胃癌根治术中腹腔低渗热灌注化疗的临床研究

目的探讨术中腹腔低渗温热灌注化疗对胃癌患者术后的临床疗效。方法将术中行一次性腹腔低渗温热灌注化疗的37例胃癌患者(灌注化疗组)与未行此方法的31例患者(对照组)的复发及预后情况进行比较。结果手术并发症2组间无显著性差异。灌注化疗组的术后复发率(18.91%)显著低于对照组(51.61%),复发时间亦显著晚于对照组,差异有显著性(P<0.01)。灌注化疗组1,3,5年生存率分别为8 8.5 6%,7 6.8 5%和5 2.3 1%,而对照组则分别为8 0.2 1%,5 7.9 2%和2 1.2 2%,两组比较3,5年生存率有显著差异(P<0.0 5)。结论一次性术中腹腔内低渗温热灌注化疗可降低患者术后复发率和提高生存率,操作简便、高效、安全。     

胃癌术中腹腔灌注术后动脉插管化疗效果观察

1994～1996年,我院对胃癌手术切除的病人,关腹前采用温热蒸馏水灌注腹腔、术后腹腔动脉插管化疗,并与单纯手术切除、术后静脉化疗进行比较。证明前者可使肝、腹腔内转移率减少,生存率提高。1对象和方法1．1对象同期手术切除胃癌146例,随机分为：术中腹腔灌注术后动脉插管化疗组（A组）89例,其中男68例,女21例,平均58岁;单纯手术切除术后静脉化疗组（B组）57例,其中男41例,女16例,平均55岁。两组性别、TNM分期、病变部位及手术方式具有可比性。1．2方法根治性手术A组sl例,B组52;姑息性手术A组8例,B组5例。术式：I。期行R…     

胃及大肠癌术后区域性动脉灌注化疗和腹腔泵温热灌注化疗的临床应用

目的探索胃及大肠癌术后的治疗、预防复发和转移的方法。方法对50例术后1～12个月胃及大肠癌患者依据化疗方法的不同分为两组:治疗组24例采取区域性动脉灌注化疗联合腹腔泵温热灌注化疗;对照组26例采取术后区域性动脉灌注化疗。跟踪随访12～36个月。结果治疗组生存率提高、术后肝转移率及腹腔内种植率均低于对照组,两者差异有显著性,P值<0.05。结论区域性动脉灌注化疗联合腹腔泵温热灌注化疗疗效明确,安全性高,能有效降低胃及大肠癌术后复发及腹腔内转移,并对术前已有腹腔内转移者能抑制肿瘤生长速度,延长患者生存期。     

卵巢癌术后腹腔温热灌注联合化疗疗效观察

目的:观察中晚期卵巢癌术后,行腹腔温热灌注联合静脉双途径化疗的临床疗效。方法:中晚期卵巢癌41例,随机分为观察组20例,于术后第7天行腹腔温热灌注联合静脉双途径化疗;对照组21例,术后第7天单纯行腹腔化疗。化疗方案为PC或PAC(顺铂 环磷酰胺 多柔比星),观察两组疗效及不良反应。结果:两组病例均随访3年,治疗组1、2、3年生存率分别为95%、85%和65%;对照组分别为80.9%、71.4%和33.3%。两组1、2年生存率比较,差异不显著(P>0.05);3年生存率比较,差异显著(P<0.05)。术后早期使用腹腔温热灌注联合静脉化疗均未出现严重不良反应。结论:中晚期卵巢癌术后行腹腔温热灌注联合静脉双途径化疗,可提高疗效,延长病人生存时间。     

手术联合腹腔化疗治疗胃癌86例

目的　探讨手术加腹腔化疗对胃癌的疗效。方法　对 86例胃癌病人实施姑息性胃癌切除术 (2 8例 )或胃癌根治术(5 8例 )并行腹腔化疗。结果　术后随访 1,3,5年生存率分别为 83.7% ,5 3.5 % ,2 5 .6 %。结论　胃癌术后早期腹腔化疗 ,是预防术后局部复发及肝转移的关键 ,能延长病人生存期 ,提高疗效。     

两种插管方法化疗预防直肠癌术后肝转移疗效观察

目的 :探讨肝动脉门静脉双插管皮下置泵化疗对直肠癌根治术后肝转移的疗效。方法 :将直肠癌根治术后 5 9例分为观察组 33例 ,采用肝动脉门静脉双插管皮下置泵化疗 ;对照组 2 6例 ,采用肝动脉插管化疗。两组化疗方案均为氟尿嘧啶 顺铂 (DDP) 丝裂霉素 (MMC)。结果 :术后随访 5年 ,经B超、CT、MRI证实 ,观察组肝转移 8例 (2 4 2 % ) ,死亡 13例 ,5年生存率 6 0 6 % ;均未发生因置管化疗所致大出血、血栓、肝肾功能障碍等并发症 ;对照组 5年肝转移 9例 (34 6 % ) ,死亡 14例 ,5年生存率 4 6 2 %。两组肝转移和生存率比较 ,差异显著 (P <0 0 5 )。结论 :直肠癌根治术后 ,以肝动脉门静脉双插管化疗可明显降低肿瘤肝转移的发生率 ,提高其 5年生存率。     

进展期胃癌术后加温低渗腹腔化疗的临床研究

进展期胃癌术后复发和转移的部位主要是手术野、腹膜表面和肝脏。作者采用术后加温低渗腹腔化疗来防治进展期胃癌术后腹腔复发和肝脏转移,疗效满意。     

氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌

目的探讨氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌的疗效。方法124例原发性肝癌患者随机分成两组，对照组64例，行肝动脉化疗栓塞治疗；联合治疗组60例，行肝动脉化疗栓塞治疗加氩氦刀冷冻术。肝动脉化疗栓塞一般每月进行1次，3次为一疗程；冷冻治疗一般每一疗程进行1～3次。结果对照组总有效率(CR PR)45．3％，联合治疗组为68．3％，两组间差异有显著性。对照组半年、1年、1年半的生存率，分别为81．3％、62．5％、43．8％，联合治疗组分别为93．3％、83．3％、63．3％，1年和1年半的生存率有显著差异。结论氩氦刀冷冻术配合肝动脉化疗栓塞术治疗原发性肝癌是一种有效的方法，可以延长患者的生存期。     

不同化疗时机对术后结肠癌患者预后影响的观察

目的：观察不同化疗时机对术后结肠癌患者预后的影响。方法：选择经病理组织学证实并接受手术治疗的结肠癌72例,随机分为A、B、C组各24例。3组均采用5-氟尿嘧啶联合奥沙利铂化疗方案,A组、B组、c组分别在术后1周、术后2周、术后3周开始实施化疗。随访60个月,观察项目包括化疗不良反应发生情况、术后1年复发及转移情况,并比较术后1年、3年、5年生存率。结果：3组间疲劳乏力、恶心呕吐、肌痛、便秘、食欲缺乏、失眠等不良反应发生率比较,均差异不显著（P〉0．05）。B组术后1年复发率及远处转移率均显著低于c组（P〈0．05）,5年生存率显著高于A组及C组（P〈0．05）;3组间1年及3年生存率差异不显著（P〉0．05）。结论：术后2周实施5一氟尿嘧啶联合奥沙利铂化疗方案可显著提高患者生存率,降低术后1年肿瘤复发及远处转移率。     

晚期胃癌动脉内灌注化疗栓塞的疗效分析(附54例报告)

目的：评价动脉内灌注化疗加栓塞治疗晚期胃癌的应用价值。方法：54例晚期胃癌，男37例，女17例，胃窦部8例，胃大弯侧8例。经股动脉穿刺，导管头端置于胃左动脉、胃右动脉、胃网膜右动脉，有肝转移者再超选入肝固有动脉；化疗方案，栓塞剂用碘化油。结果：复查病例中病灶有不同程度减小，临床症状减轻。治疗后半年、1年、2年生存率为94．4％、50％、40．7％。结论：胃动脉内化疗栓塞术是治疗晚期胃癌有效的方法之一。     

Arterial perfusion abnormalities of the liver after hepatic arterial infusion chemotherapy and their correlation with changes in the metastases: evaluation with CT and angiography

We studied the progress of hepatic arterial perfusion abnormalities in 50 patients receiving long-term arterial infusion chemotherapy for palliative treatment of liver metastases from colorectal cancers and correlated the findings with changes in the metastases. Intraarterially and IV enhanced CT scans and digital subtraction angiograms of the liver were made in all patients before chemotherapy and at 3-month intervals during chemotherapy for 1 year. Before the chemotherapy, all patients had normal hepatic arterial perfusion. Arterial perfusion abnormalities were detected in 30 patients (60%) after 6 months of chemotherapy and in 41 patients (82%) after chemotherapy for 1 year. After 6 months of chemotherapy, 36% of the regressive and 39% of the progressive metastases were located in areas with arterial perfusion abnormalities. After 1 year of chemotherapy, 54% of the regressive and 60% of the progressive metastases were situated in portions of the liver with perfusion abnormalities. Hepatic arterial perfusion abnormalities were found to be progressive during intraarterial infusion chemotherapy. No relationship between arterial perfusion abnormalities and tumor response to chemotherapy could be detected.     

结直肠癌肝转移综合介入治疗的临床应用

目的:探讨介入治疗结直肠癌肝转移(colorectal liver metastases,CLM)的临床疗效。方法:将77例无法手术切除或切除不完全的CLM分为2组,治疗组39例先行TACE,1周后在CT引导下行瘤体内注射无水乙醇,然后注入超液化碘油与丝裂霉素+阿霉素混合乳剂适量。对照组38例仅行TACE。结果:治疗组CR 4例(10.2%),PR 34例(87.2%),有效率(CR+PR)97.4%,中位生存期为42个月,1年、3年、5年生存率分别为91.7%、45.8%、31.3%。对照组CR 1例(2.6%),PR28例(73.7%),有效率(CR+PR)76.3%,中位生存期为23个月,1年、3年、5年生存率分别为71.0%、22.6%、9.6%。治疗组明显高于对照组,差异有统计学意义(P<0.05)。无严重并发症发生。结论:介入治疗是不能根治性切除的肝转移瘤患者的有效治疗方法,综合性介入治疗的有效率和生存率明显优于单纯肝动脉化疗栓塞。     

全直肠系膜切除和局部灌注化疗在直肠癌患者中的应用

目的 探讨全直肠系膜切除加髂内动脉局部灌注化疗在直肠癌患者中的应用价值.方法 回顾性分析1999-2006年收治的178例直肠癌患者在全直肠系膜切除基础上采用不同方法进行化疗的效果,其中观察组90例,在全直肠系膜切除后行髂内动脉置泵,术后行局部灌注化疗;对照组88例,在全直肠系膜切除术后行全身静脉化疗.观察并比较两组术后1、3、5年的局部复发率、远处转移率及生存率.两组患者的各项临床指标无明显差异,具有可比性.结果 术后1、3、5年局部复发率,观察组分别为0%(0/90)、2.5%(2/79)、3.9%(3/77),对照组分别为1.1%(1/88)、3.9%(3/77)、8.1%(6/74),两组间差异均有统计学意义(P<0.05).术后1、3、5年远处转移率,观察组分别为1.1%(1/90)、5.1%(4/79)、10.4%(8/77),对照组分别为2.3%(2/88)、7.8%(6/77)、17.6%(13/74),两组间差异均有统计学意义(P<0.05).两组1年生存率均为100%.3年生存率观察组为70.9%(56/79),对照组为53.2%(41/77).5年生存率观察组为65.0%(50/77),对照组为40.5%(30/74),差异均有统计学意义(P<0.05).结论 髂内动脉灌注化疗加全直肠系膜切除可显著降低直肠癌患者局部复发率及远处转移率,提高生存率.     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

125例中晚期肝癌介入治疗近期疗效分析

目的：评价经肝动脉灌注化疗与化疗加栓塞治疗中晚期肝癌的近期疗效.方法：采用Seldinger技术,经皮股动脉穿刺插管,对125例无手术指征的中晚期肝癌行肝动脉灌注化疗（TATC）和化疗加栓塞治疗（TACE）.35例行单纯肝动脉灌注化疗,90例行肝动脉化疗加栓塞治疗.结果：单纯肝动脉灌注化疗者生存率0.5年为62.9%;1年为25.7%;2年为0.3%;总有效率为68.6%;肝动脉化疗加栓塞者生存率0.5年为92.3%,1年为65.5%,2年为28.9%,总有效率为94.4%.结论：肝动脉灌注化疗与化疗栓塞是中晚期肝癌行之有效的治疗方法,肝动脉化疗加栓塞治疗疗效优于肝动脉灌注化疗.     

Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors

BACKGROUND AND PURPOSE: High-dose intraarterial chemotherapy with repeated one-shot infusion may be useful for treating head and neck tumors. We evaluated the efficacy of superselective continuous arterial infusion chemotherapy administered via a coaxial catheter system and compared the results with those of subselective catheterization for treatment of oral cavity tumors. METHODS: Forty-nine consecutive patients with tumors of the oral cavity (clinical stage I, 12 cases; stage II, 19 cases; stage III, six cases; stage IV, 12 cases) were treated by arterial infusion chemotherapy. After a guiding catheter was advanced into the superficial temporal artery, superselective catheterization was performed using a coaxial system microcatheter. Superselective catheterization was accomplished in 34 cases, and was unsuccessful in 15, owing to difficulties in performing catheterization or to multiple feeding arteries. In the latter cases, the tip of the catheter was placed near the origin of the feeding arteries (subselective catheterization). RESULTS: Thirty (88%) of 34 patients had a complete response to superselective arterial infusion chemotherapy and two (6%) had a partial response. Twelve (80%) of 15 patients had a complete response to subselective arterial infusion chemotherapy and three (20%) had a partial response. Local recurrence was more frequent after subselective treatment (13%) than after superselective (6%) treatment. CONCLUSION: Superselective continuous arterial infusion chemotherapy may be suitable for local control of oral cavity tumors, with a low rate of recurrence.     

Breast conservation for huge-sized locally advanced breast cancer: a case report

A 35-year-old woman with locally advanced stage IIIB breast cancer (medullary carcinoma) 12 cm in diameter underwent neoadjuvant chemotherapy consisting of three courses of intraarterial infusion [adriamycin (ADR), mitomycin (MMC), cisplatin (CDDP), 5-fluorouracil (5FU)] and four cycles of systemic chemotherapy (ADR, epirubicin, cyclophosphamide, MMC, CDDP) for three months. The tumor markedly diminished after the first course of intraarterial infusion chemotherapy, with a 3-cm tumor remaining after the completion of preoperative administration. Pathologically complete response was noted in specimens resected following breast conservation surgery. Postoperative radiotherapy was added and adjuvant chemohormonal therapy was continued for two years. The patient is alive without recurrence and has been able to conserve the breast for the past eight years, neoadjuvant chemotherapy including intraarterial infusion enabled breast conservation treatment even for huge-sized locally advanced breast cancer.     

动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的临床研究

目的：研究动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的效果。 方法：选取2014年1月—2016年7月我科诊治的39例结直肠癌肝转移患者,分为2组,研究组（22例）在肠系膜上动脉、肝固有动脉以51℃灌注化疗1 h,然后超选择至肝脏病灶的供血动脉,进行化疗栓塞。对照组（17例）接受传统的肝动脉化疗栓塞（TACE）治疗。比较2组的客观有效率、临床获益率及1年生存率。同时记录并比较两组的不良反应。 结果：两组的客观有效率无统计学差异（27.3% vs. 23.5%,P>0.05）,临床获益率也无统计学差异（81.8% vs. 76.5%,P>0.05）。但研究组的1年生存率显著高于对照组（63.2% vs. 46.7%,P<0.05）。两组都未出现血管痉挛、闭塞等特殊并发症。 结论：动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的远期效果优于传统TACE。     

中晚期肝癌的综合介入治疗

目的　探讨肝动脉栓塞化疗术 (TAE)、经皮穿刺注射无水酒精 (PEI)和肝动脉灌注化疗药物术 (TAI) 3种方法联合治疗中晚期肝细胞癌的临床效果。方法　常规肝动脉栓塞化疗术、肝动脉灌注化疗药物术 ,透视或CT定位经皮穿刺多点注射无水酒精。结果　随访 1～ 3年 ,1、2、3年生存率分别为6 0 .3% ,2 8.6 % ,17.3%。结论　运用 3种介入方法治疗中晚期肝癌有明显临床效果