子宫、卵巢癌选择性髂内动脉造影及经导管 动脉灌注栓塞的临床研究

目的　探讨选择性髂内动脉造影及经导管动脉灌注栓塞在子宫、卵巢癌治疗中的应用价值。方法　18例经血管造影证实的子宫、卵巢恶性肿瘤患者,于选择性髂内动脉灌注和/或栓塞后1周(平均值)行肿瘤手术切除,并作对比。结果　选择性动脉造影可清楚显示肿瘤的血供特点。双髂内动脉灌注栓塞后手术切除的12例与单纯双髂内动脉灌注化疗后手术切除的6例相比较;术前灌注加栓塞可使肿瘤明显减小,术中出血极少(平均约50ml),手术野更清楚,肿瘤更有可能完全切除。结论　选择性髂内动脉灌注栓塞在子宫或卵巢恶性肿瘤治疗中具有较好的临床应用价值。     

原发性肝癌的血管影像解剖及其临床意义

原发性肝癌是我国常见的恶性肿瘤之一,患者就诊时通常已属中晚期,90％患者已丧失手术机会。在临床工作中,肝肿瘤的介入治疗已成为主要治疗手段之一。其基本原理是经导管进行肿瘤供血动脉的局部治疗,包括化疗药物灌注及栓塞,达到肿瘤组织坏死、缩小的目的。肝癌的血供是影响肝动脉化疗栓塞的关键因素,与其疗效直接相关。因此,充分研究肝癌组织血供特点,并且根据不同的血供类型采用不同的介入治疗方法,对提高肝癌的介入治疗效果具有十分重要的意义。     

中晚期肝癌经肝动脉栓塞化疗24例护理体会

中晚期肝癌经股动脉选择性肝动脉栓塞化疗(以下简称TAE)是在肝动脉造影技术的基础上,采用Seldinger技术,将导管选择性地送入肝左、右动脉,经造影明确肿瘤大小、范围,血供来源,进一步将导管插入病灶血管进行栓塞和化疗,控制晚期肿瘤生长速率,减少微小肿瘤的转移。对中晚期不能承受手术的患者,通过多次TAE治疗,多数患者可起到积极的姑息治疗,缓解症状,缩小晚期肿瘤和延长寿命的作用。少数可使肿     

肝动脉灌注术治疗原发性肝癌的护理体会

肝动脉灌注术是经股动脉插管,选择性插入肝癌供血动脉,进行栓塞和灌注化疗药物,栓塞主要的肿瘤血管,阻断肿瘤血供,使肿瘤缺血坏死,并灌注化疗药物杀死肿瘤细胞[1]。肝动脉灌注术治疗晚期原发性肝癌,据文献报道,生存期可达12个月~3年,不失为一种较有效的保守治疗手段。我科自2011年12月~2014年2月为24例原发性肝癌患者进行肝动脉灌注术,经股动脉插管至肝动脉,选择性将药物注入肿瘤区域,治疗效果尚理想。 CT片示癌肿组只明显缩小,预后尚好,明显地延长了患者生存期,1例患者生存期已达5年。现将护理体会报告如下。     

选择性动脉栓塞术在脊柱肿瘤切除术中的应用

目的探讨脊柱肿瘤切除术前超选择供血动脉栓塞的应用价值。方法收集2009年1月至2015年9月我院收治的脊柱肿瘤患者65例,术前应用Seldinger技术经股动脉先行造影及超选择供血动脉栓塞,记录栓塞效果、术中出血量。结果 62例造影显示病变椎体明显染色,均可见肿瘤供血动脉,3例造影未显示明显的肿瘤供血动脉,肿瘤无明显染色征象,随即放弃栓塞,造影检查供血动脉阳性率约95.3%(62/65),其中1例栓塞插管不成功,其余61例均栓塞成功,栓塞后成功实施病灶完整切除,术中出血量500~3 000 mL,平均(1 400.65±230.62)mL。结论超选择供血动脉栓塞术可减少脊柱肿瘤切除术中出血,降低脊柱肿瘤切除术中风险,增加了彻底切除肿瘤的可能性,是有效的术前干预方法。     

中晚期肝癌介入治疗及预后分析

目的探讨中晚期肝癌的治疗方法和预后因素.方法将我院323例住院的中晚期肝癌患者,经股动脉穿刺行肝动脉灌注化疗栓塞术(Transcatheterarterialchemoembolization,TACE)的病例资料进行回顾性分析,依据影像学,血生化指标及生存时间判断疗效.结果323例患者术后肿块缩小占60.3%,症状改善,1年生存率48.9%,2年生存率6.2%,3年生存率4.9%,中位生存期14.9个月.结论介入治疗是中晚期肝癌的有效治疗手段,可减轻症状,延长患者寿命,但要注意并发症的发生.     

中晚期肾癌术前介入治疗的临床价值

目的探讨中晚期肾癌动脉造影及术前栓塞的临床价值。方法36例中晚期肾癌患者，均经临床检查、静脉肾盂造影、B超、CT或MRI检查而确诊；采用Seldinger’s技术，局部麻醉下经一侧股动脉穿刺插管，引入5F Yashiro导管，常规行腹主动脉及双肾动脉造影，以显示肿瘤的供血动脉，再将导管超选择插管或尽可能接近肿瘤病灶，进行化疗栓塞（栓塞组），观察其临床改善情况，计算术中失血量及手术时间，并与随机抽取我院近3年所做的17例术前未行肿瘤供血动脉栓塞的肾癌患者（对照组）进行对照。结果血管造影表现为患侧肾肿瘤供血动脉增粗，分支紊乱移位，肿瘤内可见粗细不均、扭曲杂乱的新生血管，有些呈网状改变及包绕征象，显示肿瘤血管及肿瘤染色，少数病例伴有斑点状血湖、小的动一静脉瘘，静脉期及实质期可显示肾静脉及下腔静脉癌栓形成情况；栓塞组术中失血量为0—600ml，平均310ml，手术时间为60-150min，平均90min，对照组术中失血量为0—1600ml，平均480ml，手术时间为80—195min，平均120min，栓塞组均明显低于对照组；栓塞组术中见瘤体质地变软，表面苍白，瘤体表面静脉萎陷，肾周形成明显水肿带，易于剥离；手术后经病理检查，显示瘤细胞数量明显减少，瘤细胞不同程度变性、坏死、液化。结论术前靶血管栓塞是中晚期肾癌手术前有效的辅助治疗手段，能降低手术的危险性，增加肿瘤可切除率，同时也减少术中出血量。     

中晚期肝癌介入治疗及预后分析

目的探讨中晚期肝癌的治疗方法和预后因素.方法将我院323例住院的中晚期肝癌患者,经股动脉穿刺行肝动脉灌注化疗栓塞术(Transcatheter arterial chemoembolization,TACE)的病例资料进行回顾性分析,依据影像学,血生化指标及生存时间判断疗效.结果 323例患者术后肿块缩小占60.3%,症状改善,1年生存率48.9%,2年生存率6.2%,3年生存率4.9%,中位生存期14.9个月.结论介入治疗是中晚期肝癌的有效治疗手段,可减轻症状,延长患者寿命,但要注意并发症的发生.     

89例巨块型原发性肝癌介入化疗栓塞治疗体会

目的 探索巨块型原发性肝癌介入栓塞治疗的疗效.方法 89例巨块型原发性肝癌患者,经皮股动脉穿刺插管至肝动脉,化疗栓塞治疗肝癌;碘油用量为20～50ml.再注入明胶海绵颗粒栓塞治疗.发现肝外肿瘤供血动脉,超选择插管化疗栓塞后,注入适量明胶海绵栓塞治疗.结果 本组病例中首次DSA造影发现11例存在肝外动脉供血;64例出现肝外供血动脉共计67支.术后甲胎球蛋白下降均>50%.术后4～6周复查CT,肿瘤最大直径缩小3.5～5.9cm.1、2、3年累计生存率分别为73.8%、48.3%和28.5%.结论 巨块型原发性肝癌大剂量碘油栓塞联合肝外肿瘤供血动脉介入治疗,对于提高巨块型原发性肝癌的介入疗效具有重要意义.     

中晚期肝癌介入治疗的护理

目的 探讨肝动脉化疗栓塞术作为失去手术机会的中晚期肝癌患者的非手术疗法的效果及护理.方法 通过2006～2008住院患者中 100 例中晚期肝癌患者的介入治疗,经肝动脉灌注化疗药物,使得肝脏肿瘤局部具有较高的药物浓度,从而增强对肿瘤的杀伤效能,减轻毒副作用,肝动脉栓塞则切断肿瘤的动脉血供,使其缺血坏死.结果 100例患者中1、2、3年的生存率分别为78%、66%、42%.结论 肝动脉内化疗能使局部药物浓度增高且减少全身的毒副作用.栓塞化疗可使肿瘤最大程度坏死,明显提高了中晚期肝癌患者的生存期及生存质量.     

中晚期肝癌的异常血液供应影像及对介入治疗的影响

目的分析中晚期肝癌的异常血液供应及对介入治疗的影响,旨在提高肝癌介入治疗的疗效。方法收集肝动脉化学治疗栓塞术(TACE)的中晚期肝癌患者资料143例,其中男性117例,女性26例;年龄11~80岁,平均年龄53.8岁。对其数字减影血管造影(DSA)图像进行回顾性分析并复习相关文献。结果143例中,规则性供血111例,占77.62%;异常供血32例,占22.38%,其中变异性供血17例(占11.89%),寄生性供血15例(占10.49%)。32例中,29例成功进行超选择插管并给予化学治疗栓塞治疗,其中18例使用SP微导管插管;3例异常供血未能成功超选择插管,只进行单纯灌注化学治疗。结论中晚期肝癌的异常供血发生率较高,认识其变异特点,才能确保肝癌介入治疗的准确性和彻底性。     

经TACE治疗及降糖药物治疗的原发性肝癌并2型糖尿病Child—Pugh分级变化危险因素分析

目的探讨接受降糖药物治疗的原发性肝癌并2型糖尿病患者经TACE治疗Child-Pugh分级变化的相关因素。方法回顾性分析TACE治疗接受降糖药物治疗的原发性肝癌并2型糖尿病患者126例;主要研究年龄、性别、Child-Pugh分级、二甲双胍治疗、服用其他口服降糖药治疗、是否接受肝癌手术后、糖化血红蛋白（HbAlc）、体质量指数（BMI）、既往有无发生酮症或高渗、超选择栓塞肿瘤供血支与否、胰岛素治疗及有无动静脉瘘等相关数据。观察术前后Child-Pugh分级变化,分析相关因素。结果单因素分析结果显示：既往有无发生酮症或高渗、超选择栓塞肿瘤供血支与否、胰岛素治疗及有无动静脉瘘手术前后Child-Pugh分级肝功能变化差异有统计学意义（P〈0．05）。Logistic回归分析显示：胰岛素治疗（P=0．006）、超选择栓塞肿瘤供血支与否（P=0．037）及有无动静脉瘘（P=0．003）与接受降糖药物治疗的原发性肝癌并2型糖尿病患者TACE术后肝功能Child．Pugh评分变化相关。结论胰岛素治疗、超选择栓塞肿瘤供血支与否及有无动静脉瘘是影响接受降糖药物治疗的原发性肝癌并2型糖尿病患者TACE术后肝功能主要因子。     

选择性动脉造影及介入治疗对非静脉曲张性消化道出血的诊疗价值

目的探讨选择性动脉造影(DSA)诊断和介入治疗在非静脉曲张性消化道出血中的应用价值。方法对94例非静脉曲张性消化道出血患者行选择性血管造影,术中根据不同出血原因和部位分别采用动脉栓塞和/或缩血管药物灌注治疗。结果DSA检查阳性58例(61.7%),其中13例患者造影前曾行核素扫描,有阳性发现11例(84.6%)。42例非静脉曲张性消化道出血患者获得介入治疗,其中34例行栓塞,止血率为91.2%,复发率为8.8%;动脉灌注血管加压素治疗8例,止血率为75.0%,复发率为25.0%。所有介入治疗患者均未发生肠坏死等严重并发症。结论选择性动脉造影对不明原因的非静脉曲张性消化道出血的诊断有重要价值。99Tcm-红细胞核素扫描发现出血灶较选择性动脉造影敏感,但定位诊断较差。动脉血管加压素灌注和栓塞治疗是安全、有效的止血措施。     

中晚期非小细胞肺癌的支气管动脉介入治疗的临床研究

目的观察健择、顺铂联合支气管动脉介入化疗治疗中晚期非小细胞肺癌的临床疗效。方法将64例中晚期肺癌患者随机分为支气管动脉灌注治疗组（治疗组）和静脉注射治疗组（对照组）,每组32例。观察两组疗效、生存率和生活质量。结果治疗组缓解率65.63%,中位生存期10个月,生存1年以上患者占52.13%;对照组缓解率28.13%,中位生存期6个月,生存1年以上患者占28.13%。治疗组的缓解率、1年生存率较对照组明显提高,差异均有统计学意义（P〈0.05）。治疗组的恶心呕吐症状较对照组明显减少（P〈0.05）。结论支气管动脉灌注治疗肺癌的临床疗效优于静脉滴注。更有利于改善患者的生活质量、延长患者生存时间的作用,减轻化疗药物的毒副作用。     

Fine-needle aspiration cytology of metastatic small cell carcinoma of the colon: A report of three cases

Small cell carcinoma of the large intestine is a rare, extremely aggressive malignancy often associated with an overlying adenoma. We report three cases of metastatic small cell carcinoma of the colon diagnosed by fine-needle aspiration (FNA) biopsy. Two of the patients were women (ages 33 and 46 yr old) and one was a man (69 yr old). FNA biopsy established the diagnosis of metastatic small cell carcinoma involving the liver (2 cases) and soft tissue of the scapular region (1 case). In one patient, the FNA diagnosis of hepatic metastases preceded identification of the primary site. Subsequently, the patient was found to have a small cell carcinoma subadjacent to a colonic villous adenoma, illustrating the importance of investigating villous lesions of the colon in patients with metastatic small cell carcinoma of unknown primary origin (especially in non-smokers). All three cases showed the characteristic cytologic features of small cell carcinoma. Ancillary studies performed on aspirated material confirmed the diagnosis of small cell carcinoma in one case. Immunocytochemical studies revealed punctate cytokeratin and diffuse neuron-specific enolase (NSE) positivity of the malignant cells. Ultrastructurally neurosecretory granules were evident. To the best of our knowledge, this is the first FNA cytologic report of metastatic small cell carcinoma of the large intestine. This FNA report also demonstrates when a small cell carcinoma is detected in a metastatic site in a patient lacking a lung primary, a likely primary site could be adjacent or beneath a polypoid lesion of the colon. Diagn Cytopathol 1996;15:54–59. © 1996 Wiley-Liss, Inc.     

Metastatic ovarian carcinoma of large intestinal origin simulating primary ovarian carcinoma. A clinicopathologic study of 25 cases.

The distinction of metastatic ovarian carcinoma from a primary malignant ovarian neoplasm is crucial to its subsequent management. The most common metastatic carcinoma that mimics primary ovarian carcinoma is that of large bowel origin. The clinical and pathologic features of 25 cases of intestinal adenocarcinoma metastatic to the ovaries were analyzed. The patients ranged in age from 47 to 80 years (average age, 60 years). Most patients had abdominal pain and a pelvic mass. In 56%, the ovarian tumors and the large bowel carcinomas were discovered synchronously; 44% were metachronous. Seventy-five percent of the tumors were unilateral. Gross examination revealed that all the ovarian tumors were solid and cystic with smooth outer surfaces. Most of the tumors showed hemorrhage and necrosis. Histologic examination showed that 13 cases had a predominantly endometrioid-like pattern, four cases were predominantly mucinous, and the rest demonstrated a mixed pattern. The presence of a garland pattern with cribriform areas and "dirty" necrosis were the most distinctive features that were helpful in correctly differentiating these tumors from primary endometrioid ovarian carcinoma, with which they are often confused. Immunohistochemical stains for carcinoembryonic antigen showed strong intracytoplasmic positive staining in all the cases of intestinal adenocarcinoma metastatic to the ovaries, in contrast to primary ovarian endometrioid carcinoma, which stain negatively for carcinoembryonic antigen or show only intraluminal or apical positivity. As expected, intestinal adenocarcinoma metastatic to the ovaries had a very poor prognosis. Seventy percent of the patients died within a period of 1 to 19 months (average, 8.2 months). Its distinction from primary ovarian carcinoma is crucial because the management and prognosis of metastatic ovarian carcinoma of large intestine origin is different.     

部分脾栓塞在肝癌伴脾亢介入治疗中的应用

目的:对原发性肝癌(肝癌)伴脾功能亢进(脾亢)患者行部分脾栓塞,使其血细胞恢复正常,以便能进一步行肝动脉化疗。方法:对46例不能行手术切除、且血细胞明显低于正常的肝癌伴脾亢的患者行部分脾栓塞术,栓塞面积控制在50%-70%,栓塞前后测定血细胞数量,并作方差分析和t检验。结果:脾栓术后24小时、48小时、72小时、1周、2周、4周的血WBC和PLT均较栓塞前明显升高(P<0.05和P<0.01)。结论:部分脾栓塞能治疗脾功能亢进,提高血细胞数量,使肝癌伴脾亢患者的肝动脉化疗能正常进行。     

Partial remission with transarterial embolization in a case of metastatic adrenal cortical carcinoma.

A case of metastatic adrenal cortical carcinoma in which partial remission was achieved with transarterial embolization is presented as probably the first reported case in the literature to date. A 29-year-old woman was admitted because of adrenal cortical carcinoma which had not responded to mitotane. A left adrenalectomy with segmentectomy of the involved liver had been done previously. Abdominal computerized tomography demonstrated multiple large metastatic tumors in the liver. Transarterial embolization with Gelfoam and 20 mCi of 131I-labeled lipiodol was performed and resulted in a decrease in tumor size and biochemical parameters. Transarterial embolization can be one of the therapeutic modalities for metastatic adrenal cortical carcinomas.     

Gastric epithelial atypia following hepatic arterial infusion chemotherapy

A case of a gastric ulcer with epithelial atypia following hepatic arterial infusion chemotherapy (mitomycin C and 5-fluoro-2'-deoxyuridine) for a metastatic carcinoid tumor in the liver was observed. The gastric ulcer was endoscopically detected about 2 months after the initiation of the hepatic arterial infusion chemotherapy. The gastric epithelial atypia was severe enough to cause erroneous cytologic interpretation of the smear as a carcinoma. The cytologic and histologic appearance of chemotherapy-induced epithelial atypia is described with special emphasis on possible diagnostic pitfalls in gastric cytology.