细胞因子诱导杀伤细胞灌注治疗原发性肝癌临床应用

目的 探讨肝动脉细胞因子诱导杀伤细胞(CIK细胞)灌注 超液化碘油栓塞治疗原发性肝癌的疗效.方法 采用超选择段性肝动脉灌注CIK细胞 超液化碘油栓塞治疗原发性肝癌及经皮肝穿刺瘤体内多点注射CIK细胞共38例(研究组);将同期采用常规剂量经肝动脉段性化疗栓塞(C-TACE)联合经皮肝瘤体内注入无水乙醇80例(双介入组);单纯经皮肝动脉常规剂量C-TACE 134例(单纯组)相比较.结果 研究组、双介入组和单纯组近期显效率分别为76.3%、41.3%和14.9%,研究组的AFP降至正常及明显下降率则显著高于双介入组和单纯组,3组血清A肿变化差异有统计学意义(P＜0.01).结论 采用超选择段性肝动脉灌注CIK细胞 超液化碘油栓塞综合治疗原发性肝癌,可以提高患者的免疫功能、生存质量,延长带瘤生存期.     

经皮穿刺无水乙醇消融术治疗原发性肝癌及肝外转移灶的临床观察

目的 探讨经皮穿刺无水乙醇消融术在原发性肝癌(PHC)及肝外转移灶治疗中的应用及意义.方法 回顾性分析67例PHC及部分伴有肺转移、腹腔淋巴结转移的患者临床资料.67例中,肝内病灶83个;肺转移灶53个(31例);腹腔淋巴结转移22个(16例).肝内病灶采用经皮肝动脉化疗栓塞术和(或)无水乙醇消融术治疗,肝外转移病灶采用单纯无水乙醇消融术,术后3个月复查CT平扫或增强以评价疗效.结果 全组肿瘤病灶有效率65.8%,肝内病灶有效率67.5%,肺转移灶有效率60.4%,腹腔淋巴结转移灶有效率72.7%,半年及1年生存率分别为83.5%和59.7%.结论 无水乙醇消融术在PHC及肝外转移灶的治疗中具有较好的应用价值.     

介入栓塞术和平阳霉素腔内注射治疗颌面部血管畸形

目的探讨选择性动脉栓塞和经皮注射平阳霉素治疗颌面部蔓状血管瘤的治疗效果。方法对颌面部蔓状血管瘤9例,经皮股动脉穿刺插管行选择性左、右颈外动脉造影明确诊断后,再行选择性动脉栓塞治疗。术后1、7d和半个月经皮向瘤体内注射平阳霉素,每次8mg。结果9例患者超选择插管和栓塞均取得成功,栓塞术后瘤体均有明显缩小、变硬,所有患者经随访7～29个月未见局部肿块复发。全部病例栓塞术后未见严重并发症。结论颈外动脉栓塞术结合经皮注射平阳霉素治疗颌面部蔓状血管瘤效果显著,是一种安全有效的治疗措施。     

经导管肝动脉化疗栓塞术结合经皮穿刺酒精注射治疗原发性肝癌的26例报告

目的：探讨经导管肝动脉化疗栓塞术结合经皮穿刺酒精注射治疗原发性肝癌的临床价值：方法：26例患者均先行TACE治疗，术后两周再行PEI治疗。结果：所有的患者三个月内均生存，肿块变小，边界更清楚。结论：TACE结合PEI术是非手术治疗原发性肝癌的较佳选择。     

结直肠癌合并肝脏转移的介入治疗

目的 探讨结直肠癌合并肝脏转移经导管动脉灌注及栓塞治疗的价值. 资料与方法 35例结直肠癌合并肝脏转移患者,行结直肠肿瘤供血动脉插管灌注化疗和/或栓塞术,同时对肝脏转移瘤行动脉插管灌注化疗栓塞术.其中介入治疗后1～3个月23例患者行结直肠肿瘤外科手术切除,6例肝脏单发转移癌行外科手术切除.结果 所有病例术后1～3个月随访复查CT,结直肠肿块显效11例,有效22例,无效2例;肝脏转移灶显效20例,有效12例,无效3例.23例外科手术切除肿瘤顺利,术中出血300～1500 ml,术后病理提示肿瘤坏死明显,可见纤维组织增生和炎性细胞浸润.6例肝脏转移瘤外科切除,术后病理提示1例未见癌细胞,其余5例可见少量癌细胞,坏死明显.结论 经导管动脉灌注及栓塞治疗结直肠癌合并肝脏转移疗效显著,值得推广.     

经皮穿刺肝动脉灌注化疗及栓塞术治疗原发性肝癌(附54例临床观察)

经皮穿刺肝动脉灌注化疗及栓塞术治疗原发性肝癌（附５４例临床观察）江苏省徐州市第三人民医院肿瘤科薛红健,曹秀生（徐州２２１００５）经皮穿刺肝动脉灌注化疗（ＴＡＩ）及栓塞术（ＴＡＥ）,对于不能手术的中、晚期肝癌有较高的疗效,甚至被推荐为肝癌非手术疗法中的...     

合并肝癌的门脉高压患者TIPS治疗适应证及临床结果

目的 评价肝癌患者行经颈静脉肝内门腔静脉分流术（TIPS）的安全性和可行性。方法 886例肝硬化门脉高压静脉曲张破裂出血行TIPS术病例中，36例术前伴有肝癌（4．06％），ChildA 级9例，B级11例，C级16例。31例患者术前已行至少2次肝动脉化疗灌注栓塞（TACE），癌肿已被较好控制。5例患者为急诊TIPS。肝内肿块经由增强CT确认不在穿刺分流道33例，3例居常规穿刺分流道。前者采用经典TIPS方法，后者采用经腔静脉避绕法向门静脉分支穿刺。结果 36例合并肝癌的TIPS分流道建立均获成功。静脉曲张出血及腹水得到的有效地控制。27例肝癌患者用TACE及经皮无水乙醇病灶注射已有效控制，平均术后生存率4．5年。结论 肝硬化门脉高压静脉曲张破裂出血，同时伴原发性肝癌患者TIPS是一种安全有效的方法。     

肝动脉灌注细胞因子诱导杀伤细胞联合超液化碘油栓塞介入治疗原发性肝癌

目的 探讨肝动脉灌注细胞因子诱导杀伤(CIK)细胞联合超液化碘油(UFL)栓塞介入治疗原发性肝癌(HCC)的临床价值.方法 采用Seldinger's技术,经肝动脉灌注CIK细胞后用UFL栓塞肿瘤供血动脉治疗HCC 38例(研究组),并与同期经皮肝动脉灌注栓塞化疗(TACE)联合经皮瘤体注射无水乙醇(PEI)双介入治疗HCC 62例(双介入组)进行比较.结果 研究组与双介入组治疗前后CD3、4、CD8变化的组间比较有差异(P＜0.05);AFP的下降率,0.5,1和2年生存率,2组间差异有显著性(P＜0.05);2组近期疗效组间比较无差异性(P＞0.95).结论 肝动脉灌注CIK细胞联合UFL栓塞介入治疗HCC,可以延长患者的带瘤生存期.     

双重介入治疗小肝癌的临床研究

目的 :评价综合应用化疗栓塞和瘤内无水酒精注射术治疗小肝癌的临床效果。方法 :2 4例患者 ,其中原发性肝癌 2 3例 (包括外科手术后复发性肝癌 3例 ) ,转移性肝癌 1例 ,瘤体平均大小为 4.1cm× 3 .7cm。先行超选择性肝动脉内化疗栓塞 ,术后 1周内再于瘤体内注射无水酒精。间隔 3～ 4周重复上述治疗 ,每例行综合介入治疗 2～ 3次。结果 :2 4例患者中 2 0例病变区有明显碘油沉积 ,综合介入治疗后无严重并发症发生。随访 8～ 2 6个月无死亡病例 ,瘤体明显缩小者 2 1例 (占 87.0 % ) ,16/17例患者AFP降低明显 ,14例经 2～ 3次介入治疗后病灶稳定。 3例介入治疗后手术病理切片示肿瘤组织基本坏死 ,瘤体周围包膜形成。结论 :综合应用化疗栓塞术和瘤内无水酒精注射术是治疗小肝癌安全有效的方法     

肾上腺转移癌介入化疗栓塞的探讨

目的探讨对肾上腺转移癌采用介入方法进行治疗的方法和临床疗效。方法对54例肾上腺转移癌患者行动脉插管灌注及栓塞治疗。结果1例未找到肾上腺供血动脉,53例肾上腺转移癌患者行76次灌注及栓塞治疗,技术成功率为98．1％,栓塞后临床症状改善率100％,术后3个月,75,4％患者瘤灶内碘油仍沉积良好;并发症发生率为1．88％。结论采用介入方法对肾上腺转移癌行灌注及栓塞治疗安全、有效,值得临床推广应用。     

Effect of preoperative radiological treatment of hepatocellular carcinoma before liver transplantation: A retrospective study

Purpose: To assess the results of radiological treatment of patients with hepatocellular carcinoma (HCC) performed before orthotopic liver transplantation (OLT). Methods: Sixty-two transplanted patients with a total of 89 HCC nodules were studied; 50 lesions in 38 patients had been treated prior to OLT with transcatheter arterial chemoembolization (TACE; n= 29), percutaneous ethanol injection (PEI; n= 10), or combined therapy (TACE + PEI; n= 11). The induced necrosis was pathologically evaluated. The recurrence rate after OLT in the treated group of patients (n= 38) was compared with that in the non-treated group (n= 24). Results: After TACE, necrosis was complete in 7 of 29 lesions (24.1%), partial in 11 of 29 (37.9%), and absent in 11 of 29 (37.9%). After PEI, necrosis was complete in 8 of 10 lesions (80%), and partial in 2 of 10 (20%). Using combined therapy, necrosis was complete in 11 of 11 lesions (100%). Four of 24 untreated and 4 of 38 treated patients did not survive OLT from causes not related to the HCC; 3 of 20 non-treated patients (15%) and 4 of 34 treated patients (11.8%) had post-OLT recurrence (these last four patients had undergone only TACE and did not have tumor necrosis at pathological examination). Conclusion: TACE of HCC prior to OLT had no influence on the recurrence rate. PEI and combined therapy (TACE + PEI) may be recommended in patients awaiting OLT.     

Percutaneous Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts

Purpose To assess the role of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma (HCC) and transjugular intrahepatic portosystemic shunts (TIPS). Methods Between January 1999 and September 2004, 6 patients with HCC and TIPS were treated with either TACE (n = 3) or TACE in combination with PEI (n = 3). One patient had a known advanced, untreated HCC prior to TIPS. In the remaining 5 patients HCC was diagnosed 14, 17, 51, 69, and 76 months respectively after elective TIPS. TACE was performed using a mixture of 30–60 mg of epirubicin and 10 ml of lipiodol following superselective catheterization of tumor-feeding vessels. PEI was performed under CT guidance. Methods The mean follow-up time after treatment of HCC was 26.2 months (range 7–46 months). During follow-up, all patients were free of rebleeding. Two patients died 7 and 38 months after one session of TACE and PEI (77 months after TIPS) and three sessions of TACE (91 months after TIPS), respectively. The cause of death was liver failure (Child-Pugh class C) and peritonitis, respectively. A third patient underwent liver transplantation 24 months after TIPS and several sessions of TACE. In the remaining 3 patients, the HCC is well controlled 13, 30, and 46 months after repetitive percutaneous treatment without signs of hepatic deterioration or metastasis. Conclusion Transcatheter arterial superselective chemoembolization and percutaneous ethanol injection seems to be beneficial even in HCC patients treated with TIPS, provided that the liver function is adequate.     

比较肝动脉化疗栓塞联合经皮乙醇注射与联合冷循环微波刀治疗原发性肝癌的疗效

目的比较肝动脉化疗栓塞（TACE）联合经皮乙醇注射（PEI）与TACE联合冷循环微波刀术（PMCT）治疗原发性肝癌的效果。 方法150例患者接受TACE联合PEI,160例患者接受TACE联合PMCT治疗。术后4周复查动态增强CT,观察疗效。 结果TACE+PEI或TACE+PMCT后1个月,肿瘤一次消融率分别为70.00%和87.67%,TACE+PMCT组的疗效要优于TACE+PEI组（P<0.05）。 结论TACE+PMCT是原发性肝癌的有效治疗方法,是单纯TACE疗效不佳者的理想选择。     

Radiofrequency thermal ablation with expandable needle of focal liver malignancies: complication report

The aim of this study was to describe type and rate of complications in a series of patients with liver tumors treated by the radiofrequency (RF) expandable system. A total of 166 patients, 114 with hepatocellular carcinoma (HCC; 92 small HCC, 22 large) and 52 with liver metastasis, were treated by the percutaneous RF expandable system. In large HCCs, RF ablation was performed after tumor ischemia (TAE or balloon stop flow of the hepatic artery). Major complications were those that delayed hospital discharge, with or without additional medical procedures or treatments. Minor complications did not require an additional hospital stay. No deaths occurred. Among 151 patients followed, there were 7 (4.6%) early major complications—severe pain with session interruption in 3 cases, capsular necrosis in 1 case, 1 abdominal wall necrosis, 1 dorsal burning, 1 peritoneal hemorrhage—and 3 (1.9%) delayed major complications: sterile fluid collection at the site of the treated tumor in 2 cases and cutaneous seeding in 1 case. There were 49 (32.5%) minor complications. The complication rate is similar to that observed after percutaneous alcohol injection (PEI). With the cooled system, the complication rate is seemingly lower but that may well be due to a different definition of major complications. The seeding rate after expandable system ablation is lower than after PEI. It is the same as or lower than that in other series of patients treated by the cooled system.     

TACE联合经皮无水乙醇注射在原发性肝癌治疗中的价值

目的：评价肝动脉灌注化疗栓塞（TACE）、经皮无水乙醇注射联合治疗原发性肝癌的价值。方法：应用TACE单独治疗原发性肝癌64例,TACE与PEI联合治疗原发性肝癌21例。术后对比12个月,18个月,24个月生存期,评价TACE与PEI联合治疗的价值。结果：TACE＋PEI组肿瘤缩小有效率为85．71％,TACE组肿瘤缩小有效率68．75％。TACE＋PEI组1、2．3年生存率分别为97．2％、72．1％、39．6％。TACE组患者1、2、3年生存率分别为83．6％、34．3％、16．2％。结论：TACE联合PEI可以提高原发性肝癌的疗效。     

经动脉灌注化疗栓塞联合经皮无水乙醇注射治疗原发性肝癌临床研究

目的观察比较肝动脉灌注化疗栓塞(TACE)联合经皮无水乙醇注射(PEI)与单纯TACE治疗肝癌的疗效。方法64例原发性肝癌患者分成两组,32例给予TACE联合PEI治疗,32例给予单纯TACE治疗。两组患者年龄、性别、临床资料具可比性;治疗过程中观察患者肿瘤大小及AFP变化;随防1、2、3年生存期及中位生存期。结果联合治疗组和TACE组肿瘤缩小总有效率分别为84.4%、62.7%,联合组和TACE组AFP转阴率分别为77.4%、50.0%;联合治疗组患者1、2和3年生存率分别为96.9%、71.9%和37.5%,中位生存期34.5个月;TACE组患者1、2和3年生存率分别为81.3%、31.3%和12.5%,中位生存期19.5个月。与联合治疗组相比TACE组肿瘤缩小总有效率,AFP转阴率,1、2、3年生存率及中位生存期差异有统计学意义。结论TACE联合PEI治疗原发性肝癌,可提高临床治疗效果,延长患者生存期。     

正电子发射计算机体层成像-CT在监测甲胎蛋白阳性肝癌介入治疗后残留病灶和肝外转移病灶中的作用

目的 探讨PET-CT在甲胎蛋白(AFP)阳性肝细胞癌介入术后监测碘油沉积区内残留病灶及肝外转移病灶的价值.方法 选取20例经病理组织学确诊的原发性肝细胞癌患者,在介入治疗后AFP降至正常,随访发现AFP异常升高,常规行上腹部CT、MR检查未能明确碘油沉积区内残留病灶及肝外转移病灶或发现可疑影像学表现但不能确定其性质者行PET-CT扫描,依据PET-CT的结果进一步治疗,并用影像检查及AFP检查监测其治疗效果.结果 20例患者中,常规上腹部影像检查未发现肝外转移病灶而经PET-CT检出者10例,包括邻近腹壁转移4例,肺内直径约1 cm的孤立转移3例,肠系膜转移2例,手术切口转移1例;CT或MRI发现原碘油沉积区内有碘油沉积不均匀区域,但运用包括血管造影在内的检查方法均不能确定其是否为残留病灶而经PET-CT确诊者8例;CT扫描发现肝门区及腹膜后直径<1.5 cm的淋巴结但不能明确是否为淋巴结转移,经PET-CT明确者2例.采用外科手术及介入方法对检出病灶进一步治疗,除2例淋巴结转移患者AFP仍略高于正常外,其余患者AFP均逐渐降至正常,影像检查亦提示病灶治疗效果良好.结论 PET-CT对于AFP水平异常升高而常规影像检查未能发现碘油沉积区残留病灶及肝外转移病灶或无法确定可疑影像表现性质的肝细胞癌患者是一种有效的检查方法.     

Primary adrenocortical carcinoma: CT evaluation with clinical correlation

Clinical histories and CT findings were reviewed in 38 patients with primary adrenocortical carcinomas. The primary tumors exhibited central areas of low attenuation representing tumor necrosis (n = 26), irregular contrast enhancement (n = 16), detectable calcification (n = 9), and a thin, capsulelike rim surrounding the tumor (n = 7). Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5). In eight of nine cases of liver metastasis the primary tumor arose in the left adrenal gland. Evidence of endocrinopathy was present in each of nine patients with lesions 6 cm or less in diameter, but in only two of seven adults with lesions exceeding 15 cm in diameter. We conclude that, contrary to established concepts, adrenocortical carcinoma may present as a smooth, homogeneous, functioning mass 6 cm or less in diameter on CT.     

Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications

The current review provides an overview on the palliative, combined, neoadjuvant, bridging, and symptomatic indications of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). It is based on an analysis of the current literature and the experience of the authors on the topic. Chemoembolization combines the infusion of chemotherapeutic drugs with particle embolization. Tumor ischemia raises the drug concentration compared to infusion alone, extends the retention of the chemotherapeutic agent and reduces systemic toxicity. Palliatively, TACE is performed to control symptoms and prolong survival in HCC patients; in some indications TACE allows a local tumor control of 18-63%. For combined indications, excellent results were achieved by combined therapies, such as percutaneous ethanol injection (PEI)/TACE, radiofrequency ablation (RF)/TACE, and laser-induced thermotherapy (LITT)/TACE. As a neoadjuvant therapy prior to liver resection TACE showed 70% tumor control. Though debatable, TACE still plays a role as a bridging tool before liver transplantation. Symptomatic indication of TACE in ruptured HCC showed 83-100% control of bleeding but survival was poor. Thus, TACE represents an important therapeutic tool against HCC in general in addition to its special role in cases of unresectable HCC.     

Bildgesteuerte Interventionen bei Lebertumoren

Despite remarkable progress of diagnostic imaging and operative procedures radiological interventions play a major role in diagnostic and therapeutic liver tumor interventions. Percutaneous biopsies should be taken by 16-20 g needles. CT control is indicated in cases when sonographically guidance is impossible or of risk. MR guidance is still seldom. Accuracy rates of percutaneous biopsies are high (>90%), and safe with complications (e.g. bleeding) of less than 1%. Palliative percutaneous therapeutic interventions of primary or secondary liver malignancies are thermoablative procedures of laser (LITT), cryoablation or radio-frequency, percutaneous ethanol injection (PEI) and intraarterial chemotherapy via port system or repetitive catheterisation with perfusion or embolization (TACE). For metastatic disease with less than five tumors of less than 4 cm LITT and PEI are recommended, more advanced cases should be treated by intra-arterial port system chemotherapy. For HCC best results are shown for PEI, in cases of UICC stage IIIB and IV only TACE is adequate.