肝切除联合导管栓塞化疗及无水酒精治疗合并门脉癌栓的肝癌(附28例报告)

经病理证实合并门脉癌栓的肝癌患者50例,其中28例行肝癌切除、术中门脉取栓及肝切缘无水酒精注射,术后肝动脉灌注栓塞化疗及门脉化疗;另22例行肝癌切除,门脉取栓,术中未用无水酒精,术后无化疗.结果示观察组与对照组相比,术后并发症分别为7.1%和9.0%,术后0.5、1、3年生存分别为80.8%、73.1%、26.9%和71.4%、33.3%、0%.肝切除联合导管栓塞化疗及无水酒精注射是提高合并门脉癌栓的肝癌远期疗效的有效措施.     

原发性肝癌合并门静脉癌栓的外科治疗

目的:探讨原发性肝癌合并门静脉癌栓的外科治疗及提高疗效的方法。方法:采用肝叶切除和经门静脉残端或主干切开取癌栓术治疗32例PHC合并PVTT患者,12例术后联合门静脉、肝动脉介入化疗,5例合并门静脉高压联合行断流术、脾切除或脾动脉结扎术。总结其临床资料、治疗方法、术后并发症及疗效预后,并进行统计学分析。结果:①本组病例术中出血量、输血量、肝门阻断次数时间、术后并发症发生率与同期50例单纯肝癌切除组比较无显著性差异(P>0.05)。②术后并发症:9例肝功能不全,3例术后肝断面出血、5例右胸腔积液、2例上消化道出血,1例术后3个月死于肝功能衰竭,其余恢复良好。③疗效与预后:随访26例,1、2、3年生存率分别为50％、34.6％、15.4％;术后化疗、术前肝功能状况对预后有显著影响。结论:肝叶切除和经门静脉残端或主干切开取癌栓是治疗原发性肝癌合并门静脉癌栓最有效的方法,改善术前肝功能及术后联合化疗,对提高生存期意义重大;门静脉取癌栓联合贲门周围血管断流、和/或脾切除、脾动脉结扎术能有效治疗肝癌合并门静脉高压,减少上消化道出血并发症;对于难以切除的PHC合并PVTT应争取行TACE术,仍有二期手术切除的机会。     

肝癌介入治疗术后合并肝功能损害的预防

目的观察肝癌患者经肝动脉灌注化疗栓塞术后肝功能损害的情况。方法针对我院接受介入治疗的50例肝癌患者术后肝功改变情况，探讨如何预防肝癌介入术后出现肝功能损害。结果大部分患者治疗后均有不同程度的肝功能损害，以弥漫性肝癌、合并肝硬化及有门脉癌栓患者出现肝损害严重。结论肝癌介入治疗对肝功能有一定的损害，严格掌握适应证及禁忌证，加强术前、术后保肝治疗，才能避免出现肝功能衰竭等严重并发症。     

经皮经肝门脉导管药盒植入治疗肝癌7例报告

对于失去手术机会的中晚期肝癌患者,肝动脉灌注化疗栓塞术成为目前主要的治疗手段。同时联合微波治疗、热射频消融治疗、冷冻治疗、B超引导下的瘤体内无水酒精注射等治疗措施均有一定的疗效,故对中晚期肝癌由单一的治疗模式转变综合治疗模式。我科2002年10月至2004年6月对7例不能手术的中晚期肝癌患者经肝动脉灌注化疗栓塞术无效者,行经皮经肝门脉导管药盒植入,门静脉持续灌注化疗取得了较好疗效,现报道如下：     

原发性肝癌

金龙胶囊联合肝动脉化疗栓塞治疗原发性肝癌疗效观察；热休克蛋白-抗原肽复合物疫苗预防肝癌术后复发32例；肝切除、冷冻及射频治疗对肝细胞癌血源性播散影响的研究；Survivin，Caspase-3蛋白在原发性肝癌中的表达及意义；AFP、AFU、SF联检对原发性肝癌的诊断价值；原发性肝癌并门静脉癌栓的肝动脉化疗栓塞治疗。[编按]     

肝癌伴门静脉高压症的肝切除术

目的探讨合并门脉高压症的肝癌患者手术切除疗效。方法分析东方肝胆医院1996年至2001年共626例肝癌患者的临床资料,随访终点为2008年9月1日,以死亡作为终点事件。对外科治疗的生存率及预后相关危险因素进行分析。结果合并门脉高压症患者术后1、3、5、10年生存率分别为79.9%、48.7%、37.3%和21.2%,非门脉高压症患者分别为82.7%、54.8%、42.4%和29.7%,两者差异无统计学意义(P>0.05);肿瘤数目>1个、微血管癌栓、肿瘤无包膜或不完整、肿瘤直径>10cm及HBsAg阳性是影响术后生存的独立危险因素。结论门脉高压症并不是肝癌外科手术的禁忌证,对于合并有门脉高压症的肝癌患者,只要肝功能储备良好,肝切除术仍能获得较好的术后生存率。     

选择性肝动脉结扎栓塞化疗并无水酒精注射治疗中晚期肝癌56例

选择性肝动脉结扎栓塞化疗并无水酒精注射治疗中晚期肝癌５６例湖北医科大学附属第二医院（武汉，４３００７１）刘志苏钱群艾中立我们自１９９２年７月至１９９６年７月采用选择性肝动脉结扎栓塞并无水酒精注射治疗５６例中晚期肝癌疗效满意，现报道如下。１临床资料本组...     

TACE治疗不可切除原发性肝癌合并下腔静脉癌栓1例

原发性肝癌(primary liver cancer,PLC)直接侵犯下腔静脉形成癌栓较少见,预后极差。有研究表明,对于原发病灶可切除的患者,外科切除联合取栓术是可行的治疗选择;而针对原发病灶不可切除的患者,目前尚无具体治疗建议。现报道1例不可切除PLC合并下腔静脉癌栓患者行肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)治疗的经过。     

老年可切除肝癌伴门静脉癌栓预后的影响因素分析

[目的]分析老年可切除肝癌伴门静脉癌栓预后的影响因素。[方法]入选对象254例,均为接受了肝癌根治性切除+门静脉切开取栓、门静脉癌切除、右半肝或左半肝切除的老年患者,治疗完毕后均进行了随访,每半年随访1次,汇总收集的资料中涉及到多项内容[性别、分化程度、肿瘤直径、癌栓分型、合并肝硬化、甲胎蛋白、术后肝动脉化疗栓塞术(TACE)、肝内转移、癌栓类型]。[结果]随访结束后,生存患者共84例(生存组),死亡患者共170例(死亡组)。2组性别、分化程度、癌栓类型、甲胎蛋白比较差异无统计学意义(P>0.05);与生存组比较,死亡组低分化、肿瘤直径≥8 cm、患有肝硬化的例数均超过生存组,并且手术完成后,行TACE例数、出现肝内转移、浸润癌栓类型均超过生存组(P<0.05)。将单因素分析中差异有统计学的指标归入多因素分析,表明低分化、肿瘤直径≥8 cm、术后TACE、肝内转移、浸润型癌栓是影响预后的主要因素。[结论]影响老年可切除肝癌伴门静脉癌栓预后的主要因素是分化程度、肿瘤直径、术后TACE、肝内转移和癌栓类型。     

原发性肝癌合并肝动脉-门静脉瘘的相关因素及临床特点

目的:探讨原发性肝癌合并肝动脉-门静脉瘘(hepatic arterioportal fistula,HAPF)发生的部分相关因素及临床特点.方法:152例行肝动脉化疗栓塞术的原发性肝癌患者按血管造影是否合并HAPF分为观察组和对照组,对比分析临床及影像学资料,探讨影响HAPF发生的部分相关因素及临床特点.计量资料采用两样本均数t检验,计数资料采用?2检验或Fisher精确概率法,以P<0.05为差异有统计学意义.结果:观察组在肝功能B级及C级、腹水、上消化道出血及门脉瘤栓发生率高于对照组(t=4.858、4.522、4.496、6.024,均P<0.05),HAPF容易出现于巨块型血供丰富肝癌(P<0.05),两组在合并肝硬化、肝内子灶及甲胎蛋白异常无显著性差异(P>0.05).观察组介入治疗短期内瘘口改善率89.9%,22.2%患者门脉高压症状明显缓解.结论:原发性肝癌合并HAPF产生与肝癌血供丰富、肿瘤巨大及门脉癌栓关系密切,容易损害患者肝功能并加重门脉高压症状.介入栓塞治疗可短期内改善分流并部分缓解临床症状.     

Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement

AIM: The aim of this study was to examine the effectiveness and toxicity of radiation therapy in combination with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with extensive portal vein tumor thrombus (PVTT). METHODS: The combined therapy was performed in 24 HCC patients with extensive PVTT. External radiation targeted for PVTT (50 Gy in 2 Gy fractions) was performed in combination with repetitive TACE for intralobar lesions using 30-60 mg epirubicin every 3 months, and associations of the following variables with the survival rate were evaluated: gender, age, viral etiology, Child's class, performance status, extrahepatic metastasis, size and number of HCC, and location of PVTT. RESULTS: The local response confined to PVTT was complete response (CR) in four patients, partial response (PR) in eight patients, no change (NC) in eight patients, and progressive disease (PD) in four patients. By using the stepwise Cox's regression analysis, only Child's class was associated with the survival rate. The survival rates after 1 and 2 years were 73 and 21% in Child's A, 10 and 0% in Child B or C, and 61 and 21% in patients in whom the local response was CR or PR, and 19 and 9% in those in whom the local response was NC or PD, respectively. By using the multiple logistic regression analysis, Child's class was the only factor associated with the local response (P = 0.006). CONCLUSIONS: The combined therapy is feasible and may be useful to reverse PVTT in patients with good hepatic function reserve.     

介入治疗原发性肝细胞癌合并门静脉癌栓66例的临床分析

目的探讨介入治疗原发性肝癌(hepatic cell carcinoma,HCC)合并门静脉癌栓(portal vein tumor thrombus,PVTT)的临床疗效与安全性。方法收集第三军医大学大坪医院收治的66例HCC患者,按照随机数字表法分为联合治疗组和经导管动脉化疗检塞术(TACE)治疗组。联合治疗组采用TACE联合门静脉化疗(PVC)治疗,TACE治疗组采用单独TACE治疗,比较两组患者的临床疗效。结果治疗半年后联合治疗组治疗的有效率和PVTT缩小率分别为72.73%和78.79%,显著高于TACE治疗组的63.64%和51.52%(P0.05)。联合治疗组患者的中位生存时间及半年、1年、2年生存率均较TACE治疗组高(P0.05)。1个月后联合治疗组的毒副反应发生率为36.36%,显著低于TACE治疗组的81.82%(P0.05)。治疗半年后联合治疗组和TACE治疗组的AFP分别为(425.36±113.32)IU/ml和(725.32±113.32)IU/ml(P0.05)。结论 TACE联合PVC治疗HCC合并PVTT可提高中、晚期HCC患者治疗的有效率,改善患者的生存质量,还可降低抗癌药所产生的毒副反应和AFP水平。     

Improved survival for hepatocellular carcinoma with portal vein tumor thrombosis treated by intra-arterial chemotherapy combining etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil: A p

AIM: To investigate the poor prognosis of HCC with PVTT, we evaluated the efficacy by a new combination chemotherapy for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).METHODS: From 2002 to 2007, a total of 10 consecutive patients with Stage IVA HCC accompanied by PVTT were studied prospectively to examine the efficacy of treatment by intra-arterial infusion of a chemotherapeutic agents consisting of etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil.RESULTS: The mean course of chemotherapy was 14.4 (range, 9-21) mo. One patient showed complete response (CR) with disappearance of HCC and PVTT after treatment, and the two patients showed partialresponse (PR), response rate (CR + PR/All cases 30%).The median survival time after the therapy was 457.2 d. The one-year survival rate was 70%. Adverse reactions were tolerable.CONCLUSION: Although the prognosis of most patients with Stage IVA HCC by PVTT is poor, our combination chemotherapy may induces long-term survival and is an effective treatment and produced anti-tumor activity with tolerable adverse effects in patients for advanced Stage IVA HCC accompanied by PVTT.     

Improved survival for hepatocellular carcinoma with portal vein tumor thrombosis treated by intra-arterial chemotherapy combining etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil： A pilot study

AIM： To investigate the poor prognosis of HCC with PVTT, we evaluated the efficacy by a new combination chemotherapy for advanced hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVTT）.
METHODS： From 2002 to 2007, a total of 10 consecutive patients with Stage IVA HCC accompanied by PVTT were studied prospectively to examine the efficacy of treatment by intra-arterial infusion of a chemotherapeutic agents consisting of etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil.
RESULTS： The mean course of chemotherapy was 14.4 （range, 9-21） too. One patient showed complete response （CR） with disappearance of HCC and PVI-F after treatment, and the two patients showed partial response （PR）, response rate （CR ＋ PR/All cases 30%）. The median survival time after the therapy was 457.2 d. The one-year survival rate was 70%. Adverse reactions were tolerable.
CONCLUSION： Although the prognosis of most patients with Stage IVA HCC by PVTT is poor, our combination chemotherapy may induces long-term survival and is an effective treatment and produced anti-tumor activity with tolerable adverse effects in patients for advanced Stage IVA HCC accompanied by PVTT.     

Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus

BACKGROUND/AIMS: To study the value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). METHODOLOGY: From January 1997 to December 2001, 63 cases of HCC with portal vein tumor thrombus underwent liver resection combined with PVTT removal (group 1). Between December 2001 and December 2003, 20 patients received adjuvant portal vein chemotherapy (PVC) after the surgical procedures mentioned above (group 2). Treatment outcome and the surgical features in these two groups were studied. RESULTS: The median overall survival in group 2 was significantly longer than that in group 1 (10.9 months vs. 7.8 months, p < 0.05). There were significant differences between the survival of the two groups (log-rank, p < 0.05). In group 1 the 1-, 3-, and 5-year survival rates were 18.0%, 14.8% and 1.6%, respectively. In group 2 the 1-year survival rate was 30%. CONCLUSIONS: Liver resection combined with PVTT removal and the postoperative PVC is beneficial to the survival of HCC patients with PVTT. Postoperative PVC might enhance the effect of these surgical approaches.     

Efficacy of therapy for advanced hepatocellular carcinoma: intra-arterial 5-fluorouracil and subcutaneous interferon with image-guided radiation

Background and Aim: To evaluate the efficacy of intra‐arterial 5‐fluorouracil (5‐FU) and subcutaneous interferon (IFN) combined with image‐guided radiation therapy (IGRT) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods: Twenty HCC patients with PVTT were treated with 5‐FU and IFN combined with image‐guided radiation therapy (IGRT) (IGRT group), and as controls, 20 patients with PVTT were treated with 5‐FU and IFN alone (non‐IGRT group). Overall survival (OS) time, response rates, time to progression (TTP) and safety were compared across groups. Results: Complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) of PVTT were 5%, 55%, 40% and 0% in the IGRT group and 0%, 30%, 35% and 35%, in the non‐IGRT group, respectively. CR, PR, SD, and PD of the whole tumor were 0%, 35%, 45% and 20% in the IGRT group and 0%, 30%, 35% and 35%, in the non‐IGRT group, respectively. Overall median survival was significantly longer in the IGRT group (12.0 months 95% confidence interval [CI], 9.3–17.6 months) than in the non‐IGRT group (9.1 months [95% CI, 5.5–11.1 months]) (P = 0.041). TTP was significantly longer in the IGRT group (6.9 months [95% CI, 5.6–10.2 months]) than in the non‐IGRT group (4.0 months [95% CI, 3.3–6.4 months]) (P = 0.034). Conclusions: The response rates, median OS time and TTP in patients with advanced HCC with PVTT who received this novel combination therapy of intra‐arterial 5‐FU and subcutaneous IFN with IGRT are encouraging, and this combination therapy warrants further investigation.     

Successful preoperative treatment for hepatocellular carcinoma with tumor thrombus in the major portal branch by three-dimensional conformal radiation therapy--two case reports

The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus in the main portal branch (PVTT) is very poor and a standard treatment regimen for HCC with PVTT has not yet been established. Therefore, a new strategy is necessary to control the patients of HCC with PVTT. Conventional radiation therapy for HCC was not effective because of low liver tolerance. On the other hand, because three-dimensional conformal radiation therapy (3D-CRT) can focus high-dose irradiation on a small area, we tried it for patients with PVTT as the preoperative adjuvant treatment. 3D-CRT which targeted the PVTT was performed for two HCC patients with PVTT before radical hepatectomy. Treatment schedules of 3D-CRT were as follows: in Case 1, the daily fraction size was 3 Gy, given five times per week, and the total dose was 39 Gy. In Case 2, the daily size was 6 Gy and the total dose was 60 Gy. Three or four weeks after 3D-CRT, the main tumor and PVTT were completely removed. On histological examination, the PVTT showed complete necrosis in Case 1, and 60% necrosis in Case 2. No serious complications occurred, and there have been no recurrences for more than one year after surgery in both cases. 3D-CRT targeting the PVTT may be promising as a preoperative adjuvant therapy for HCC with PVTT.     

内镜下射频热疗联合局部化疗治疗晚期大肠癌的随机对照研究

目的：探讨射频加局部化疗治疗晚期大肠癌的疗效,并与单纯射频治疗比较。方法选择晚期大肠癌失去手术切除时机患者55例行射频加局部化疗或单纯射频治疗,随机分为射频加局部化疗组（A组）27例、射频组（B组）28例,观察两组患者5年内肠梗阻缓解率、再转移率、生存率。结果 A组与B两组1～5年肠梗阻缓解率分别为88.9%vs 70.8%、95.8 vs 70%、89.5%vs 52.9%、100%vs 33.3%、100%vs 0,具有统计学差异（P＜0.05）;5年内再转移情况,A组27例无一例出现再转移,再转移率为0（0/27）,B组11例出现了新的转移病灶,再转移率为39.3%（11/28）,有统计学差异（P＜0.05）;A组5年生存率为44.4%（19/27）,B组为无一例生存,有统计学差异（P＜0.05）。结论内镜下射频热疗联合局部化疗能显著提高晚期大肠癌患者5年内肠梗阻缓解率和5年生存率,显著降低再转移率。     

榄香烯联合奈达铂胸腔灌注治疗肺癌恶性胸水

目的观察榄香烯联合奈达铂胸腔灌注治疗恶性胸水的疗效。方法将65例肺癌恶性胸水患者随机分成联合治疗组(34例)和对照组(31例),联合组给予两药联合,对照组单纯给予奈达铂。结果联合组有效率为88.23%,对照组为58.06%,(P0.01)。联合组生活质量改善优于对照组(76.47%,61.29%),(P0.05)。主要不良反应有骨髓抑制、发热、胸痛、消化道反应等,联合组发热、胸痛发生率高于对照组(P0.05),经对症处理可较好控制。结论榄香烯联合奈达铂胸腔注射治疗肺癌恶性胸水疗效确切,改善晚期肿瘤患者的生存质量,毒副反应较低,安全有效。     

Surgical treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus

The Barcelona Clinic Liver Cancer staging system recommends a tyrosine kinase inhibitor (sorafenib) as standard therapy in advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). Sorafenib has been shown to prolong median overall survival (OS) by approximately 3 months in advanced HCC patients with PVTT (8.1 vs. 4.9 months). However, its clinical effectiveness is still controversial and standard treatment with sorafenib is not established in Japan. Surgical resection is considered a potentially curative treatment and provides an acceptable outcome for carefully selected patients. The surgical mortality rate in patients with PVTT who receive surgical resection ranges from 0% to 10%. The median survival time and 1-year OS rate in HCC patients with PVTT who undergo surgical resection have been found to range from 8 to 22 months and 21.7% to 69.6%, respectively. But improvement in therapeutic outcome is difficult with surgical treatment alone. Combination treatment in conjunction with such methods as transarterial chemoembolization, hepatic artery infusion chemotherapy, and radiotherapy has been found to improve the prognosis (median survival time, 11.5–37 months; 1-year OS rate, 46.8–100%). Yet, many problems remain, such as surgical indications and surgical techniques. After resolving these points, a multidisciplinary strategy based on surgical treatment should be established for advanced HCC with PVTT.