放射性粒子立体植入治疗肿瘤

放射性粒子立体植入治疗肿瘤是一种非常有效的治疗手段，它的优点在于：（１）放射性粒子立体植入可以提高靶区局部与正常组织剂量分配比；（２）肿瘤的再增殖由于受到射线持续的照射而明显减少；（３）由于剂量率下降而肿瘤的氧增比减少。出于安全的考虑，放射性核素必须释放低能量光子、利用特殊植入设备和特殊的三维治疗计划系统。１放射性粒子植入治疗的特点 放射性粒子立体植入治疗包括短暂插植和永久植入两种。短暂插植治疗使用的同位素是１９２Ｉｒ和１３７Ｃｓ，通过术中插植导管，利用后装治疗机将放射源运输到肿瘤部位进行照射；…     

放射性^125I粒子植入在脑胶质瘤治疗中的应用

脑胶质瘤由于其特殊的解剖位置及生物学特性，外科手术通常不易完全切除，并且容易复发，因此，脑胶质瘤的治疗应采用多学科综合治疗。放射性^125I粒子植入是应用放射性同位素技术在肿瘤组织内进行放射治疗，由于其具有特殊的生物学和物理学特性，近年来的研究结果显示：放射性^125I粒子植入治疗脑胶质瘤局部控制率高、并发症发生率低，可以提高肿瘤患者的生存率，被认为是一种较为有效的治疗手段。     

125I放射性粒子组织间植入在局部进展期胰腺癌治疗中的研究进展

胰腺癌是难治恶性肿瘤之一,其发病率及死亡率均较高,缺乏有效治疗手段,近年来我国相继开展125I放射性粒子植入治疗局部进展期胰腺癌.放射性粒子植入治疗肿瘤具有微创、并发症少、安全性高等特点,并可提高肿瘤局部控制率和患者生存质量.全文就125I放射性粒子植入治疗胰腺癌的治疗方法、安全性及临床疗效作一综述.     

放射性粒子组织间植入近距离治疗恶性肿瘤

放射性粒子组织间植入是一种近距离治疗恶性肿瘤的新颖而有效的手段。在治疗程序上包括微型放射源，放射剂量计算，治疗计划与剂量验证等3个环节。粒子组织间植入方法分影像引导下植入和手术中植入。这种方法已经在许多肿瘤的综合治疗中取得了满意效果。     

结直肠癌患者放射性粒子125I植入后近期不良反应观察

目的探讨放射性粒子植入的安全性。方法手术切除肿瘤后在瘤区、相应引流血管根部或瘤体内植入不同剂量的放射性粒子^125I。结果血液系统的不良反应，粒子植入组与非粒子植入组患者之间差异无显著性。粒子植入组患者腹部并发症的发生率为14．0％，非粒子植入组为7．8％（P〉0．05）。粒子植入组患者中，年龄〈60、60～69和≥70岁三组腹部并发症率分别为4．3％、8．6％和30．8％（P〈0．005）；有、无并存疾病患者并发症率为25．9％和4．5％（P〈0．005）。结论手术中放射性粒子植入较为安全，但是，高龄和并存疾病可能增加放射性粒子植入后腹部并发症发生的危险性，对于高龄及有并存疾病的患者要慎重。     

放射性125Ⅰ粒子植入治疗肺肿瘤52例

目的 探讨放射性125Ⅰ粒子植入治疗肺肿瘤的方法和效果.方法 2004年8月至2008年12月应用放射性125Ⅰ粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统(TPS)和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量(MDP),在CT引导下经皮穿刺植入放射性125Ⅰ粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能.评估生活质量(Karnofsky评分).结果 肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91.1%.而对血象、肝肾功能影响不大,Karnofsky评分提高.结论 合理分布的125Ⅰ粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效.是肺肿瘤有效的综合治疗手段之一.     

放射性125Ⅰ粒子植入治疗肺肿瘤52例

目的 探讨放射性125Ⅰ粒子植入治疗肺肿瘤的方法和效果.方法 2004年8月至2008年12月应用放射性125Ⅰ粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统(TPS)和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量(MDP),在CT引导下经皮穿刺植入放射性125Ⅰ粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能.评估生活质量(Karnofsky评分).结果 肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91.1%.而对血象、肝肾功能影响不大,Karnofsky评分提高.结论 合理分布的125Ⅰ粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效.是肺肿瘤有效的综合治疗手段之一.     

放射性125Ⅰ粒子植入治疗肺肿瘤52例

目的 探讨放射性125Ⅰ粒子植入治疗肺肿瘤的方法和效果.方法 2004年8月至2008年12月应用放射性125Ⅰ粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统(TPS)和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量(MDP),在CT引导下经皮穿刺植入放射性125Ⅰ粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能.评估生活质量(Karnofsky评分).结果 肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91.1%.而对血象、肝肾功能影响不大,Karnofsky评分提高.结论 合理分布的125Ⅰ粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效.是肺肿瘤有效的综合治疗手段之一.     

放射性125Ⅰ粒子植入治疗肺肿瘤52例

目的 探讨放射性125Ⅰ粒子植入治疗肺肿瘤的方法和效果.方法 2004年8月至2008年12月应用放射性125Ⅰ粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统(TPS)和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量(MDP),在CT引导下经皮穿刺植入放射性125Ⅰ粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能.评估生活质量(Karnofsky评分).结果 肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91.1%.而对血象、肝肾功能影响不大,Karnofsky评分提高.结论 合理分布的125Ⅰ粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效.是肺肿瘤有效的综合治疗手段之一.     

放射性125Ⅰ粒子植入治疗肺肿瘤52例

目的 探讨放射性125Ⅰ粒子植入治疗肺肿瘤的方法和效果.方法 2004年8月至2008年12月应用放射性125Ⅰ粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统(TPS)和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量(MDP),在CT引导下经皮穿刺植入放射性125Ⅰ粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能.评估生活质量(Karnofsky评分).结果 肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91.1%.而对血象、肝肾功能影响不大,Karnofsky评分提高.结论 合理分布的125Ⅰ粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效.是肺肿瘤有效的综合治疗手段之一.     

肝癌组织中PTEN基因蛋白表达的研究

目的 探讨肝癌组织中抑癌基因PTEN蛋白的表达情况及其临床病理意义。方法 应用免疫组织化学S－P法检测41例肝细胞癌、5例胆管细胞癌及其相应的癌旁组织中PTEN蛋白的表达情况，同时结合患者的临床病理资料进行分析。结果 46例癌旁组织PTEN全部阳性表达，癌组织中PTEN阳性表达率为36．9％，阴性表达率为63．1％。PTEN蛋白在肝癌组织中的阳性表达与患者性别、年龄及组织类型无明显相关性，但与组织分化程度明显相关。结论 肝癌组织中PTEN蛋白阴性表达率较高，说明PTEN基因失活在肝癌的发生发展中起着重要作用，PTEN阳性表达有一定的预后意义。     

Safety and growth suppressive effect of intra-hepatic arterial injection of AdCMV-p53 combined with CDDP to rat liver metastatic tumors

Surgical resection is thought to be the best treatment for liver carcinoma, including hepatocellular carcinoma and metastatic liver carcinoma if there are a small number of tumors. Liver carcinoma is one of the main causes of death from cancer worldwide. The prognosis of liver carcinoma is still poor. Mutation of p53, which is well known as a tumor suppressor gene, is observed in many cases of advanced liver carcinoma. Cancer gene therapy using p53, which transduces the wild-type p53 gene in the tumor, is a promising new strategy for treating liver carcinoma. Selective and less invasive gene delivery to the liver tumor is necessary for clinical liver tumor gene therapy. The first purpose of the current study was to determine the best way to deliver the gene of interest to the liver tumor selectively. The second purpose was to study the tumor suppressive effect of intrahepatic arterial injection of an adenovirus vector with the p53 gene (AdCMV-p53), followed by administration of CDDP and noting its side effects. We injected AdCMV-LacZ via hepatic arteries of rats bearing RCN-9 colon cancer metastasis in the liver. Injection via the hepatic artery resulted in more successful gene transduction to the liver tumor in a tumor-selective manner than did injection via the portal vein. At 48 hrs after arterial injection of AdCMV-p53, CDDP (3 mg/kg) was administered in the peritoneal cavity of each rat. The use of CDDP with arterial injection of AdCMV-p53 resulted in more extensive apoptosis in the rat liver tumors without any deterioration in liver function. In conclusion, hepatic arterial injection of an adenovirus vector is better than portal vein injection for gene transduction efficiency, and causes no liver function disorder even when the injection is combined with CDDP.     

原发性肝癌蓖麻凝集素受体的观察

应用蓖麻凝集素(RCA)以ABC亲和细胞化学方法标记原发性肝癌组织,其RCA受体阳性率为86.4％(57/66),其中肝细胞癌63例,胆管上皮癌3例,其阳性率分别为85.7％(54/63)和100.0％(3/3),而对照组包括10例正常肝组织,9例肝炎,22例肝硬化的肝细胞均无RCA受体表达。作者认为,RCA受体出现是原发性肝癌重要标记之一。结果表明,RCA受体阳性率与肝细胞癌分化程度或排列方式无明显关系,但RCA受体分布型式与肿瘤分化程度似乎有一定关系,提永低分化肝细胞癌糖基可能更加紊乱。本文结果还显示,癌旁宿主部分肝细胞RCA受体呈阳性,这种化学结构异常先于形态学改变,对于认识癌前病变及诊断也有重要意义。     

Liver resection in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma is a leading cause of cancer death worldwide. Liver resection and liver transplantation remain the only options for cure. Since the indications for orthotopic liver transplantation are limited, partial liver resection is the more common treatment. Recently, indications for liver resection have been expanded and there have been advances in the associated surgical techniques. This review describes the state-of-the-art of liver resection for hepatocellular carcinoma. Topics covered include: new indications, such as treatment of large tumors, bilobar tumors and those associated with vascular invasion; preoperative assessment of liver function; and surgical strategies. An overview of the most common staging systems, which are useful in predicting prognosis after liver resection for hepatocellular carcinoma, is given.     

原位肝移植治疗原发性肝癌６８例报告

目的：探讨原位肝移植在原发性肝癌治疗中的价值。方法：对６８例接受肝移植原发性肝癌病例进行回顾性分析,随访６个月以上,对术后患者存活情况进行分析。结果：６８例肝移植手术均获成功,无围手术期死亡,５４例存活至今,最长无瘤存活已达６５个月。小肝癌复发率为２.２％（１／４６）,大肝癌复发率为５４.５％（１２／２２）,其中肝内门脉分支有癌栓者复发率为６６.６％（４／６）,门脉主干有癌栓者为１００％（３/３）;小肝癌患者的存活时间显著长于大肝癌（Ｐ＝０.０００）。此外,肝癌肝移植术后及早停用类固醇激素,并维持抗排斥药物在较低的药物浓度也可能有助于减少肿瘤术后复发。结论：原位肝移植是治疗肝癌特别是小肝癌的有效手段,对于门静脉主干无癌栓的中晚期肝癌也能起到积极治疗作用。     

Liver resection in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma is a leading cause of cancer death worldwide. Liver resection and liver transplantation remain the only options for cure. Since the indications for orthotopic liver transplantation are limited, partial liver resection is the more common treatment. Recently, indications for liver resection have been expanded and there have been advances in the associated surgical techniques. This review describes the state-of-the-art of liver resection for hepatocellular carcinoma. Topics covered include: new indications, such as treatment of large tumors, bilobar tumors and those associated with vascular invasion; preoperative assessment of liver function; and surgical strategies. An overview of the most common staging systems, which are useful in predicting prognosis after liver resection for hepatocellular carcinoma, is given.     

肝癌切除术中血流控制方法的临床研究

本研究旨在探讨原发性肝癌（以下称肝癌）切除术中血流控制的方法，以了解不同方法术中出血量、血流动力学的改变和术后血液生化的变化，从而选择肝癌不同术式最佳血流控制的方法。研究结果表明：周边型的较小肝癌应选择局部血流控制法；而位于下腔静脉附近或侵犯下腔静脉的肝癌应选择Ｂｉｓｍｕｔｈ氏法；位于中心部位的较大肝癌如无肝硬化可选择Ｐｒｉｎｇｌｅ氏法，如合并有肝硬化，选择性入肝血阻断应为道选的方法。     

Identification of differentially expressed genes in hepatocellular carcinoma and metastatic liver tumors by oligonucleotide expression profiling

BACKGROUND: The characterization of differentially expressed genes between cancerous and normal tissues is an important step in the understanding of tumorigenesis. Global gene expression profiling with microarrays has now offered a powerful tool to measure the changes of thousands of genes in any carcinoma tissues in an effort to identify these key disease-related genes. To compare the gene expression of a primary liver carcinoma, metastatic carcinoma to the liver, and normal liver, the authors analyzed tissue from six primary hepatocellular carcinomas (HCCs), five colorectal adenocarcinoma metastases to the liver, and eight normal livers. METHODS: Samples were processed from total RNA to fragmented cRNA and hybridized onto Affymetrix GeneChip(R) expression arrays. Analyses were performed to determine the consensus pattern of gene expression for primary liver carcinoma, metastatic liver carcinoma, and normal liver tissue and their changes in expression level. RESULTS: In hepatocellular carcinoma, 842 genes were overexpressed, and 393 genes were underexpressed in comparison with genes of normal liver tissue. Of note, 7 of the 20 most increased identified known genes previously have been associated with liver carcinoma or other types of cancers. The 13 additional identified genes until now have not previously shown strong association with cancers. Furthermore, the authors identified 42 genes and 24 expressed sequence tags that are expressed at a significant level in both HCC and metastastic tumors, presenting a list of marker genes indicative of cancerous liver tissue. CONCLUSIONS: In this study, genes that can be involved in the production of and maintenance of hepatic carcinomas were identified. These data offer new insight into genes that are potentially important in the pathogenesis of liver carcinoma, as well as additional targets for new strategies for cancer therapy and treatment.     

Oral contraceptive-associated liver cell adenoma and hepatocellular carcinoma. Cytomorphology and mechanism of malignant transformation.

From January 1976 to May 1990, 1673 patients with a liver mass or masses detected by imaging techniques underwent percutaneous fine-needle aspiration biopsy of the liver. Of these, 99 were diagnosed cytologically as "hepatocellular carcinoma" and 9 as "consistent with liver cell adenoma." The cytologic diagnoses were confirmed in the follow-up of all cases. Among the 99 patients with hepatocellular carcinoma, 3 had taken oral contraceptives for a period of 10, 11, and 12 years, respectively. The nine patients with liver cell adenoma were all users of oral contraceptives over a period ranging from 5 to 10 years. Of these, two who had taken oral contraceptives for a period of 8 and 10 years, respectively, had foci or areas of liver cell dysplasia within the adenomas. The cytologic criteria for the diagnosis of liver cell dysplasia included cytoplasmic and nuclear enlargement, nuclear pleomorphism together with prominent nucleoli, hyperchromasia and multinucleation. The cytologic features of liver cell dysplasia strikingly mimic hepatocellular carcinoma. From this study, the foci or areas of liver cell dysplasia arising within the liver cell adenomas appear to be the missing link responsible for the transformation of liver cell adenoma to carcinoma. It is believed that liver cell adenomas are not premalignant and may undergo reversible change after withdrawal of causative agents, whereas liver cell dysplasia is an irreversible, premalignant change and will eventually progress to hepatocellular carcinoma.     

晚期原发性肝细胞癌的药物治疗

原发性肝癌（PLC）是临床上常见的消化系统恶性肿瘤之一,90%以上为肝细胞癌（HCC）。大多数原发性肝细胞癌患者存在肝炎基础疾病,肝功能差,局部治疗后易复发,确诊时已到晚期,进展快,预后极差。晚期原发性肝细胞癌系统治疗包括基础肝病治疗、系统化疗、分子靶向治疗、免疫治疗,本文就晚期原发性肝细胞癌的系统化疗、分子靶向治疗、免疫治疗作一综述。