中晚期肝癌介入化疗栓塞150例报告

目的 中晚期肝癌介入治疗中,探讨良好配方及安全有效栓塞方法,进一步提高治疗效果。材料与方法 通过150例中晚期肝癌选择优化组合的化疗配方,经过426次灌注化疗及栓塞,进行疗效观察。结果 经治疗患者生活质量有明显改善,半年、一年、两年及五年生存率分别为87％、67％、3l％及5％。对伴有门脉癌栓的病例若有栓塞指征,应争取栓塞可提高疗效。结论 选择良好的化疗方案,适度安全有效的栓塞、是提高肝癌患者介入治疗疗效的关键。     

康莱特联合介入化疗栓塞治疗中晚期肝癌疗效观察

目的：探讨康莱特注射液（KLT）联合介入化疗栓塞（TACE）治疗中晚期肝癌的疗效。方法：分组比较单用介入化疗栓塞（对照组25例）与康莱特联合介入化疗栓塞（治疗组31例）对症状改善、血生化指标及近期疗效的差异。结果：在临床症状改善，抑制瘤体生长，减轻介入化疗后毒副作用方面，治疗组明显优于对照组。结论：康莱特联合介入化疗栓塞治疗中晚期肝癌能明显提高疗效。改善症状，降低介入化疗栓塞 的毒副作用。     

原发性肝癌患者行肝癌介入化疗栓塞术的可行性及安全性研究

目的 研究原发性肝癌患者行肝癌介入化疗栓塞术后的并发症.方法 选取接受治疗并确诊为原发性肝癌的患者170例.依照甲胎蛋白(AFP)的水平分成阳性组(AFP>26 ng/ml)和阴性组(AFP≤26 ng/ml);肝功能分级分为肝功能A级组和B级组;体内肿块形态分为弥漫型组、结节型组和巨块型组;患者肿瘤血供分为肿块的乏血供组和肿块的富血供组.调查各组并发症发生情况和之间的差异.结果 患者肿瘤血供中乏血供42例(24.7％),富血供128例(75.3％);肿块分型中弥漫型37例(21.8％),结节型63例(37.1％),巨块型70例(41.2％);肝功能A级105例(61.8％),B级65例(38.2％);甲胎蛋白阳性98例(57.6％),阴性72例(42.4％).富血供患者发热、胃肠道反应、肝功能不全发生率均明显高于乏血供患者,差异均有统计学意义(P<0.01);不同肿块分型患者发热、胃肠道反应、骨髓抑制和肝功能不全发生率比较,差异均有统计学意义(P<0.05);肝功能分级为B级的患者骨髓抑制和肝功能不全发生率均明显高于A级患者,差异均有统计学意义(P<0.01).结论 原发性肝癌患者行肝癌介入化疗栓塞术后,主要并发症有发热、胃肠道反应、肝功能不全和骨髓抑制,如果患者手术后注意饮食,小心护理,一般可治愈这些并发症.因此肝癌介入化疗栓塞术是安全可行的.     

肝癌病人化疗栓塞前后LAK细胞活性变化的研究

经肝动脉化疗栓塞（ＴＡＣＥ）与免疫疗法是当前中晚期肝癌治疗中的活跃领域，但ＴＡＣＥＥ对肝癌病人肿瘤免疫的影响尚不明确。本研究观察测定了未行治行的肝癌病人，行一次ＴＡＣＥ治疗的肝癌病人及反复行ＴＡＣＥ治疗的肝癌病人的ＬＡＫ细胞活性。结果表明：单纯行一次ＴＡＣＥ治疗的肝癌病人其ＬＡＫ细胞活性未见明显变化，而反复行ＴＡＣＥ治疗的肝癌病人其ＬＡＫ细胞活性明显增强。提示反复ＴＡＣＥ疗法对肝癌病人的肿瘤免疫有增强作用，而ＴＡＣＥ治疗中化疗药物的用量是对肿瘤免疫产生影响的重要因素。     

康莱特联合介入化疗栓塞治疗中晚期肝癌疗效观察

目的　探讨康莱特注射液 (KLT)联合介入化疗栓塞 (TACE)治疗中晚期肝癌的疗效。　方法　分组比较单用介入化疗栓塞 (对照组 2 5例 )与康莱特联合介入化疗栓塞 (治疗组 31例 )对症状改善、血生化指标及近期疗效的差异。　结果　在临床症状改善、抑制瘤体生长、减轻介入化疗后毒副作用方面 ,治疗组明显优于对照组。　结论　康莱特联合介入化疗栓塞治疗中晚期肝癌能明显提高疗效 ,改善症状 ,降低介入化疗栓塞的毒副作用。     

转移性肝癌的血供对肝动脉化疗栓塞术疗效评价

目的探讨转移性肝癌的血供对肝动脉化疗栓塞术（TACE）的疗效。方法观察TACE治疗34例转移性肝癌的近期疗效和转移后生存率。结果转移性肝癌以乏血供为主,富血供组有效率为66．7％（8／12）,乏血供组为31．8％（7／22）,两组疗效差异有统计学意义（P〈0．05）。富血供组6、12月转移后生存率分别为100％、75．0％,转移后中位生存期21．6月;乏血供组6、12月转移后生存率分别为81．8％、40．9％,转移后中位生存期13．5月,两组转移后中位生存期差异有统计学意义（P〈0．05）。结论富血供的转移性肝癌治疗效果明显优于乏血供组。     

转移性肝癌的血供对肝动脉化疗栓塞术疗效评价

目的探讨转移性肝癌的血供对肝动脉化疗栓塞术(TACE)的疗效。方法观察TACE治疗34例转移性肝癌的近期疗效和转移后生存率。结果转移性肝癌以乏血供为主,富血供组有效率为66.7%(8/12),乏血供组为31.8%(7/22),两组疗效差异有统计学意义(P<0.05)。富血供组6、12月转移后生存率分别为100%、75.0%,转移后中位生存期21.6月;乏血供组6、12月转移后生存率分别为81.8%、40.9%,转移后中位生存期13.5月,两组转移后中位生存期差异有统计学意义(P<0.05)。结论富血供的转移性肝癌治疗效果明显优于乏血供组。     

放射治疗合并肝动脉灌注化疗栓塞治疗原发性肝癌

目的：观察放射治疗（RT）结合肝动脉灌注化疗栓塞的介入疗法[简称介入化疗（IVCT]治疗，原发性肝癌的疗效。方法：治疗组（62例）先行IVCT（化疗方案：5－Fu、ADM、DDP或5-Fu、MMC、ADM）一次，然后行放射治疗。放射治疗结束后，每间隔1－1．5个月再行IVCT一次，共2－5次。对照组（68例）单用IVCT，化疗方案同治疗组，每间隔1－1．5个月一次，共3－6次。结果：治疗组总缓解率（CR＋PR）为77．4％，1，2，3年生存率分别为79．0％、64．5％、38．7％。对照组总缓解率为57．4％，1，2，3年生存率分别为58．8％、39．7％、22．3％。两组比较总缓解率和1，2，3年生存率均有统计显著差异（P＜0．05）。结论：我们认为RT＋IVCT治疗原发性肝癌安全、有效，是一种值得肯定的综合治疗手段。     

化疗栓塞疗法治疗肝癌的研究进展

化疗栓塞疗法为Kato 1981年首次提出的。将化疗药物与栓塞物质有机结合成化疗栓塞剂,经肝动脉注入后,一方面阻断肿瘤的血供,导致肿瘤缺血、坏死;另一方面释放出化疗药物,发挥靶向抗癌作用。药物微球和微囊是近年来发展较快的新型化疗栓塞剂,能选择性进入肿瘤组织,发挥化疗、栓塞双重作用,降低全身毒副反应,被誉为90年代的新药。本文综述了药物微球和微囊的研究进展。     

康莱特注射液联合介入化疗栓塞治疗原发性中晚期肝癌

目的 探讨康莱特注射液联合介入化疗栓塞治疗中、晚期原发性肝癌的疗效。方法 本组共80例肝癌患者，采用随机对照方法分两组，治疗组（康莱特＋介入化疗栓塞）与对照组（单纯介入化疗栓塞）各40例。观察临床症状变化、Karnofsky评分、血生化指标及近期疗效，对临床资料进行分析。结果 在临床症状改善、抑制肿瘤瘤体生长、体重增加、Karnofskv评分提高、减轻介入化疗骨髓抑制毒性反应（白细胞、血小板下降）和增加方面，治疗组明显优于对照组（P〈0．05），而在血红蛋白下降、肝功能损害、恶心、呕吐方面两组差异无统计学意义（P〉0．05）。结论 临床观察表明，康莱特在中、晚期肝癌介入治疗中能明显改善患者生存质量，减轻化疗栓塞后毒副反应，在提高综合疗效方面效果肯定，值得临床推广应用。     

肝癌介入治疗的一些体会

本文就肝癌介入治疗中一些有争议的问题如碘油用量,化疗药物用量、疗效评价、肝癌合并AVS、APVS的治疗、老年肝癌的介入治疗、DSA在肝癌诊断上的意义等结合文献进行讨论,并结合作者的临床实践提出一些自己的心得。     

可切除大肝癌TACE后手术切除标本的病理研究

目的 探讨可切除大肝癌TACE后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前TACE组(36例)与一期手术组(47例)，术前TACE组31例二期切除(二期手术组)，5例失去手术切除机会，78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE组除较一期手术组肿瘤坏死广泛、包膜更完整外，两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异；TACE组TACE后肿瘤体积缩小并不显著，子灶、门脉癌栓完全坏死者少，肝硬化加重。结论 可切除大肝癌术前TACE不能使肿瘤完全坏死，部分患者耽误手术时机，应严格选择应用。     

可切除大肝癌TACE后手术切除标本的病理研究(英文)

目的探讨可切除大肝癌 TACE 后手术切除标本的病理改变及其意义。方法 2002年1月～2003年1月收治的83例可切除大肝癌患者随机分成术前 TACE 组(36例)与一期手术组(47例),术前 TACE组31例二期切除(二期手术组),5例失去手术切除机会,78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。结果 TACE 组除较一期手术组肿瘤坏死广泛、包膜更完整外,两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异;TACE 组TACE 后肿瘤体积缩小并不显著,子灶、门脉癌栓完全坏死者少,肝硬化加重。结论可切除大肝癌术前 TACE 不能使肿瘤完全坏死,部分患者耽误手术时机,应严格选择应用。     

Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone

Aim: The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.     

Nausea and Vomiting after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Incidence and Risk Factor Analysis

Background: Nausea and vomiting after transcatheter arterial chemoembolization (TACE) for hepatocellularcarcinoma (HCC) are common in clinical practice, but few studies have reported the incidence and risk factorsof such events. Objective: The purpose of this study was to analyze the incidence and risk factors of nausea andvomiting after TACE for HCC. Methods: This study was a single-center retrospective analysis of a prospectivelymaintained database. Between May 2010 and October 2012, 150 patients with HCC were analyzed for incidenceand preprocedural risk factors. Results: The incidence of postembolization nausea and vomiting was 38.8%and 20.9%, respectively, in patients with HCC. Patients who developed nausea had lower levels (<100 IU/L)of serum alkaline phosphatase (ALP) compared to those without nausea (123.04 ± 69.38 vs. 167.41 ± 138.95,respectively, p=0.044). Female gender correlated to a higher incidence of nausea as well (p=0.024). Patients whodeveloped vomiting, compared to those who did not, also had lower levels (<100 IU/L) of serum ALP (112.52 ±62.63 vs. 160.10 ± 127.80, respectively, p=0.010), and serum alanine transferase (ALT) (35.61 ± 22.87 vs. 44.97± 29.62, respectively, p=0.045). There were no statistical significances in the incidences of nausea and vomitingbetween male patients over 50 years old and female patients who have entered menopause (p=0.051 and p=0.409,respectively). Multivariate analysis by logistic regression analysis demonstrated that female gender and ALP>100IU/L were the most independent predictive factors of postembolization nausea (odds ratio (OR): 3.271, 95%CI: 1.176-9.103, p=0.023 and OR: 0.447, 95% CI: 0.216-0.927, p=0.030, respectively). ALP>100 IU/L was alsothe most independent predictive risk factor of postembolization vomiting (OR: 0.389, 95% CI: 0.159-0.952,p=0.039). Conclusions: Postembolizaiton nausea and vomiting are common in patients with HCC. Recognitionof the risk factors presented above before TACE is important for early detection and proper management ofpostembolization nausea and vomiting. Nevertheless, future studies are required.     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

目的: 探讨恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的疗效及安全性。 方法: 选取30例中晚期肝癌患者入组研究,均给予恩度肝动脉灌注联合介入化疗栓塞治疗,同时选取30例中晚期肝癌患者作为对照组,仅行介入化疗栓塞治疗。于1～2个治疗周期后比较RECIST疗效,甲胎蛋白转阴率及生活质量评分,同时比较治疗副作用。 结果: 实验组30例患者中29例可评价疗效。实验组治疗后K氏评分显著升高(80.39±8.37Vs73.93±9.22,P=0.002);恩度治疗组的治疗有效率及甲胎蛋白转阴率显著高于对照组(P=0.021,P=0.046)。治疗副作用轻微。 结论: 采用恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌,患者生活质量及近期疗效提升明显,甲胎蛋白转阴率亦有明显改善,而治疗相关副作用不大,值得临床推广及进一步研究。     

Health-Related Quality of Life of Patients with Intermediate Hepatocellular Carcinoma after Liver Resection or Transcatheter Arterial Chemoembolization

Background: The aim of our present study was to compare quality of life (QoL) between intermediate-stage(BCLC-B) HCC patients who had undergone either liver resection or transcatheter arterial chemoembolization(TACE). Materials and Methods: A total of 102 intermediate-stage HCC patients participated in our study,including 58 who had undergone liver resection and 44 who had undergone TACE. Baseline demographiccharacteristics, tumor characteristics, and long-term outcomes, such as tumor recurrence, were compared andanalyzed. QoL was assessed using the Short Form (SF)-36 health survey questionnaire with the mental andphysical component scales (SF-36 MCS and PCS). This questionnaire was filled out at HCC diagnosis and 1,3, 6, 12, 24 months after surgery. Results: For the preoperative QoL evaluation, the 8 domains related to QoLwere comparable between the two groups. The PCS and MCS scores were significantly decreased in both theTACE and resection groups at1 month after surgery, and this decrease was greater in the resection group.These scores were significantly lower in the resection group compared with the TACE group (P<0.05). However,these differences disappeared at 3 and 6 months following surgery. One year after surgery, the resection groupshowed much higher PCS scores than the TACE patients (P=0.018), and at 2 years after surgery, the PCS andMCS scores for the resection group were significantly higher than those for the TACE group (P<0.05). Elevenpatients (19.0%) in the resection group and 17 (38.6%) in the TACE group suffered HCC recurrence (P<0.05).Univariate and multivariate analyses indicated that tumor recurrence (HR=1.211, 95%CI: 1.086-1.415, P=0.012)was a significant risk factor for poorpostoperative QoL in the HCC patients.Conclusions: Due to its effectson reducing HCC recurrence and improving long-term QoL, liver resection should be the first choice for thetreatment of patients with intermediate-stage HCC.     

肝癌术后预防性肝动脉化疗栓塞对延缓复发的意义

[目的]了解预防性肝动脉化疗栓塞术(TACE)在延缓肝癌手术后复发方面的作用.[方法]对823例行根治性切除并经病理证实为肝细胞癌患者进行随访分析.其中126例患者手术后行预防性TACE,将可能影响原发性肝癌术后复发的观察指标包括性别、年龄、术前AFP、有无癌栓、手术切缘、手术前肿瘤是否破裂、肿瘤大小、肿瘤有无子灶、肿瘤包膜情况、手术后有无行预防性TACE等,用Cox模型分析各因素与复发时间之间的关系.所有数据经SAS6.12和SPSS统计软件处理分析.[结果]年龄小、有癌栓、手术前肿瘤有破裂、肿瘤体积大和肿瘤周围有子灶等因素使肝癌手术后复发时间提前,保证较大手术切缘距离和手术后行预防性TACE可延缓肝癌手术后复发.预防性TACE可明显降低肝癌患者术后2年的复发率.[结论]对有早期复发病理学征象的肝癌患者行预防性TACE治疗可能延缓术后肿瘤复发.     

动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析

目的 建立肝细胞癌（简称肝癌）根治性切除术后预防性动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）治疗的卫生经济学评价模型。方法 140例肝癌患者根治性切除术后分为TACE组和非TACE组（即门诊随访组）,收集两组治疗方案直接医疗成本和治疗效果（复发率及无瘤生存时间）,进行成本效果分析、增量成本效果分析和敏感度分析。结果 （1）40例非TACE组患者门诊总平均费用为7 121.44元/人;100例TACE组患者复发前总费用为2 8250.45元/人。（2）非TACE组和TACE组的1、2、3、4、5年复发率比较差异无统计学意义（P＞0.05）;两组无瘤生存时间比较差异无统计学意义（P=0.322）。（3）非TACE组的成本效果比为389.15元/月,TACE组为1 278.30元/月,增量成本效果比为5 560.27元/月。（4）敏感度分析中非TACE组的成本度效果比为350.84元/月,TACE组为1 215.81元/月,增量成本效果比为5 381.35元/月。结论 从卫生经济学角度,预防肝癌术后复发,预防性TACE并不是最优方案,至少不是每个患者都应该或都适合做,在相同的效果下（复发率、无瘤生存时间）门诊随访治疗可能更经济。