同期手术切除治疗结肠癌伴肝转移31例

目的探讨对结肠癌伴肝转移患者行同期手术切除的疗效。方法回顾分析2005年10月—2010年10月收治的31例结肠癌伴肝转移患者行同期手术切除的临床资料和随访结果。结果本组结肠癌伴肝转移患者术后1、2、3、5年生存率分别为80.65%、64.52%、35.48%、22.58%,并发症发生率为16.13%(5/31),围术期无死亡病例。结论结肠癌伴肝转移行同期手术切除是安全有效的,能够明显提高患者的生存率及生存质量。     

胰腺囊性肿瘤15例分析

作者报告了该院３０年来经手术及病理证实的１５例胰腺囊性肿瘤，男５例，女１０例，其中囊腺瘤３例，囊腺瘤恶变３例，囊朱癌９例，肿瘤位于胰尾部８例，体尾部６例，胰头部１例。２例有肝转移，１例肿瘤浸润胃后壁，根治生切除１０例，单纯肿瘤切除、肿瘤切除加肝转移瘤局部切除、囊腺癌内外引流、肿瘤活检各１例。术后死亡１例。随访１２例，１０例效果满意，２例囊腺癌行内外引流者术后６、９个月死亡。文中讨论了胰腺囊性肿瘤的     

肝动脉化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的疗效分析

目的 评价经肝动脉灌注化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的临床效果.方法 对21例胰腺神经内分泌肿瘤肝转移患者,共进行77例次经动脉介入治疗,其中单纯经动脉灌注化疗54例次,肝动脉化疗栓塞23例次.分析临床疗效、影像学评价、无进展生存期(PFS)、总生存期(OS)和并发症.结果 所有患者均顺利完成介入治疗,无严重并发症发生.临床反应为显效10例、有效6例、无效5例,总有效率76.2%(16/21);影像学疗效评价有效11例、稳定4例、疾病进展6例;PFS(15.0 ± 10.9)个月,OS(31.2 ± 17.4)个月.结论 经肝动脉灌注化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移安全有效,可作为不能手术切除患者的一线治疗方法.     

CT对食管癌的分期及手术切除性的估价(附20例分析)

ＣＴ对食管癌的分期及手术切除性的估价（附２０例分析）都继成路德成李炳秀杨丽贵姜辉马槐食管癌是消化道常见肿瘤，以往的检查难以判断肿瘤和相邻组织的关系，有无转移及能否手术切除。本文通过对２０例治疗后病人的分析，初步探讨了食管癌手术无法切除的ＣＴ标准。１资...     

肝内胆管-消化道搭桥术治疗阻塞性黄疸

自 1 986年我们对晚期肿瘤等引起的阻塞性黄疸 ,术中不能切除肿瘤也不能行胆 -肠吻合的病人 ,采用肝内胆管 -消化道搭桥术治疗阻塞性黄音。取得了一定的临床经验 ,现总结如下。1　临床资料本组病人共 2 0例 ,男 1 2例 ,女 8例 ,年龄 39岁～ 68岁 ,1 6例为胆囊、胆管癌晚期 ,3例为消化道恶性肿瘤肝门、肝转移引起的阻塞性黄疸。 1例为硬化性胆道炎 (肝外胆管已完全闭缩、肝内胆管狭窄 )。术中取右肝 - 1 2指肠搭桥 1 1例 ,左肝 - 1 2指肠搭桥 7例 ,左肝 -胃搭桥 2例。术中对肿瘤不能切除 ,特别是肿瘤已广泛浸犯肝门 ,肝脏有转移的病人 ,术中…     

3.0TMRI多期增强扫描术前评估胰腺癌可切除性

目的：探讨3.0T MRI多期增强扫描在胰腺癌可切除性评估中的价值。方法对行3.0T MRI 多期增强扫描并经手术病理证实为胰腺癌的38例患者,分析 MRI图像,观察肿瘤对周围血管及邻近器官侵犯、远处转移和腹膜后淋巴结转移情况,作出能否切除的术前评估;并与手术结果比较。结果38例胰腺癌中,32例位于胰头,4例位于胰体,2例位于胰尾。19例术前 MRI认为肿瘤可切除,实际成功切除17例,可切除的阳性预测值为89.5%。另外19例术前MRI认为无法切除,实际手术探查后发现均无法切除。不可手术切除的主要原因包括胰周主要血管受侵、肝转移、淋巴结转移及腹膜种植转移。结论 MRI多期增强在胰腺癌可切除性评估中具有重要价值,可为临床选择合适的治疗方案提供参考依据。     

CT对食管癌的分期及手术切除性的评估（附24例分析）

食管癌是消化道发病率较高的肿瘤，依靠食道点片及胃镜检查难以判断肿瘤和邻近组织的关系，有无转移及能否手术切除，本资料通过对24例治疗后病人的分析，初步探讨了食管癌手术切除的CT标准，     

消化道肿瘤切除术后患者营养风险筛查和影响因素的临床研究

目的：对患者消化道肿瘤切除术后的营养风险及影响因素进行评估，并且对血浆ghrelin的临床意义进行探究。方法选择2009年1月～2012年12月进行消化道肿瘤切除手术的患者150例作为研究对象，随机分成实验组和对照组，每组各75例。使用营养筛查的方法对其进行评估，检查他们的血浆ghrelin水平，分析临床的特征。结果被选入研究的患者营养风险的风险率为80.23％。与营养风险相关的因素有：手术的方式、手术的部位、合并用药、白蛋白、血红蛋白等。而性别、病程、饮酒以及吸烟等因素则与营养风险无关。结论经过研究发现，NRS2002在发现消化道肿瘤切除术后患者的营养风险中发挥着重要的作用，同时，血浆ghrelin水平也有利于对患者手术后的营养状况进行评估。     

结合影像特征对结直肠癌同时性肝转移同期及二期切除术患者的预后分析

目的:探讨与结直肠癌同时性肝转移(sCRLM)患者术后生存时间相关的影像学特征及临床危险因素,进而指导临床治疗决策的制定.方法:通过纳入69例采用一期或二期切除的结直肠癌同时性肝转移患者,提取临床及影像相关因素并对患者进行随访,获得生存时间进行分析.结果:最终有57例患者获得了有效随访信息.一期与二期切除两种手术方式在...     

联合切除腹腔多脏器肿瘤36例

多脏器肿瘤联合切除、消化道重建是治疗腹腔多脏器原发肿瘤或单发肿瘤浸润邻近脏器的首选根治术式。1986～2001年，我院共行多脏器肿瘤联合切除36例，占同期手术的2．8％。     

Evaluation of hepatic tumors by contrast ultrasonography with carbon dioxide]

For evaluating hepatic tumors, ultrasonograms using carbon dioxide by arterial injection (CO2US) was performed in 37 patients, including 28 hepatocellular carcinomas, 11 hepatic metastases, and 3 hepatic hemangiomas. Hepatic tumors were enhanced by CO2US and easily identified. CO2US of hepatic tumors were classified into six patients. Generally, on CO2US hepatocellular carcinomas were well enhanced, and hepatic metastases had ring-like enhancement. Hepatic hemangiomas showed peripheral patchy enhancement. In the patients with hepatocellular carcinoma, the primary tumors were better identified on CO2US than conventional sonography. The daughter nodules with hepatocellular carcinoma were also better demonstrated than other examinations. CO2US is helpful in evaluating and differentiating hepatic tumors.     

小肝癌栓塞化疗的效果观察

目的：探讨小肝癌经导管肝动脉注射碘油抗癌药栓塞化疗（ＴＯＣＥ）的疗效及影响预后的因素。材料与方法：小肝癌３０例,全部接受ＴＯＣＥ治疗后随访３￣５年以上,其中２４例单纯行ＴＯＣＥ治疗,作为Ａ组;另６例ＴＯＣＥ后４￣６周行手术切除,作为Ｂ组。两组分别统计和生存率和死亡原因。结果：Ａ组１、３、５年生存率分别为７９．３％、３７．５％和２２．２％;Ｂ组则为１００％、６６．７％和２５％。生存≥３年的患者主要死     

Localizing insulinomas with combined radiographic methods

Twenty-one patients with hyperinsulinism were studied to localize the source of the insulin production. Nineteen patients had pancreatic tumors and two patients studied after pancreatectomy had hepatic metastases. Of the 19 pancreatic tumors, 16 were identified by angiography. CT found six tumors in 14 patients studied while sonography correctly localized only three of 12 tumors. Neither CT nor sonography was positive in those patients with a negative arteriogram. Noninvasive imaging methods can localize large tumors and may be useful for detecting hepatic metastases. Angiography, however, remains the most accurate method for detecting smaller lesions.     

Computed tomography and sonographic findings of hepatic metastases from gastrointestinal stromal tumors after chemotherapy

OBJECTIVE: The purpose of this study was to evaluate the computed tomography (CT) and sonographic findings in patients with hepatic metastases from gastrointestinal stromal tumors (GISTs) after STI-571 treatment. METHODS: Computed tomography and sonographic findings of 8 lesions in 6 patients with hepatic metastases from GISTs that were treated with STI-571 were retrospectively analyzed. The change in size, attenuation, and echogenicity of the hepatic metastases from GISTs after STI-571 treatment was evaluated. RESULTS: After treatment with STI-571, the hepatic metastases were decreased in size and the attenuation of the hepatic metastases was homogeneously hypodense on CT. Sonography revealed the hepatic metastases to be centrally cystic with a thin wall (n = 4) or predominantly solid (n = 4) after STI-571 treatment. On color Doppler sonography, no blood flow was identified within the solid portion of the mass. CONCLUSION: After treatment with STI-571, although the hepatic metastases from GISTs exhibit a cystic appearance on CT, they may appear as solid masses on sonography.     

鼻咽癌肝转移超声诊断的价值

目的探讨二维及彩色多普勒超声诊断鼻咽癌肝转移的价值.材料与方法回顾性分析6例19个鼻咽癌肝转移病灶的二维及彩色多普勒声像图特征.结果鼻咽癌肝转移二维超声表现为以囊性为主的囊实混合性回声或囊肿样回声.囊壁多不规则增厚、囊内有分隔或囊壁上有乳头样结节样实性突起.5例为多发病灶.6例彩色多普勒均于瘤内或壁上引出动脉血流信号,其中5例为高速动脉血流(流速＞40cm/s)结论鼻咽癌肝转移表现以囊性为主的囊实混合性肿块或囊肿样回声,彩色多普勒在病灶内引出高速动脉血流信号为鼻咽癌肝转移与肝脏良性囊性病变的鉴别诊断提供了重要依据.     

胃肠道间质瘤肝转移灶的18F-FDG PET/CT显像特点

目的分析胃肠道间质瘤(GIST)肝转移灶¹⁸F-脱氧葡萄糖(FDG)PET/CT显像特点,以提高诊断准确性。方法回顾性分析2013年5月至2019年7月间在福建省肿瘤医院行¹⁸F-FDG PET/CT检查并确诊肝转移的33例GIST患者(男18例,女15例,年龄34~70岁)的临床和影像资料。患者均行¹⁸F-FDG PET/CT早期显像,另有9例后行延迟显像。对患者PET/CT图像行视觉分析,比较病灶与肝本底的放射性摄取,将转移灶分为高代谢、稍高代谢、等或低代谢;计算并比较GIST原发灶与肝转移灶的最大标准摄取值(SUVmax),另分析两者的关系。采用Wilcoxon秩和检验和Spearman秩相关分析数据。结果33例GIST的肝转移患者中,肝转移单发9例,多发24例,共104个病灶。104个肝转移病灶直径为0.8~14.6[2.2(1.5,3.9)]cm,SUVmax为1.4~21.5[3.6(2.4,5.7)]。94.2%(98/104)的病灶边界清楚;65.4%(68/104)的病灶密度均匀(其中2个囊性病灶),34.6%(36/104)的病灶密度不均匀,可见出血、囊变或坏死。PET图像视觉分析中,38.4%(40/104)的病灶为高代谢,26.0%(27/104)的病灶为稍高代谢,35.6%(37/104)的病灶为等或低代谢。24例多发肝转移患者中,79.2%(19/24)同时存在不同代谢水平的病灶。67个代谢增高病灶中,34.3%(23/67)呈均匀代谢,其中13个病灶直径<2.0 cm;65.7%(44/67)呈不均匀代谢,其中36个病灶直径≥2.0 cm。15例GIST同时性肝转移患者的原发灶与肝转移灶SUVmax[9.2(6.8,14.5)与3.8(2.1,6.0)]间呈中等程度相关(rs=0.556,P<0.01);两者差异有统计学意义(z=-5.098,P<0.01)。延迟显像中,13/15的等或低代谢肝转移病灶转为稍高代谢。结论GIST肝转移¹⁸F-FDG PET/CT显像通常边界清楚,常合并囊变、出血或坏死;代谢表现多样;延迟显像有助于低代谢GIST肝转移病灶的诊断。     

探讨化学消融在肝周转移瘤治疗中的价值

目的 探讨化学消融术在肝周转移瘤治疗中的临床应用价值.方法 对77例肝周转移瘤施行化学消融治疗,比较肿块灭活程度、体积及消融前后相关癌胚抗原变化.结果 化学消融后1个月行CT复查,38例肝包膜下转移瘤患者,瘤体缩小27例;病灶消失2例,增大9例.肝门区病灶17例,治疗后11例缩小,3例大小无变化,3例进展.胃癌肝门区淋巴结转移瘤22例,其中15例单个病灶缩小,3例无变化,4例进展.总有效率为70%.治疗后30例患者腹部疼痛症状明显改善.10例胆管梗阻患者胆管受压缓解,黄疸指数下降.化学消融术后肿瘤相关指标明显下降(P ＜ 0.01).结论 化学消融技术在肝周转移瘤的治疗中创伤小、肿瘤毁损彻底、费用低、适用于晚期转移瘤患者的局部治疗.     

MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques

OBJECTIVE: The aim of our prospective study was to assess the MR imaging characteristics of hepatic metastases of neuroendocrine tumors and to determine the optimal MR sequence for their detection. SUBJECTS AND METHODS: Thirty-seven consecutive patients with liver metastases from neuroendocrine tumors underwent 1.5-T MR imaging of the liver comprising T2-weighted fast spin-echo with respiratory monitoring, breath-hold T2-weighted single-shot fast spin-echo, and T1-weighted gradient-recalled echo sequences before and after the injection of gadoterate dimeglumine. Images were reviewed independently by three observers for the number, location, and pattern of signal and enhancement of metastases. RESULTS: A total of 359 metastases were detected, 279 on T2-weighed fast spin-echo, 231 on T2-weighed single-shot fast spin-echo, 272 on unenhanced T1-weighted, 322 on hepatic arterial phase, and 228 on portal venous phase images. Hepatic arterial phase images revealed the greatest number of metastases in 70% of patients, including 35 metastases seen only on this sequence, and was significantly superior to the unenhanced T1-weighted and portal venous phase sequences (p < 0.01). The lesion-to-liver contrast was significantly greatest with T2-weighed fast spin-echo sequences. The enhancement patterns of metastases were predominantly hypervascular, hypovascular, peripheral with progressive fill-in, and delayed in, respectively, 27, four, four, and two patients. Most metastases with peripheral enhancement and progressive fill-in were heterogeneous on T2-weighted images and were without globular peripheral enhancement. CONCLUSION: Hepatic metastases of neuroendocrine tumors had a typical hypervascular pattern in 73% of patients. Hepatic arterial phase and fast spin-echo T2-weighed sequences are the most sensitive.     

肝动脉化疗栓塞术后并发上消化道出血23例临床分析

目的　探讨肝动脉化疗栓塞 (TACE)后并发上消化道出血原因及治疗方法 ,并为预防出血提供依据。方法　回顾总结分析 2 3例TACE后短期内并发上消化道出血患者的临床资料。结果　出血患者多有肝功能严重损害 ;出血以食道胃底静脉曲张破裂为主 ,其次胃、十二指肠粘膜病变及胆道出血。 73 9%出血发生在TACE术后 15d之内 ,2 6 1%出血发生在术后 16～ 30d ;因出血死亡患者占 13 0 %。结论　及时预防及正确治疗对延长肝癌患者生命和提高生存质量有着重要意义。     

肝转移性肿瘤DSA表现分析

目的 探讨肝转移瘤血供特点与原发性肝癌的鉴别以及和原发肿瘤的相关性。材料与方法 搜集５１例肝转移瘤ＤＳＡ影像,根据肿瘤血管的多少和肿瘤染色深浅分为多血供、中血供和少血供,原发肿瘤包括腺癌３８例,鳞癌８例,其他类型５例。结果 肝转移瘤血供来源主要为肝动脉,门静脉参与供血,多血供肝转移１２例,中血供７例,少血供３２例。累及肝右叶少血供转移２７例,腺癌转移多于动脉晚期及以后显示多或单发环状染色;鳞癌转移