动脉灌注栓塞治疗难治性绒癌肺转移成功1例报告并文献复习

笔者近来对绒癌肺转移1例进行肺动脉灌注栓塞治疗,取得了很好的疗效,现报道如下并结合文献进行分析讨论。女,25岁,主因绒癌半年于2002-12-17入院。患者半年来经过4个疗程的静脉化疗(5-Fu1疗程、OMP2疗程、MAC一疗程)。血β-HCG于第1个疗程后降为正常,并在以后的随访中一直维持在正常水平,胸部X片提示:左下肺野转移灶直径2cm,经过4个疗程的化疗后,一直未能消失或缩小,彩色B超及妇科查体未查及异常。诊断为难治性绒癌Ⅲa期。患者化疗期间反应严重,骨髓抑制Ⅳ级,消化道反应Ⅳ级[1]。不堪忍受化疗之苦,行经皮股动脉穿刺插管超选择性肺动脉…     

双侧同时性原发性乳腺癌2例

例 1,女 ,4 6岁。 4个月来自觉双乳腺无痛性肿块由黄豆大小增至蚕豆大小 ,无乳头溢液溢血。否认乳腺癌家族史。查体 :左乳外上象限可触及 1.5ｃｍ× 1.5ｃｍ大小肿块 ,右乳外侧可触及 1.0ｃｍ× 1.5ｃｍ大小肿块 ,质中 ,边界清 ,双侧腋下未触及肿大淋巴结。门诊经检查诊为双乳良性肿块 ,并在局麻下行双乳肿块切除术 ,术后病理报告为双乳浸润性导管癌收治入院。入院后在全麻下行双乳改良根治术 ,术后患者恢复良好 ,术后病理报告双乳浸润性导管癌 ,右腋窝淋巴结 1/ 11转移 ,左腋窝淋巴结 0 / 11转移 ;ＥＲ(- ) ,ＰＲ <2 0 % ,ｅｒｂＢ 2 (+)术…     

外生性肝癌误诊肾上腺转移1例报道

患者　男 ,43岁。因确诊肝癌 3月 ,疑右肾上腺转移 10ｄ于 2 0 0 1-0 3 -14入院。 3月前 ,腹部ＣＴ示肝右叶占位性病变 ,范围约 7.2ｃｍ× 8ｃｍ× 8.5ｃｍ ,边界清楚。ＡＦＰ >40 0ｎｇ/ｍｌ。乙型肝炎病毒标志物第 1、4、5项阳性。经皮肝穿刺活组织病理检查 :肝细胞癌 (ＥｄｍｏｎｄｓｏｎⅡ级 )、病毒性肝炎及肝硬化。先后于 2 0 0 0 -12 -13和 2 0 0 1-0 1-15在我科接受了两次经导管肝动脉栓塞化疗 (ＴＡＣＥ)。 3月 5日外院腹部ＣＴ报告提示 :肝癌介入术后改变 ,碘油沉积良好 ,肝内病灶缩小 ;疑右肾上腺转移(图 1)。入院后第二天行ＩＡ…     

肺动脉化疗药盒埋置术治疗肝癌肺转移

目的 研究肺动脉化疗导管药盒置术治疗原发性治疗原发性肝癌肺转移的疗效。方法 原发性癌肺转移病例６２例,其中一侧肺转移者１９例,两侧肺转移者４３例。除常规肝动脉化疗栓塞治疗外,加作经锁骨下静脉穿刺肺动脉化疗导管药盒埋置术。一侧肺转移病灶者,导管头端埋于患者侧肺动脉内;两侧转移灶者,导管头端埋于肺部动脉处。化疗方案为ＦＤＭ或ＦＤＡ。如果肝癌控制良好,则在药盒内每月注入化疗药物１次。结果 肺动脉化疗药盒     

肝癌介入化疗后髂动脉栓塞一例

患者女５３岁,临床确诊为原发性肝癌,伴右肝多发转移;腹腔动脉造影显示,右肝内多血供性多发转移瘤,有寄生性动脉供血,右膈下动脉及网膜右动脉参与肿瘤供血。曾２次经右股动脉选择性肝固有动脉插管化疗每次经导管一次性灌注５ＦＵ１２５０ｍｇ、ＣＤＤＰ４０ｍｇ。...     

胸片和动态CT上类似动静脉畸形的转移性绒癌

作者报告了1例绒癌肺转移类似动静脉畸形(AVM)的病人。妊娠性绒癌是一种起源自妊娠期滋养层的。肺是最常见的转移部位,发生率为45～87%。病人31岁,因咳血住院。三年前曾患绒癌而化疗。胸片见右肺下叶-2～3cm的分叶状结节,并有两支较大供养血管。动态CT扫描见一早期增强的肿块,造影剂廓清快。在其后内侧另有一结节。手术切除-4×2.5×2 cm大小的圆柱状肿块。显微镜下见一低分化的恶性肿瘤,其HCG免疫过氧化酶染色强阳性,与转移性绒癌相符。以往尚无胸片及动态CT上类似静脉畸形的绒癌肺转移报     

CDFI与血β—HCG联合诊断滋养细胞肿瘤的临床价值

目的：探讨彩色多普勒血流显像（ＣＤＦＩ）与血β绒毛膜促性腺激素（β－ＨＣＧ）联合诊断滋养细胞肿瘤的临床应用价值。材料和方法：观察组５１例，对照组５０例，所有病例均在人工流产或刮宫术以及化疗前后作ＣＤＦＩ及血β－ＨＣＧ检测，并与手术病理对照。结果：恶性肿瘤内血流为高速低阻特性，以ＰＳ≥６０ｃｍ／ｓ、ＲＩ≤０．４６作为诊断恶性肿瘤界定指标，其敏感性为９３．１％，特异性９５．５％，准确性９４．１％。与血β－ＨＣＧ联合测定，诊断准确率更为提高，动态观察化疗患者，两指标呈正相关。结论：ＣＤＦＩ检测对鉴别良恶性质具有应用价值，与血β－ＨＣＧ联合应用，既能提高符合率，又可作为评价化疗效果及判断预后的有效指标     

原发性肝癌肝动脉内灌注化疗、栓塞的治疗

我院自1992～1996年行肝动脉内灌注化疗(ＴＡＩ)、栓塞(ＴＡＥ)治疗原发性肝癌42例,现将其中资料完整的34例进行分析讨论,以便进一步提高其治疗水平。1　资料和方法34例中男30例,女4例,年龄42～68岁,平均56岁,均经临床检查诊断为肝癌。结节型8例,巨块型26例,肿瘤直径4.2～10.5ｃｍ,平均7.6ｃｍ。伴有肝硬化者30例。采用Ｓｅｌｄｉｎｇｅｒ方法,将导管插入腹腔动脉或选择性插入肝动脉及肝固有动脉进行化疗药物灌注(图1),化疗药物用5-Ｆｕ1000ｍｇ、ＭＭＣ10～20ｍｇ、ＤＤＰ50ｍｇ;外周栓塞用ＭＭＣ10ｍｇ与40%碘化油(Ｌｐ)的混悬剂(图2),中…     

青年人巨大肺腺癌自发破裂并大出血

男 ,30岁。咳嗽、咯血痰伴胸痛 10余天 ,于 1996 -0 6 -17入院。 13ｄ前因咳嗽、痰带血丝伴左胸刺痛而求医。经治疗无效 ,近日症状加重。既往身体健康 ,近一年有吸毒史 ,戒毒后 2 0ｄ出现症状。体检 :左肺呼吸音低 ,未闻干湿性罗音 ,左胸后部叩诊呈实音。Ｘ线检查 :左肺见一巨大椭圆形肿块约 14ｃｍ× 13ｃｍ× 12ｃｍ ,边缘光滑完整 ,其内见少许散在性小钙化点。纵隔向前移位 (图 1,2 )。ＣＴ检查 :左肺见一混合密度的巨大圆形肿物 ,其内见点片状钙化。大小为 9.5ｃｍ× 9.5ｃｍ× 12ｃｍ ,ＣＴ值 39～ 10 4ＨＵ ,边缘光整 ,肿块与后胸壁接…     

瘤区注射高聚生协同微波凝固治疗肝癌的临床观察

对 2 2例经组织病理学诊断的肝癌志愿者的 2 8个结节行高聚生瘤区注射治疗。其中 ,肝细胞癌 (ＨＣＣ) 19例 ,转移癌 3例 ,原发癌为胃癌者 2例 ,直肠癌 1例 ;低分化癌 9例 ,中分化癌 11例 ,高分化癌 2例。肿瘤最大径线 1 7～ 5 5ｃｍ ,平均 3 8ｃｍ。其中 ,<3ｃｍ者 8例 ,3～ 5ｃｍ 9例 ,>5ｃｍ 5例 ;单发结节者 16例 (占 73% ) ,双结节者 6例 (占 2 7% )。全部病例均于高聚生肝内注射前接受超声引导经皮穿刺微波凝固治疗 ,并经穿刺组织学活检证实肿瘤呈凝固性坏死。高聚生肝内注射前行常规肌肉注射 ,试验性给药3天 ,剂量分别为 5 0 0Ｕ、10…     

慢性阻塞性肺部疾病的肺功能与CT肺功能研究

慢性阻塞性肺疾病(chronic obstructive pulmonarydisease,COPD)是指具有气流阻塞的慢性支气管炎和肺气肿。没有气流阻塞的慢性支气管炎和肺气肿不属于COPD。慢性阻塞性肺疾病以不可逆性气流受限为特征,继发于气道炎症和肺实质的肺气肿性改变。气道高反应性也是COPD的常见征象[1]。因此,对怀疑有COPD的患者,临床诊断常用肺功能试验(pulmonaryfunction test,PFT)测定第1秒用力肺活量实测值与预测值百分比(forced expiratory volume at1second,FEV1%)、第1秒用力肺活量与用力肺活量(forced vi-tal volume,FVC)的比值(FEV1/FVC)等…     

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

CardioVascular and Interventional Radiology - Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially lethal outcome of pulmonary embolism. Balloon pulmonary angioplasty (BPA) is...     

Pulmonary embolism

Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. In addition, areas of the lung that are not well ventilated will be poorly perfused. Thus, a ventilation scan and a chest radiograph are essential to optimal interpretation of the perfusion scan. Ventilation/perfusion scans are interpreted as degrees of probability of pulmonary embolism. Emboli are not present in patients with a normal V/Q scan. An embolus is unlikely (10%-15%) among patients with a low-probability V/Q scan. However, small emboli that are nonocclusive may be present, and pulmonary arteriography may be used to further evaluate patients with a high clinical suspicion of pulmonary embolus.(ABSTRACT TRUNCATED AT 400 WORDS)