超选择性支气管动脉栓塞化疗治疗肺癌

目的　探讨超选择性支气管动脉栓塞化疗治疗肺癌的安全性和疗效。方法　回顾分析32 9例经病理学诊断的肺癌作单纯支气管动脉灌注化疗和超选择性支气管动脉栓塞化疗的资料。(1)单纯支气管动脉灌注化疗组 (2 2 1例 ) :普通导管插至支气管动脉主干或肋间 支气管动脉干造影后 ,经导管注入顺铂 4 0～ 6 0mg或卡铂 2 0 0～ 30 0mg ,联合用丝裂霉素 10～ 2 0mg或鬼臼乙叉甙 10 0～ 2 0 0mg。间隔 2～ 4周再次灌注化疗 ,2 2 1例共行 5 4 9次。 (2 )超选择性支气管动脉栓塞化疗组(10 8例 ) :普通导管插管造影后 ,在路图成像指引下 ,将微导管超选择性插至供瘤动脉近瘤处 ,经微导管注入抗癌药 (同单纯支气管动脉灌注化疗组 )和栓塞剂。栓塞剂选用 0 5～ 1 5mm3 明胶海绵颗粒30～ 5 0颗和 (或 )超液态碘油 3～ 8ml。间隔 6～ 9周再次作栓塞化疗 ,10 8例共行 2 6 6次。结果　 2组均未出现脊髓损伤等严重并发症。 2 2 1例单纯支气管动脉灌注化疗中 ,完全缓解 (CR) 2 8例 ,部分缓解 (PR) 79例 ,稳定 (S) 88例 ,进展 (P) 2 6例 ,有效率 (CR +PR)为 4 8 4 % ,1年生存率为 5 3 8% ,2年生存率为 4 4 8% ;10 8例超选择性支气管动脉栓塞化疗中 ,CR 16例 ,PR 5 3例 ,S 32例 ,P 7例 ,有效率为 6 3 9% ,1年生存率为 77 8% ,2年     

碘油化疗栓塞术治疗支气管肺癌的临床研究

目的 研究经支气管动脉碘油化疗栓塞术治疗支气管肺癌的临床应用价值。材料与方法 50例支气管肺癌,腺癌17例,鳞癌30例,小细胞肺癌3例。其中Ⅱa期4例,Ⅱb期17例,Ⅲa期22例,Ⅲb期7例。支气管动脉造影明确该动脉的分支和肿瘤血管,选择性插管肿瘤血管,行局部灌注化疗后,以3－10ml碘油加100mg卡铂的乳剂进行栓塞。结果 （1）栓塞血管：左支气管动脉干5例,其肿瘤分支13例,右支气管动脉干4例,其肿瘤分支21例,左右共干之左支气管动脉肿瘤支3例,左右共干之右支气管动脉肿瘤支4例。（2）近期疗效：CR 1例,PR37例,SD12例,PD 0例,有效率76％。症状缓解率44．4％。（3）并发症：9例在支气管动脉干栓塞治疗者,1例出现一过性脊髓缺血;3例支气管动脉－肋间动脉共干且在支气管动脉干栓塞治疗者,均出现肋间动脉并发症;在支气管动脉肿瘤支栓塞者未出现以上并发症。栓塞过程中出现肺动脉分支碘油沉积者占12％,4％伴有症状。上述并发症对症治疗后均缓解。结论 支气管动脉碘油化疗栓塞术治疗支气管肺癌近期疗效较好,使用同轴导管技术选择性肿瘤血管支插管值得推荐应用。     

肝动脉化疗栓塞治疗转移性肝癌25例分析

目的:通过肝动脉化疗栓塞治疗转移性肝癌的疗效分析,提出影响疗效的有关因素。材料与方法:转移性肝癌25例(其中24例肝多发性转移,23例少血管型)。瘤体直径1.2～5.5cm,平均3.2cm。经肝因有动脉注入5-Fu750～1000mg,CDDP60～80mg,碘油乳剂(40％碘化油6～10ml加MMC16～20rag),0.2～0.5cm明胶海2～3条栓塞治疗。结果:按照WHO实体肿瘤近期疗效标准,CR1例、PR5例、NC15例、PD4例,有效率24％(CR PR)。中位生存11.3月。结论:肝动脉化疗栓塞治疗转移性肝癌是一种有效的方法。     

动脉化疗栓塞治疗晚期卵巢癌

目的 探讨经动脉化疗栓塞治疗晚期卵巢癌的疗效.资料与方法 对48例晚期卵巢癌患者行髂内动脉、卵巢动脉化疗栓塞,其中Ⅲ期26例、Ⅳ期22例,灌注药物剂量分别为:顺铂(DDP)50 mg/m~2或卡铂400～600 mg、丝裂霉素(MMC)6～10 mg.栓塞剂选用明胶海绵.在介入术前3 h静脉注射5-氟尿嘧啶(5-FU)1000～1250 mg.结果 采用单纯介入治疗者总有效率69.2%(9/13),完全缓解(CR)4例,部分缓解(PR)5例,稳定(SD)3例,进展(PD)1例,患者2年生存率46.2%(6/13).采用介入+手术治疗者总有效率91.4%(32/35),CR21例,PR 11例,SD 3例,患者2年生存率71.4%(25/35).无严重并发症发生.结论 经导管动脉化疗栓塞治疗晚期卵巢癌疗效肯定,为综合治疗晚期卵巢癌增加了新的治疗手段,并为无法手术者提供了二期手术机会.     

Ⅲ期非小细胞肺癌的综合治疗

目的:探讨支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗Ⅲ期非小细胞肺癌(NSCLC)的疗效。方法:143例Ⅲ期NSCLC患者分为2组,对照组71例,化疗与放射治疗同步进行;介入组72例,采用支气管动脉化疗栓塞,第2天行放疗,介入治疗2个周期。放疗总剂量60～70Gy,6～7周完成。所有患者3～4周后采用长春瑞滨、顺铂(NP)方案,共化疗2～4个周期。结果:2组全部完成治疗计划。介入组完全缓解(CR)占37.5%,部分缓解(PR)占45.8%,有效率83.3%;对照组CR占23.9%,PR占39.4%,有效率63.3%。介入组中位生存期为22.6个月,对照组为14.5个月。1、2、3年生存率介入组为78.6%、44.3%、23.5%,对照组为63.2%、33.4%、14.5%。介入组明显高于对照组,差异有统计学意义(P<0.05)。无严重并发症发生。结论:经支气管动脉化疗栓塞结合放疗、静脉化疗治疗Ⅲ期NSCLC能延长患者的中位生存期,提高生存率,具有较好的临床疗效。     

聚乙烯醇栓塞介入治疗中央型肺癌的临床应用

目的 研究聚乙烯醇(PVA)栓塞化疗与单纯支气管动脉灌注化疗(BAI)在中央型肺癌介入术中的临床应用价值.方法 45例中央型肺癌患者,均经病理证实.随机分成2组,即对照组和试验组,分别为24例和21例.行支气管动脉及其他供血动脉造影确认肿瘤供血动脉后,对照组支气管动脉内灌注化疔药,而试验组用同轴导管技术将微导管超选择插至肿瘤供血动脉,依血供情况分别经每一条供血动脉灌注化疗药物,继以聚乙烯醇(PVA 300～600 μm)经微导管栓塞上述每一条供血动脉.结果 对照组缓解率(CR PR)50%,实验组缓解率(CR PR)90.4%.对照组获得手术根治机会者2例,术后全部化疗,余22例行综合治疗.实验组获得手术根治机会者达7例,术后全部化疗,余14例行综合治疗.随访2～24 个月,对照组3例死亡,实验组无1例患者死亡.结论 聚乙烯醇栓塞介入治疗中央型肺癌,其近期临床疗效优于单纯支气管动脉灌注化疗药物灌注.长期疗效有待于大量增加的临床病例及长期随访,以确定其临床应用价值.     

支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗中心型肺癌

目的探讨支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗中心型肺癌的疗效。方法178例中晚期中心型肺癌患者采用支气管动脉化疗栓塞,第2天行放疗。放疗总剂量60～70 Gy,6～7周完成。3～4周后采用长春瑞滨、顺铂或伊托铂苷、顺铂方案,共化疗2个周期。结果患者临床症状均有明显好转。CR 39.89%,PR 46.06%,有效率(CR+PR)85.95%,中位生存期为23.4个月,1、2、3年生存率分别为79.7%、45.3%、24.5%。无严重并发症发生。结论经支气管动脉化疗栓塞结合放疗、静脉化疗治疗中心型肺癌能延长患者的中位生存期,提高患者的生存率,具有较好的临床疗效。     

中晚期中心型肺癌的综合治疗

目的:探讨支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗中心型肺癌的疗效。方法:156例中晚期中心型肺癌患者分为两组,放化疗组77例,化疗与放射治疗同步进行。介入组79例,采用支气管动脉化疗栓塞,第二天行放疗,介入2个周期。放疗总剂量60～70G,6～7周完成。所有患者3～4周后采用长春瑞滨、顺铂或依托铂苷、顺铂方案,共化疗2～4个周期。结果:两组病例全部完成治疗计划。介入组CR 39.2%,PR 46.7%,有效率(CR+PR)85.9%,中位生存期为23.3个月,1、2、3年生存率为79.7%、49.4%、26.6%。对照组CR 25.9%,PR 38.9%,有效率(CR+PR)64.8%,中位生存期为15.8个月,1、2、3年生存率为63.6%、31.2%、13.0%。介入组与对照组之间疗效差异有统计学意义(P<0.05)。无严重并发症发生。结论:经支气管动脉化疗栓塞结合放疗、静脉化疗治疗中心型肺癌能延长患者的中位生存期,提高患者的生存率,具有较好的临床疗效。     

动脉灌注化疗并栓塞治疗中晚期恶性肿瘤935例临床疗效及并发症分析

目的:为总结动脉灌注化疗合并栓塞术治疗各种中晚期恶性肿瘤的临床疗效以及并发症发生的原因。材料与方法:采用回顾性临床总结过去6年中935例各种中晚期肿瘤.共进行动脉插管化疔药物灌注2715例次,肿瘤供血动脉栓塞675例次,所用化疗药物一般2～3联.所用栓塞剂为40%碘化油5～20ml 以及明胶海绵碎屑。结果:935例病人CR113例,PR201例,MR288例,SD241例,PD92例,总有效率(CR+PR+MR)为63.2%。栓塞后综合征发生率为6.6%。结论:经皮穿刺肿瘤供血动脉插管化疗药物灌注及栓塞术对中晚期恶性肿瘤的疗效肯定。     

125I粒子植入联合支气管动脉灌注治疗中晚期肺癌的临床应用

目的 评估125I粒子植入联合支气管动脉灌注化疗治疗中晚期肺癌的临床疗效.方法 回顾性分析行125I粒子植入联合支气管动脉灌注化疗的中晚期肺癌患者30例的疗效和不良反应,每例粒子植入数为3～70粒(6711型,0.7 mCi/粒).所有患者分别在粒子植入术前7 d、术后30、60 d进行支气管动脉灌注化疗,根据RECIST标准判定疗效.结果 所有患者共40个病灶均成功植入125I粒子,未发生手术相关严重并发症,术后随访2～24个月.本组患者2年生存率为86.6%(26/30),术后4个月评估疗效:CR 26例,PR 10例,NC 2例,PD 2例,总有效率为90%.结论 125I植入联合支气管动脉灌注化疗治疗中晚期肺癌疗效明显,是一种治疗中晚期肺癌安全,有效的方法之一.     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

经支气管动脉化学栓塞术治疗中心型肺癌的疗效分析

目的：探讨经支气管动脉化学栓塞治疗中心型肺癌的近期疗效。方法：对25例病理确诊的原发性中心型肺癌进行选择性支气管动脉插管造影，并将3F同轴微导管置于肿瘤的供血动脉内注入适当剂量的碘化油＋顺铂乳剂。结果：经支气管动脉化学栓塞治疗后，临床症状改善率为100％，且无严重并发症发生，1年生存率为72％（18／25）。结论：经支气管动脉化学栓塞术治疗中心型肺癌具有较好的临床疗效。     

肝脏磁共振波谱分析对肝癌化疗栓塞后疗效评价的试验性研究

目的:应用磁共振波谱(MRS)技术评价兔肝癌化疗栓塞的疗效。方法:建立兔肝癌模型,Seldinger's法股动脉插管行选择性肝动脉造影,采用化疗栓塞术(TACE)治疗,治疗前后行MRS扫描,记录MRS各峰的峰值。结果:TACE治疗后的肝脏肿瘤组织具有一个异常增高的PCr峰,治疗后的PME/PDE比例较治疗前明显降低。结论:MRS作为无创性检查方法,可用于评价化疗的栓塞疗效。     

肝脏磁共振扩散加权成像对肝癌化疗栓塞后疗效评价的实验性研究

目的应用MR扩散加权成像(diffusion weighted imaging,DWI)技术评价兔肝癌化疗栓塞疗效。材料与方法首先建立兔VX2肝癌模型,采用Seldinger’s法经股动脉插管行选择性肝动脉造影成功后,行肝动脉化疗栓塞术(TACE),治疗前后行MR DWI,记录表观扩散系数(apparent diffusion coefficient,ADC)值。结果 DWI图像质量随b值增加而明显下降。整个肿瘤ADC值TACE术前为(1.48±0.36)×10 s/mm2,TACE术后为(1.78±0.15)×10 s/mm2,两者差异有统计学意义(t=2.885,P<0.05)。结论 MR DWI作为无创性检查方法,可以用于评价肝癌化疗栓塞疗效。     

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.     

Transcatheter arterial chemoembolization of hepatocellular carcinoma: usefulness of coded phase-inversion harmonic sonography

OBJECTIVE: The purpose of our study was to assess the value of coded phase-inversion harmonic sonography performed approximately 1 week after the patients had undergone transcatheter arterial chemoembolization with iodized oil for hepatocellular carcinoma. SUBJECTS AND METHODS: We studied 40 patients with 44 nodules measuring 1.5-11.0 cm in diameter (mean +/- SD, 3.9 +/- 2.0 cm) who underwent transcatheter arterial chemoembolization. Coded phase-inversion harmonic sonography, a technique based on a combination of phase-inversion harmonics and coded technology, was performed with a contrast agent approximately 1 week after chemoembolization. The results were compared with those obtained using dynamic CT (n = 44 lesions) and dynamic MR imaging (n = 20 lesions). We also evaluated the recurrence of hepatocellular carcinoma during clinical follow-up in 17 patients who did not undergo additional local therapy. RESULTS: The detection rates of intratumoral vascularity of coded phase-inversion harmonic sonography, dynamic CT, and dynamic MR imaging were, respectively, 38 (86%) of 44 lesions, 19 (43%) of 44 lesions, and 10 (50%) of 20 lesions. Of 19 nodules of hepatocellular carcinoma treated only by transcatheter arterial chemoembolization, 17 nodules showed enhancement on coded phase-inversion harmonic sonography, suggesting incomplete responses. In all 17 nodules, apparent recurrence was noted on dynamic CT during clinical follow-up, even in nodules that had been observed to be completely filled with iodized oil 1 week after the chemoembolization. CONCLUSION: We found coded phase-inversion harmonic sonography to be highly sensitive and accurate for evaluating the treatment response in patients with hepatocellular carcinoma even shortly after treatment. Consequently, it allows early recognition of the need for additional local ablation therapy and estimation of the risk of hepatocellular carcinoma recurrence.     

左侧膈下动脉参与肝癌供血的介入治疗研究

目的 探讨左膈下动脉(LIPA)对肝癌的供血及其介入性栓塞在肝癌治疗中的价值.评价经导管行LIPA栓塞化疗的安全性和效果.资料与方法 对16例经DSA确认有LIPA 参与肝癌供血者进行肝动脉栓塞化疗术(TACE).其中,结节型15例,巨块型1例.术前行CT或MRI平扫及增强扫描,术中常规行腹腔动脉、肝动脉及膈下动脉造影,在确认供血范围后将导管超选择至供血支,先用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海绵颗粒或聚乙烯醇(PVA)颗粒.观察术后临床经过、相关实验室检查和影像学表现,并与DSA进行对照分析.结果 病灶位于肝左叶13例(81.2%):5例位于S3, 5例位于S2,3例位于S4.病灶位于肝右叶(S5)3例 (18.8%).16例患者LIPA TACE全部成功.8例进行LIPA化疗栓塞时发现肝动脉完全阻塞.2例术后发生左下肺叶盘状肺不张和少量胸腔积液.结论 LIPA参与肝癌供血多见于多次行TACE的患者并且肿块位于肝左叶.栓塞LIPA的安全性很高,并发症少且多为自限性.     

Transcatheter Arterial Chemoembolization with Spherical Embolic Agent in Patients with Pulmonary or Mediastinal Metastases from Breast Cancer

Purpose

To evaluate safety and feasibility of transcatheter arterial chemoembolization with superabsorbent polymer microspheres (SAP-MS) for patients with pulmonary or mediastinal metastasis from breast cancer.

外生性肝癌的血供特点及介入治疗

目的探讨外生性肝癌血供特点及经肿瘤供血动脉化疗栓塞术的疗效。方法5例外生性肝癌经股动脉插管,肿瘤供血动脉造影、化疗栓塞治疗,用榄香烯350 mg肿瘤血管内热灌注化疗和顺铂60～80 mg加碘油8～15 ml乳剂及明胶海绵化疗栓塞。结果5例患者共行10次经血管途径的化疗栓塞术。造影显示肿瘤供血动脉以肝外血管为主,肝动脉部分参与供血。5例患者术后瘤体缩小30%～50%,4例AFP下降。结论外生性肝癌有不同于肝内肝癌的血供特点,经肿瘤供血动脉化疗栓塞术对外生性肝癌同样有效,是可供选择的治疗方法之一。