0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016).ConclusionA significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.     

肝动脉化疗栓塞术患者的多模式疼痛管理

目的评价多模式疼痛管理方案应用于肝动脉化疗栓塞术患者的效果。方法将166例肝动脉化疗栓塞术患者随机分为对照组80例和干预组86例,对照组采用传统疼痛管理策略,干预组采用多模式疼痛管理策略,包括建立医生、护士、药师及疼痛治疗师多学科团队,实施多模式镇痛知识宣教、超前非甾体抗炎药镇痛、局部浸润渗透、静脉自控镇痛泵、疼痛分级护理等措施。结果干预组术后24h内疼痛严重程度、不良反应(恶心呕吐、便秘腹胀)发生率及睡眠质量显著优于对照组(P0.05,P0.01)。结论多模式疼痛管理方案可有效控制肝动脉化疗栓塞术患者术后疼痛,有利于促进术后恢复。     

肝动脉栓塞化疗并发梗阻性黄疸的诊断与治疗

肝海绵状血管瘤是肝脏最常见的良性肿瘤,近年来接受肝动脉栓塞化疗的患者越来越多,相关的并发症、后遗症也随之增多,其中胆管损伤所致的梗阻性黄疸是严重的并发症之一.对于这类症状不典型的梗阻性黄疸有可能误诊为胆道恶性肿瘤,从而对后续处理带来难以预料的影响.同济大学附属同济医院收治2例肝动脉栓塞化疗治疗肝血管瘤后发生梗阻性黄疸患者,总结其诊断与治疗经验.     

原发性肝癌经肝动脉栓塞化疗术后再行肝切除的临床观察

１９８７年１月至１９９２年１２月，作者共为４８例经肝动脉栓塞化疗（ＨＡＣＥ）后肿瘤缩小的肝癌患者施行了肝切除术。全组无手术死亡。术后１、２、３年生存率分别为８４．６％、５７．２％和４４．９％。已有２例生存时间超过５年。本文对原发性肝癌（ＰＨＣ）经ＨＡＣＥ后再行切除的临床意义以及ＨＡＣＥ后再作肝切除的手术时机问题进行了讨论。     

C臂CT扫描用于TACE治疗肝细胞癌

目的探索C臂CT(CCT)扫描在TACE治疗肝细胞癌中的价值。方法对80例接受TACE治疗的肝细胞癌患者行CCT扫描。观察患者CCT图像检出肝内病灶的情况,并与DSA及治疗前其他影像学检查的检出情况进行比较;观察CCT图像对病灶异常供血动脉的显示情况,评价其对于TACE操作的指导作用。结果 80例患者中,CCT扫描检出病灶139个,其中4例患者较64排螺旋CT扫描共多检出5个病灶,2例患者较常规DSA检查共多检出2个病灶。TACE治疗前,77例患者CCT扫描显示131个病灶供血动脉清晰满意,其中28例(28/77,36.36%)为微导管超选择插管治疗提供了直接的帮助;发现4例患者肝癌病灶异常供血动脉,1例病灶供血动脉走行异常显示清楚。结论在应用TACE治疗肝细胞癌过程中,CCT扫描有助于检出肝内病灶、显示病灶供血动脉和动脉异常走行,对TACE操作具有非常重要的价值。     

肝动脉灌注化疗与经动脉化疗栓塞/栓塞治疗不可切除肝细胞癌疗效与安全性系统评价和Meta分析

背景与目的 肝细胞癌（HCC）是常见的恶性肿瘤之一。经动脉化疗栓塞（TACE）和经动脉栓塞（TAE）是不可切除HCC的常见治疗选择。近年来,肝动脉灌注化疗（HAIC）已用于治疗晚期HCC,并且取得了良好的治疗效果。但是,很少有研究直接将HAIC与TACE/TAE进行比较。因此,本研究旨在评估HAIC与TACE/TAE治疗不可切除HCC的疗效和安全性。方法 检索PubMed、OvidSP、Cochrane Library、Web of Science、万方数据库、中国知网及维普中文期刊数据库中截至2021年8月14日发表的有关HAIC和TACE/TAE治疗不可切除HCC的文献;提取总生存期（OS）,无病生存期（PFS）,客观反应率（ORR）,疾病控制率（DCR）和不良事件等结局指标的相关数据,用Review Manager 5.4软件进行Meta分析。结果 最终共纳入5篇文献。Meta分析结果显示,HAIC组在OS（HR=0.39,95% CI=0.18~0.86,P= 0.02）,ORR（RR=3.82,95% CI=2.41~6.04,P<0.000 01）和DCR（RR=1.52,95% CI=1.12~2.05,P=0.006）方面优于TACE/TAE组。并且,敏感度分析排除可能的异质性来源后,结果仍一致。HAIC组与TACE/TAE组之间PFS差异无统计学意义（HR=0.34,95% CI =0.11~1.04,P =0.06）,但排除可能的异质性来源后,HAIC组的PFS优于TACE/TAE组（HR=0.56,95% CI=0.43~0.73,P<0.000 1）。对于任何等级的不良事件,HAIC组发生血小板减少症（RR=1.59,95% CI=1.04~2.44,P=0.03）和腹泻（RR=4.57,95% CI=2.01~10.37,P=0.003）的风险高于TACE/TAE组,而发生丙氨酸氨基转移酶升高（RR=0.57,95% CI=0.35~0.92,P=0.02）、高胆红素血症（RR=0.37,95% CI=0.26~0.53,P<0.000 01）的风险低于TACE/TAE组;对于3~4级不良事件,HAIC组发生白细胞减少症的风险高于TACE/TAE组（RR=6.32,95% CI=1.71~23.28,P=0.006）;无论是3~4级或任何等级的不良事件,HAIC组发生发热的风险低于TACE/TAE组（P<0.05）;两组的贫血、中性粒细胞减少症、低蛋白血症、腹痛、呕吐等发生情况差异均无统计学意义（均P>0.05）。结论 与TACE/TAE相比,HAIC具有更好的肿瘤反应、更长的生存期以及可接受的不良反应,是不可切除HCC患者更好的治疗选择。     

兔膀胱5—氟尿嘧啶微球化学栓塞的实验研究

采用以５－氟尿嘧啶、人血清白蛋白为材料制成的微球，注入实验兔髂内动脉、测定髂内动注入微球后的血药浓度及膀胱组织药物浓度。同时对５只兔以同法注入等量常规５－Ｆｕ作为对照。结果：制成的微球直径３５－７５μｍ，含药量均为１０％。     

射频消融联合肝动脉化疗栓塞治疗肝癌合并动静脉分流

目的:探讨射频消融(RFA)联合肝动脉化疗栓塞(TACE)对肝癌合并动静脉分流(AVS)的治疗效果.方法:回顾性分析45例肝癌伴AVS患者临床资料,患者术前均经血管造影或增强CT明确动静脉分流,先行RFA,2周后行TACE,术后1个月后复查腹部增强CT及AFP,了解分流道封闭及肿瘤消融情况.结果:手术均获成功,术后总AVS消失率及封闭有效率分别为28.9％,77.8％,总肿瘤完全消融率及有效率分别为68.9％,80.0％; 37例AFP阳性患者,28例转阴(75.7％),9例下降(24.3％);未发生严重并发症.结论:RFA联合TACE治疗的肝癌合并AVS安全、有效.     

经动脉化疗栓塞与经动脉灌注化疗序贯栓塞治疗肝癌对比分析

目的评价TACE与经动脉灌注化疗序贯栓塞(TAI+TAE)治疗不可切除肝细胞癌(HCC)所致急性肝功能损伤及远期疗效的差异。方法回顾性分析195例接受动脉血管介入治疗患者的临床及介入治疗资料;其中TACE组111例,共接受介入治疗277例次,TAI+TAE组84例,共接受介入治疗250例次。结果两组间患者性别、年龄、合并肝炎、病灶类型、远处转移、门静脉癌栓、基线腹腔积液、介入治疗前肝功能Child-Pugh分级及血清甲胎蛋白(AFP)差异均无统计学意义(P均0.05)。介入治疗前,TACE组与TAI+TAE组肝功能生化指标[血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、前白蛋白(PALB)、白蛋白(ALB)]差异均无统计学意义(P均0.05)。两组患者介入治疗后ALT、AST、TBIL均较治疗前明显升高(P均0.001),PALB、ALB明显减低(P均0.001)。介入治疗前后肝功能生化指标变化值(ΔALT、ΔAST、ΔTBIL、ΔPALB、ΔALB)中,ΔALT、ΔAST、ΔPALB两组间差异有统计学意义(P均0.05),ΔTBIL、ΔALB两组间差异无统计学意义(P均0.05)。TACE组患者1、2、3年累积生存率(53.20%、33.30%、23.40%)高于TAI+TAE组(42.90%、22.60%、16.70%),差异有统计学意义(P=0.048)。结论 TACE较TAI+TAE所致急性肝功能损伤程度轻微,患者生存期更长,更有利于延缓肝硬化进展,改善远期疗效。     

Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma involving microvascular invasion

Background

Microvascular invasion (MVI) has recently been reported to be an independent prognostic factor in patients with hepatocellular carcinoma (HCC). This study compared the outcomes of adjuvant transarterial chemoembolization (A-TACE) after hepatic resection (HR) in patients with HCC involving MVI.

Intrarenal gas abscess

Intrarenal abscess owing to gas-forming gram-negative bacteria is rare. Female patients and diabetics, or those with urinary calculi or obstructive uropathic conditions commonly are affected. We report on a nondiabetic man who was infected with Pseudomonas aeruginosa. Initial medical management and subsequent partial nephrectomy offered cure.     

Isolated tuberculous hepatic abscess

Tuberculous hepatic abscess occurs rarely, most of these being associated with tuberculosis at other sites. Only 11 reports of isolated tuberculous hepatic abscess have been made in the English literature. A further case of isolated tuberculous hepatic abscess is reported with particular emphasis on the difficulty that may be encountered in reaching the correct diagnosis.