硫普罗宁在肝动脉化学栓塞治疗肝癌中的护肝作用

硫普罗宁 (商品名凯西莱 )是一种含游离巯基的甘氨酸衍生物 ,具有肝脏解毒和改善肝功能的作用。我们在对原发性肝癌患者进行肝动脉化学栓寒 (TACE)前后采用凯西莱治疗 ,以期减轻TACE后时肝功能的损伤 ,取得较好疗效。资料和方法一、临床资料5 6例均为住本科治疗的原发性肝癌患者 ,男 42例 ,14例 ,年龄 2 0～ 67岁 ,平均 49.5岁 ,诊断均符合《中国常见恶性肿瘤诊治规范》。分成两组 ,其中治疗组 3 2例 ,对照组 2 4例。二、治疗方法对照组每例给予维生素C ,门冬氨酸钾镁等护肝治疗 ,治疗组在TACE前 3天起加用凯西莱 0 .2g加入 5 %GS 2 5…     

硫普罗宁对肝癌介入治疗后肝损害的修复作用

硫普罗宁(tiopronin)注射液是一种新型的含巯基甘氨酸类药物，是治疗肝脏疾病的自由基清除剂，对肝脏组织、细胞具有保护作用。我科采用硫普罗宁治疗肝癌介入术后所致的肝功能损害，取得了较好的临床治疗效果，现报道如下。     

肝癌患者动脉化疗栓塞治疗后上消化道粘膜损害

本文对17例肝癌患者行20次肝动脉化疗栓塞(TACE)后上消化道粘膜损害的发生率和内镜下特征进行初步探讨。TACE后有12例次出现新的上消化道粘膜损害或原病损加剧占60％,损害部位自食道至十二指肠降部,粘膜呈弥漫性或局灶性。粘膜损害呈不规则充血、水肿、糜烂和粘膜下出血灶。分析其损害原因可能与栓塞物质造成粘膜缺血、抗癌药物毒性作用和应激反应有关,鉴此,在行TACE术前建议应常规做胃镜检查。     

肝癌病人动脉化疗栓塞致上消化道粘膜损害

近年来国内外有关动脉化疗栓塞(TACE)治疗中晚期肝癌报道较多,但对术后上消化道粘膜损害报道较少,国内尚未见报道。我院近1年来对17例中、晚期肝癌患者分别在 TACE 术前、后行纤维胃镜检查,旨在了解上消化道粘膜损害的发生率及内镜下特征。     

肝动脉化疗栓塞术对肝癌患者肝功能影响评价

肝动脉化疗栓塞术 (ＴＡＥ)广泛用于不能手术的肝癌患者 ,其疗效取决于对肝癌组织的杀灭和对正常肝组织的保护两方面。本文对 71例ＴＡＥ术前后肝功能的变化及影响因素进行分析 ,探讨ＴＡＥ对肝脏损害的程度及其临床意义。材料与方法一、临床资料选择肝癌患者 71例 ,男 47例 ,女 2 4例。年龄为 2 3～ 74岁 ,肝癌病例经临床和 /或病理检查确诊 ,肝硬化病例均符合1995年北京会议制定的肝硬化诊断标准。二、治疗方法经股动脉穿刺 ,超选择导管进入肝固有动脉或肝叶、肝段动脉内 ,灌注阿霉素 40～ 5 0ｍｇ ,丝裂霉素 12～ 16ｍｇ ,有时加 5 -氟尿…     

硫普罗宁对D—氨基半乳糖所致肝损害保护作用

目的与方法 实验采用Ｄ－氨基半乳糖（Ｄ（ＧａｌＮ）诱导的大鼠急性肝损伤模型，观察大鼠肝脏酶组织化学的变化，探讨硫普罗要对急性肝损伤的保护作用，结果与结论 硫普罗宁可显著改善Ｄ－氨基半乳糖所致肝损害的ＳＤＨ活性，及ＣＣＯ，ＣｈＥ的功能，对肝细胞膜系统也有定的保护作用，其对肝损伤的保护作用与肝得健一致。     

经肝动脉化疗栓塞治疗原发性肝癌56例

2005年2月-2006年2月,我院采用经导管肝动脉化疗栓塞术（TACE）治疗原发性肝癌56例,取得满意疗效。现报告如下。     

肝动脉插管化疗栓塞对肝癌患者常规肝功能的影响

肝动脉插管化疗或／和栓塞（以下简称插管治疗）目前已成为原发性及继发性肝癌中晚期治疗的一种常用方法［１～３］。我院自１９９２年２月至１９９７年１２月对７７例肝癌病人进行插管治疗，现将该疗法对肝功能的影响分析如下。材料与方法一、病例：共７７例，其中原发性...     

肝动脉化疗栓塞对肝癌术后高危复发患者的疗效分析

目的 探讨原发性肝癌切除术后肝动脉化疗栓塞(TACE)的疗效.方法 将86例肝癌术后的高危复发患者分为干预组(TACE治疗组)和对照组(未行TACE治疗组).术后高危复发的标准为:①单发病灶>5 cm;②病灶数≥2处;③术后病理检查有镜下癌栓.符合其中任意一条为术后高危复发患者.干预组术后1～2月行TACE治疗.结果 ...     

中药用于肝动脉栓塞化疗所致肝损害效果观察

肝动脉栓塞化疗是目前治疗中晚期肝癌的有效方法,但对肝功能可造成损害。自1999年3月以来,我们将中药用于40例肝动脉栓塞后肝功能损害患者,取得较好疗效。     

CT引导经导管动脉化疗栓塞治疗肝细胞癌

目的探讨CT引导经导管动脉化疗栓塞（transcatheter arerial chemoembolization,TACE）治疗肝细胞癌（hepatocellular carcinoma,HCC）的初步疗效,分析局部复发的危险因素。方法对32例患者的34个HCC病灶进行了CT引导TACE治疗。结果32例中26例实现局部控制,6例出现局部复发。采用Logistic回归分析发现,TACE治疗后中央型HCC病灶是局部复发的危险因素（P=0．0408）。结论CT引导TACE是治疗小HCC的好方法,其局部控制率高、复发率低。中央型HCC是TACE术后局部复发的危险因素。     

多烯磷脂酰胆碱治疗原发性肝癌经导管肝动脉化疗栓塞相关性肝损伤的临床研究

目的观察多烯磷脂酰胆碱治疗原发性肝癌(primary liver cancer,PLC)患者行经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)后肝损伤的效果。方法 66例PLC患者被随机分为治疗组和对照组,每组各33例,均行TACE治疗。TACE治疗前2天,对照组开始接受谷胱甘肽等药物常规保肝治疗,治疗组在对照组基础上加用多烯磷脂酰胆碱静脉滴注,930 mg/d。在药物治疗前和TACE治疗后第3天检测2组患者的TBIL、前白蛋白、ALT和AST水平。结果治疗组经多烯磷脂酰胆碱治疗后,TBIL、ALT和AST与对照组相比均显著改善(P均0.05)。结论多烯磷脂酰胆碱治疗PLC患者TACE相关性肝损伤效果较好。     

Combined hepatocellular carcinoma and neuroendocrine carcinoma with sarcomatous change of the liver after transarterial chemoembolization

Primary hepatic neuroendocrine carcinoma is rare and its origin is not clearly understood. An admixture of hepatocellular carcinoma (HCC) and neuroendocrine carcinoma is particularly rare. Here, we report a patient with an extremely rare combination of HCC and neuroendocrine carcinoma of the liver. To our knowledge, this is the first reported case in which the carcinoma showed sarcomatous change. The patient was a 76‐year‐old man who had received outpatient treatment for chronic hepatitis C. On abdominal computed tomography (CT), the hepatic tumor was enhanced in the arterial phase but its density was lower than that of normal liver in the portal phases. His serum α‐fetoprotein (AFP) level was very high. Therefore, transarterial chemoembolization (TACE) was performed based on the diagnosis of HCC. Ten months after TACE, his serum AFP level had increased to the level measured before TACE. Partial hepatectomy was performed because CT revealed poor enhancement of the recurrent tumor. Histopathologically, the tumor consisted of two distinct components: moderately differentiated HCC was intermingled with a neuroendocrine carcinoma, which was accompanied by sarcomatous changes. Immunohistochemically, the neuroendocrine carcinoma cells were positive for CD56, chromogranin A and neuron‐specific enolase, and negative for AFP. The sarcomatous area was positive for AE1/3 and CD56, consistent with sarcomatous change of neuroendocrine carcinoma. The neuroendocrine carcinoma and/or sarcomatous change may have been due to phenotypic changes and/or dedifferentiation of HCC induced by TACE. Six months after surgery, the patient was diagnosed with metastasis of the neuroendocrine carcinoma to sacral bone. He died 7 months after surgery.     

Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma

Resection of hepatocellular carcinoma (HCC) offers the only hope for cure. However, in patients undergoing resection, recurrences, in particular, intrahepatic recurrence are common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for unresectable HCC was exploited by numerous liver units and employed preoperatively in the setting of resectable HCC with an aim to prevent recurrence and prolong survival. A systematic literature search of databases (Medline and PubMed) to identify published studies of TACE administered preoperatively as a neoadjuvant treatment for resectable HCC was undertaken. A systematic review by tabulation of the results was performed with disease‐free survival (DFS) as the primary endpoint. Overall survival (OS), rate of pathological response, impact on surgical morbidity and mortality and pattern of recurrences were secondary endpoints of this review. Eighteen studies; three randomized trials and 15 observational studies were evaluated. This comprised of 3927 patients, of which, 1293 underwent neoadjuvant TACE. The median DFS in the TACE and non‐TACE group ranged from 10 to 46 and 8 to 52 months, respectively, with 67% of studies reporting similar DFS between groups despite higher extent of tumour necrosis from the resected specimens indicating a higher rate of pathological response (partial TACE 27–72% vs. non‐TACE 23–52%; complete TACE 0–28% vs. non‐TACE zero), with no difference in surgical morbidity and mortality outcome. No conclusion could be drawn with respect to OS. Both randomized and non‐randomized trials suggest the use of TACE preoperatively as a neoadjuvant treatment in resectable HCC is a safe and efficacious procedure with high rates of pathological responses. However, it does not appear to improve DFS.     

肝动脉栓塞化疗联合CT引导精准微波消融治疗原发性肝癌患者疗效及对外周血T淋巴细胞亚群的影响

目的 探讨肝动脉栓塞化疗（TACE）联合CT引导精准微波消融治疗原发性肝癌患者的疗效及对外周血淋巴细胞亚群的的影响。方法 2010年1月~2014年12月新疆维吾尔自治区阿克苏地区第一人民医院肿瘤内科收治的原发性肝癌患者60例,对30例患者行TACE治疗,另30例在行TACE治疗后7天接受CT引导下精准微波消融术。采用酶联免疫吸附法测定血清α-L-岩藻糖苷酶水平,使用流式细胞仪检测外周血T淋巴细胞亚群水平。结果 在治疗3个月后,TACE治疗患者临床有效率为50%（15/30）,显著低于联合治疗组患者的83.3%（25/30,P<0.05）;联合治疗患者2 a生存率为70.0%,显著高于TACE治疗组的43.3% （P<0.05）;联合治疗患者2 a复发率为10%,显著低于TACE的36.7%（P<0.05）;治疗后,联合组外周血CD4⁺、CD8⁺、CD4⁺/CD8⁺比值、血清α-L-岩藻糖苷酶水平分别为（39.05±4.07）%、（21.35±3.24）%、（1.67±0.21）、（17.91±2.98） u/L,较TACE组的（28.63±3.61）%、（35.12±4.62）%、（0.96±0.11）、（26.03±4.75） u/L改善更明显（P<0.05）;治疗期间,两组患者均在TACE术后出现一些轻症反应,如腰酸、腹胀、恶心等,予以对症治疗及护理后均消失。结论 TACE联合CT引导下经皮精准微波消融治疗原发性肝癌患者临床效果确切。与单用TACE治疗比,可提高长期生存率,降低复发率,纠正机体免疫功能紊乱。     

超选择性化疗栓塞术治疗高龄肝癌102例分析

目的探讨老年中晚期肝癌肝动脉化疗栓塞的效果。方法回顾性分析102例高龄肝癌患者，采用肝动脉化疗栓塞的临床随访资料。结果102例老年中晚期肝癌进行147次化疗栓塞，总有效率（CR＋PR）72．5％，半年生存率为79．1％，1年生存率为39．5％，2年生存率为7．8％。结论老年中晚期肝癌行肝动脉化疗栓塞是安全而有效的介入治疗方法。     

Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization

BACKGROUND AND AIMS: The aim of this study was: (i) to define the characteristics of hepatocellular carcinoma (HCC) associated with recurrences following initial remission by transcatheter arterial chemoembolization (TACE); (ii) to evaluate the patterns of recurrences; and (iii) find a better surveillance method of detecting recurrent HCC. METHODS: Out of 230 consecutive HCC patients who underwent TACE, 77 with initial remission were followed prospectively for at least 12 months. We compared the recurrence rates according to the characteristics of the tumors and analyzed the locations of the recurrent HCC. The diagnostic efficacies of CT scans with serum AFP, angiography and Lipiodol CT scan in detecting recurrent HCC were also evaluated. RESULTS: Recurrent HCC was detected in 40 patients during a median period of 27 months. The recurrence rate of multinodular HCC was higher than the single nodular type. All six patients with portal vein thrombosis recurred. Even though 45% of recurrences were adjacent to original tumors, 63% were separated from them (8% at both). Hepatocellular carcinoma with heterogeneous Lipiodol uptake tended to recur at the site adjacent to the original tumors more frequently than HCC with homogeneous Lipiodol uptake. Only 18 of 40 recurrent HCC were initially detected by serum alpha-fetoprotein (AFP) and CT scans: 19 by angiography and three only by Lipiodol CT scan. CONCLUSION: Our data indicated that HCC of the multinodular type and with portal vein thrombosis recur more frequently following initial remission by TACE. It is also suggested that regular angiography in addition to serum AFP and CT scan may be valuable in detecting recurrent HCC. Other treatment modalities may need to be combined to ablate tumors completely and to therefore reduce recurrences, especially in HCC with heterogeneous Lipiodol uptake.