经皮血管内导管药盒系统植入术治疗耐药性滋养细胞肿瘤的临床分析

自1952年Cromer等首先报道动脉灌注化疗应用于子宫颈癌的治疗后,50多年来动脉插管的治疗方法应用于妇科肿瘤领域逐渐增多,特别是近十年以来,血管性介入治疗深入应用于妇科恶性肿瘤.本文主要在于探讨导管药盒系统（implantable port-catheter system,PCS）植入术在滋养细胞肿瘤领域的临床应用价值.     

经皮左锁骨下动脉导管药盒系统植入术(附13例报告)

目的　探讨经皮左锁骨下动脉导管药盒系统植入术的操作方法与技巧。方法　回顾分析 13例经皮左锁骨下动脉导管药盒系统植入术的操作过程、技术关键及植入后导管药盒系统的维护。结果　 13例病人均成功植入导管药盒系统 ,左锁骨下动脉穿刺成功率 10 0 % ,靶血管到位率 92 % ,无一例出现气胸、血胸等严重并发症 ,亦无发现导管移位、堵塞、化疗药渗漏致皮肤坏死等情况。结论　经皮左锁骨下动脉导管药盒系统植入术是一项创伤小、安全、病人容易接受的介入治疗 ,只要掌握操作要领 ,不会出现严重并发症。     

经皮股动脉导管药盒系统介入治疗肝细胞癌的临床应用

目的探讨经皮股动脉导管药盒系统介入治疗肝细胞癌的临床疗效及并发症。方法从1999年1月到2001年3月应用经皮股动脉植入导管药盒系统（PCS）对45例肝细胞癌患者进行化疗和碘油栓塞治疗，回顾性分析临床疗效及并发症。结果PCS介入治疗肝细胞癌的有效率为66．7％（30／45）。患者1、2、3年生存率为75．6％（34／45），33．3％（15／45），17．8％（8／45）。弪皮股动脉导管药盒植入术的并发症包括1例切口感染及切口延迟愈合，4例PCS堵塞和1例留置导管尖移位。所有并发症经适当处理后无严重后遗症。结论经皮股动脉导管药盒系统植入术对介入治疗肝细胞性肝癌是1种安全有效技术。     

进展期胃癌介入治疗的疗效评价

介入治疗进展期胃癌的方法主要有动脉灌注化疗，胃动脉栓塞术，经皮动脉穿刺植入药盒术等。对于可根治切除的进展期胃癌外科术前，术后及不能根治切除的进展期胃癌患者，可选择相应的方法，介入治疗术后疗效评价标准主要包括肿瘤病灶的改变，危及生命的临床症状的改善，肿瘤相关性抗原实验室检查，病理组织学，副反应，中位生存期，生存率的统计学分析和健康相关生命质量分析。目前的研究表明，进展期胃癌经介入治疗后确定起到了延长生存期并改善生存质量的效果，但是也还存在着一定的问题，今后的研究方向在于介入治疗方法的选择原则，如何最大限度减少对正常组织的损害以减少可能的并发症（尤其是痊塞剂的种类和量的研究），术前与术后介入治疗的选择原则，化疗方案的选择原则及循证医学在介入治疗进展期胃癌疗效评价中的应用。     

植入式导管药盒系统在肿瘤临床中的应用

植入式导管药盒系统在肿瘤临床中的应用李彩霞王庆良１９８１年植入式导管药盒系统（Ｉｍｐｌａｎｔａｂｌｅｐｏｒｔｃａｔｈｅｔｅｒｓｙｓｔｅｍ，ＰＣＳ）在美国问世，用于肿瘤治疗，扩大了治疗范围。近年来李彦豪、罗鹏飞教授率先在国内开展了此项工作［１］。常用...     

42例介入化疗药盒植入并发症分析

目的为探讨介入化疗药盒系统植入并发症原因及防治。方法回顾分析42例晚期肿瘤患者，经左锁骨下动脉置管14例，股动脉置管28例。结果药盒为Braun产品，肝素水注射间隔4～10周。共有8例（19％）发生并发症，其中4例再次手术。皮肤切口裂开3例，导管移位2例，导管扭曲、导管堵塞及囊内血肿各1例。认为并发症主要原因为病人营养差，凝血机制不佳，股动脉置管易牵拉及术者经验不足，不排除有少见的排异反应存在。结论建议药盒植入应由有经验者施术，并严格术后管理，推荐经左锁骨下动脉置管。     

经植入性药盒系统持续长程CF/5-Fu灌注化疗为主治疗中晚期肝脏肿瘤

长期以来，肝脏恶性肿瘤的介入治疗多在影像学界和介入放射学界开展，肿瘤临床学专业的医师参与较少，使与肿瘤介入治疗相关的肿瘤学某些问题未能得到很好的讨论，其结果可能导致治疗用药与肿瘤细胞代谢特点及药代动力学相悖。我们1999年1月至2002年12月，采用经植入性动脉导管药盒输注系统(PCS)，持续长程CF 5Fu灌注化疗为主治疗各种晚期肝癌27例，现报告如下：     

经皮导管药盒系统植入术在晚期恶性肿瘤中的应用

目的 探讨经皮导管药盒系统植入术在晚期恶性肿瘤治疗中的应用．方法 10例晚期恶性肿瘤病人，采用经右锁骨下静脉及右股动脉穿刺植入导管化疗药盒系统于右侧前胸壁及大腿内侧腹股沟下约3cm，留置管到达相应靶血管，术中给予化疗栓塞，术后行经药盒规则灌注化疗及定期护理。结果 10例病人成功植入10个导管药盒系统，无并发症发生。随访12个月均保持药盒通畅及无留置管移位。本组病人生存期最短10个月，最长约37个月。结论 经皮导管药盒系统植入术为行长期规律性晚期恶性肿瘤区域灌注化疗或化疗栓塞提供了一条安全、微创、简便有效的途径。在床边或门诊即可实现区域化疗，达到提高疗效，降低费用的效果，易为病人接受，不失为治疗恶性肿瘤良好手段。     

经皮股动脉植入导管药盒系统治疗转移性肝癌

 目的　探讨经皮股动脉植入导管药盒系统的临床疗效。方法　 30例转移性肝癌采用经皮股动脉植入导管药盒系统。依据肿瘤供血特点 ,在透视监控下 ,施行导管药盒系统植入式。结果　CR3例、PR1 4例、CR+PR5 6 .7% ,半年生存率 1 0 0 % ,1年生存率 5 3.3% (1 6 / 30 ) ,2年生存率1 6 .7% (5 / 30 ) ,无 1例严重并发症发生。结论　经皮股动脉植入导管药盒系统治疗转移性肝癌是安全可行 ,有效的。     

42例介入化疗经盒植入并发症分析

目的 为探讨介入化疗药盒系统植入并发症原因及防治。方法 回顾分析４２例晚期肿瘤患者,经左锁骨下动脉置管１４例,股动脉置管２８例。结果 药盒为Ｂｒａｕｎ产品,肝素水注射间隔４～１０周。共有８例（１９％）发生并发症,其中４例再次手术。皮肤切口裂开３例,导管移位２例,导管扭曲、导管堵塞及囊内血肿各１例。认为并发症主要原因为病人营养差,凝血机制不佳,股动脉置管易牵拉及术者经验不足,不排除有少见的排异反应存     

药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床研究

 目的　评价药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床效果。方法　采用左锁骨下动脉药盒埋置持续性动脉灌注化疗治疗的 2 5例胰腺癌患者为介入治疗组 ,同期接受全身化疗的 2 8例胰腺癌患者为全身化疗组 ,两组均给予健择 +5 氟尿嘧啶方案 ,比较两组临床受益反应、肿瘤大小变化、患者生存情况以及毒副反应。结果　介入治疗组和全身化疗组临床受益率分别为 5 2 .0 %和 2 1.4 %(P <0 .0 5 ) ;总有效率 (CR +PR)分别为 16 .0 %和 10 .7% (P >0 .0 5 ) ;中位生存时间分别为 8.1个月和 6 .8个月 (P >0 .0 5 ) ,半年累积生存率分别为 79.4 %和 5 2 .3% (P <0 .0 5 ) ;1年累积生存率分别为 35 .7%和31.5 % (P >0 .0 5 )。毒副反应以胃肠道反应为主 ,无Ⅲ度以上的血液学、胃肠道及肝肾功能的毒副反应。结论　药盒埋置持续性动脉灌注化疗可以提高中晚期胰腺癌的临床受益率和短期生存率     

经皮左锁骨下药盒肝动脉灌注拓僖为主治疗晚期肝癌临床分析

目的观察经皮左锁骨下药盒肝动脉灌注拓僖为主治疗晚期原发性肝癌的近期疗效.方法晚期原发性肝癌82例随机分两组: A组(一次性插管组)40例,每月一次插管介入化疗栓塞治疗;B组(药盒系统组)42例,经左锁骨下动脉植入药盒系统,栓塞治疗后连续灌注拓僖5 d,6 mg/(m2*d).结果 A组PR 19例(47.5%),NC 18例(45.0%),PD 3例(7.5%);B组PR 30例(71.4%),NC 9例(21.4%),PD 3例(7.1%).两组相比B组疗效明显优于A组(P<0.05),毒副作用B组明显低于A组(P<0.05).结论经皮左锁骨下药盒肝动脉灌注拓僖为主治疗晚期原发性肝癌副作用小,疗效高,值得进一步研究.     

经皮锁骨下动脉穿刺导管药盒植入系统的临床应用

作者报告21例经皮锁骨下动脉穿刺配合皮肤小切口植入导管药盒系统，行动脉内化疗灌注，治疗中晚期恶性实体瘤的初步经验。与外科剖腹和局部手术切开动脉植入法比较，本方法具有操作简单，创伤小，并发症少，安全可靠等优点。本文还对植入的技术要点，适应证和禁忌证的掌握，并发症的预防和处理进行了讨论。作者认为，对不能手术切除的中晚期实体瘤，该介入治疗方法适宜，并可取代外科手术植入。     

Clinical evaluation of the cordis vascular access port systems: A multicenter study

Two non-metallic vascular access port systems, the Multipurpose Access Port (MPAP) and Miniport, developed by CORDIS S.A., France, have been evaluated clinically in 78 cancer patients. During the investigational period covering a total experience of 369 treatment cycles and 1,370 infusion days, no cases of infection or septicemia were observed. Serious complications such as drug extravasation and catheter occlusion occurred, although the incidence was relatively low (±1%) when compared with the number of treatment courses (cycles), but in relation to the number of patients included in this study, the procedure-related complication rate was 17.5% for the MPAP and 15.8% for the Miniport. Procedure-related complications can be avoided by proper handling and use of suitable drug combinations to minimize crystallization reactions within the port-catheter systems. The final complication rate (total minus procedure-related) in terms of termination of treatment,i.e. explantation of the port-catheter system was 12.1% for the MPAP and 12.5% for the MINIPORT, which generally confirms the results of other groups. More than 87% of both port-catheter systems were still functional at the end of evaluation.     

Adverse Effects and Complications Related to the Use of Barium Sulphate Contrast Media for Radiological Examinations of the Gastrointestinal Tract: - A Literature Review -

Barium sulphate is considered a safe and efficacious contrast medium that is routinely used for radiologic examinations of the gastrointestinal tract. Although the examinations rarely result in complications, the technique is moderately invasive and not entirely innocuous. Complications resulting from the procedures, and adverse reactions from the barium itself, have ranged from mild to severe and in rare instances have led to patient death. This paper reviews the clinical application, biological requirements and clinical properties of barium sulphate contrast media used in diagnostic x-ray imaging. It also outlines the risk factors and associated adverse reactions and complications involved with the use of barium sulphate, and presents documented cases where iatrogenic injuries have resulted.     

A safe and simple method of percutaneous transfemoral implantation of a port-catheter access system for hepatic artery chemotherapy infusion]

The purpose of this study was to perform a simple percutaneous transfemoral implantation of a portcatheter access system using a new catheter coating for hepatic artery chemotherapy infusion, and to evaluate the complications of transfemoral infusion port implantation. The methods of treatment for complications were also studied. The port-catheter system was percutaneously implanted via femoral artery access in 180 patients with malignant liver tumors. Blood flow redistribution was performed using embolization coils. An unfixed 5 Fr catheter was placed in a hepatic artery, and connected to a port implanted subcutaneously below the level of the inguinal ligament. The success rate of implantation was 99%. Complications after placement were observed as follows: port system obstruction (9.6%); dislocation of the catheter tip (8.4%); drug toxicity (4.5%); and infection (3.4%). Notable is the avoidance of cerebral infarcts. In 3 of 17 patients with port obstruction, recanalization of the port was achieved. In 11 of 15 patients with catheter dislocation, replacement of the catheter-port system was successful. In 5 patients with hepatic artery occlusion, the replacement of a microcatheter-port access system was achieved, and hepatic artery chemotherapy infusion was resumed. This percutaneous transfemoral implantation of a catheter-port access system would seem to be a very simple and useful method for many clinical doctors, and it may improve the quality of life in patients with an unresectable malignant liver tumor.     

经股动脉药盒导管植入系统治疗晚期恶性肿瘤

目的 探讨应用经皮股动脉穿刺药盒导管植入系统（ＰＣＳ）对晚期恶性肿瘤进行介入治疗的可行性，临床疗效。并发症及其处理。方法 经ＰＣＳ化疗灌注和（或）化疗栓塞治疗５３例晚期恶性肿瘤，其中原发性肝癌２４例，肝转移瘤１３例，胰腺癌２例，胃癌２例，宫颈癌术后复发７例，直脾性癌术后盆腔转移３例，盆腔横纹肌肉瘤１例，左髂骨尤文氏肉瘤１例，每４－６周为一疗程。结果 ５３例患者经ＰＣＳ治疗后生存期５－１８个月，中位     

Hepatic arterial infusion chemotherapy (HAIC)--hepatocellular carcinoma

Hepatic arterial infusion chemotherapy (HAIC) has been often selected as a therapeutic option for advanced hepatocellular carcinoma (HCC) with intrahepatic metastases or portal vein thrombosis, which is not eligible for hepatic resection, tumor ablation, or embolization. Among various regimens, HAIC, consisting of 5-fluorouracil (5-FU) in combination with either low-doses of cisplatin (CDDP) or interferon-alpha has been reported to improve the response rates for advanced HCC. As both regimens require the use of an implanted port-catheter system, maintaining the patency of hepatic arteries is an important factor for the intrahepatic drug distribution and the efficacy of HAIC. Recently, a new product, CDDP powder has been also developed for intraarterial use, which adds a new option to HAIC. However, the long-term outcome or the survival benefit remains unclear with HAIC, and it may be significantly affected by liver function and cirrhosis. None of the regimens have been proved to be the standard for HAIC, and prospective multi-center clinical studies with standardized protocol are needed in the future.