肝癌经肝动脉化疗术后上消化道出血的原因与预防

本文分析４０８例肝癌行肝动脉化疗术后二周内上消化道出血的发病情况。甲组７５例，肝动脉化疗后未使用甲氰脒胍；乙组３３３例，肝动脉化疗后常规使用甲氰脒胍。甲、乙两组肝功能无显著性差异。肝动脉化疗方式有三种：（１）单纯肝动脉化疗，甲与乙组均无上消化道出血。（２）碘油化疗药物混悬剂栓塞化疗，甲与乙组出血各为１９％与２．５％。（３）ＬＰ－ＴＡＥ＋明胶海绵栓塞，甲与乙组出血各为１７Ｔ及３．２％。肝功能Ａ级、Ｂ     

肝得健在肝动脉栓塞化疗时保肝作用的临床观察

对接受肝动脉栓塞化疗的３３例原发性肝癌病人给予肝得健保肝,并设３０例对照组。结果治疗组治疗前后肝功能无变化,对照组胆红素（ＢＩＬ）３天升高,２周未降至正常;丙氨酸转氨酶（ＡＬＴ）和门冬氨酸转氨酶（ＡＳＴ）３天、７天明显升高,２周降至正常;白蛋白（ＡＬＢ）７天开始下降,２周回升,但未至正常水平。表明肝得健可防止正常肝细胞损害,保护肝功能,增强对栓塞化疗的耐受性。     

肝癌根治性切除术后肝动脉化疗栓塞联合LAK细胞肝动脉灌注的价值

目的研究肝癌根治性切除术后肝动脉化疗栓塞,联合LAK细胞/IL-2肝动脉灌注的价值。方法将42例肝癌根治性切除患者随机分为观察组和对照组。肝癌根治性切除术后肝动脉化疗栓塞,联合LAK细胞/IL-2肝动脉灌注患者21例为观察组;肝癌根治性切除术后单纯肝动脉化疗栓塞患者21例为对照组。结果观察组１年、２年、３年的肝内复发率（0、19.05%、57.14%）较对照组（28.57%、47.62%、85.71%）降低（χ     

干扰素联合肝动脉栓塞化疗预防肝细胞癌根治性切除术后复发的初步观察

目的 探讨干扰素联合肝动脉栓塞化疗预防肝细胞癌根治性切除术后复发的临床价值。方法１０例肝细胞癌患者于根治性切除术后２～８周经肝动脉导管行栓塞化疗。化疗后皮下注射重组α干扰素２α（罗扰素），第１～４周自１００万单位渐增至４５０万单位维持１２周。每周３次，４～６周后重复栓塞化疗一次。结果 ９例患者随访超过１年，１例９个月，所有患者均未见肝内复发。结论 罗扰素可能有助于减少肝癌根治性切除术后肝内复发。     

肝动脉化疗栓塞治疗原发性肝癌的疗效及影响因素

目的观察肝动脉化疗栓塞治疗对原发性肝癌的疗效及影响因素．方法单纯化疗（Ａ组）；化疗加碘油栓塞（Ｂ组）；化疗加碘油加明胶海绵栓塞（Ｃ组）．结果５年内肝动脉化疗栓塞治疗中、晚期肝癌４２８例，３８６例经２个月～５０个月随访．肿瘤缩小率：Ａ组１４％，Ｂ组５５％，Ｃ组７９％（三组间Ｐ＜００１）．肿瘤基本消失：Ｃ组５％，Ａ，Ｂ两组无１例消失．生存时间：１年生存率Ａ组０％，Ｂ组１０％，Ｃ组４５％，其中１２例患者获Ⅱ期手术切除，切除标本病理检查见肿瘤区癌细胞全部或部分凝固坏死，瘤旁癌细胞稀疏．结论影响疗效因素与肿瘤的病理类型及血供情况，门静脉主干瘘和癌栓、肝动脉插管治疗方式有关．     

原发性肝癌术前经肝动脉化疗栓塞的病理观察

原发性肝癌术前经肝动脉化疗栓塞的病理观察山东省千佛山医院（２５００１４）滕木俭毕玉华刘瑞鸣张丽丽王涛１９９２年３月以来，我们收治１７例术前经导管行肝动脉化疗栓塞（ＴＡＥ）的原发性肝癌患者，均行肿瘤及部分肝切除。现就其病理结果讨论如下。１资料与方法本组...     

CT对肝癌经肝动脉栓塞化疗的评价

ＣＴ对肝癌经肝动脉栓塞化疗的评价山东省千佛山医院（２５００１４）李群周祝谦经肝动脉栓塞化疗术是治疗中晚期肝癌的主要方法之一。我们选择近年来施行肝动脉栓塞化疗的肝癌患者１００例，从ＣＴ影像角度对其疗效进行评价。１资料与方法１．１临床资料本组男９２例，女...     

肝动脉、门静脉联合介入治疗原发性肝癌(附15例报告)

原发性肝癌患者35例，对其中15例行肝动脉栓塞化疗术后再行经门静脉栓塞化疗（双重化疗组），20例行单纯肝动脉栓塞化疗术（单一化疗组）。术后定期随访患者的超声、CT表现和血清甲胎蛋白（AFP）。结果：双重化疗组在延长患者生存期、缩小肿瘤大小等方面均优于单一化疗组。认为肝动脉、门静脉联合介入治疗法是治疗肝癌的有效方法。     

肝动脉化疗,栓塞治疗原发性肝癌的疗效分析

肝动脉化疗、栓塞为不能手术切除的肝癌的首选疗法。本文系统分析经介入放射治疗的１９２例原发性肝癌随访１０－５２个月的结果，总疗效为：症状缓解者７２．９％，显效２６．０％，有效５１．０％，ａ－ＦＰ下降者６０．８％，治疗后１、２、３年生存率分别为５２．１％、２４．３％、１５．１％，平均生存期１３．８月，最长已存活５２月。其中，１０８例栓塞治疗组的１、２、３年生存率分别为６２．３％、３８．２％、２５．３％     

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。     

还原型谷胱甘肽在原发性肝癌介入治疗中护肝作用的观察

目的探讨还原型谷胱甘肽(GSH)在原发性肝癌病人介入治疗中的护肝作用。方法原发性肝癌病人72例,随机分为两组,对照组和治疗组各36例。所有病例在行肝动脉灌注化疗(HAI)及肝动脉栓塞治疗(HAE)的同时进行保肝治疗,对照组给予能量合剂、门冬氨酸钾镁和肌苷静脉滴注,当天介入治疗前使用一次,介入治疗后1次/日×7天。治疗组在上述给药的基础上加用GSH1500mg/m2.d静脉滴注,当天介入治疗前使用一次,介入治疗后1次/日×7天。治疗前后监测肝功能变化及腹水生成情况。结果介入治疗后第3天两组病人皆出现不同程度的肝功能受损,但治疗组ALT、AST、TBIL上升幅度均较对照组低(P<0.05)。介入治疗后第7天两组病人肝功能皆好转,但治疗组ALT和AST显著低于对照组,TP显著高于对照组(P<0.05)。两组腹水生成率的差异无统计学意义(P>0.05)。结论GSH在原发性肝癌病人介入治疗中可产生显著的保肝作用。     

Hepatic arterial infusion chemotherapy and embolization in the treatment of primary hepatic carcinoma

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阿苯达唑微球肝动脉灌注对大鼠肝泡状棘球蚴病的治疗作用

目的观察阿苯达唑-PEG6000固体分散体壳聚糖微球经肝动脉灌注治疗大鼠肝泡状棘球蚴病的效果。方法将肝泡状棘球蚴病模型大鼠30只,随机均分为3组,即生理盐水对照组(A)、空白微球组(B)和阿苯达唑微球组(C),A、B和C组分别经肝动脉灌注0.3 ml生理盐水、空白微球2.7 mg/kg(溶于0.3 ml生理盐水)、阿苯达唑-PEG6000固体分散体壳聚糖微球2.7 mg/kg(溶于0.3 ml生理盐水)。于灌注后第1、3、7、14和42天采集大鼠外周静脉血,检测白细胞(WBC)、门冬氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)的值。第42天处死全部大鼠,取肝泡状棘球蚴组织,观察各组病理变化。结果各组大鼠白细胞第1天出现暂时性升高[A组(86.11±19.14)×109/L、B组(117.11±21.76)×109/L和C组(118.11±24.52)×109/L],第7天恢复正常[A组(7.85±6.57)×109/L、B组(11.73±4.85)×109/L和C组(8.49±1.36)×109/L]。B、C组在第3天AST、ALT达到最高值[B组AST(193.15±21.57)U/L、ALT(78...     

Hepatic arterial infusion alternating with systemic chemotherapy in patients with non-resectable hepatic metastases from colorectal cancer

BACKGROUND AND AIM: Hepatic arterial infusion (HAI) chemotherapy has a number of limitations, including a low rate of complete response and frequent extrahepatic recurrence, in colorectal cancer patients with non-resectable hepatic metastases. METHODS: Twenty-nine colorectal cancer patients with non-resectable hepatic metastases were consecutively enrolled for HAI alternating with systemic chemotherapy (HA + SC group). The protocol comprised six cycles of alternating HAI (5-FU + leucovorin for 14 days, and mitomycin C on the first day) and systemic chemotherapy (5-FU + leucovorin). Colorectal cancer patients with two or more hepatic metastases treated using hepatic resection and systemic chemotherapy (HR + SC group) were selected as a comparative group. RESULTS: Within the HA + SC group, complete response was achieved in eight patients (28%), whereas 13 patients (45%) showed progressive disease. Six of the eight patients with complete response lived for more than 38 months. Extrahepatic recurrences were more frequent in the HR + SC group than the HA + SC group (47 vs 21%, P = 0.024). The two groups did not differ with respect to overall and hepatic progression-free survival (P = 0.947 and 0.444, respectively), displaying median +/- SE values of 38 +/- 7 and 20 +/- 3 months in the HA + SC group, and 39 +/- 9 and 33 +/- 14 months in the HR + SC group, respectively. One patient in each group experienced toxic hepatitis, and sclerosing cholangitis occurred in one patient of the HA + SC group. Other complications were mostly grade 1 or 2. CONCLUSIONS: HAI alternating with systemic chemotherapy led to a promising response and hepatic progression-free survival, possibly reducing extrahepatic recurrence in colorectal cancer patients with non-resectable liver metastases.     

Hepatic arterial infusion in the management of colorectal cancer liver metastasis: Current and future perspectives

The technique of hepatic arterial infusion (HAI) for the treatment of liver metastases from colorectal cancer has been developed over more than 30 years. Although the indications and protocols for this technique have evolved with time, HAI is not routinely performed in clinical practice. Studies have been heterogeneous, with different regimens of intra-arterial drugs, associated or not with systemic chemotherapy, and with unconvincing outcomes. Technical difficulties for catheter placement have limited the implementation of this method in routine practice. The aim of this review is to present recent studies, highlighting technical improvements and promising combinations of oxaliplatin-based HAI with systemic treatments. HAI is being investigated in both the metastatic setting – in the first line and beyond – and in the adjuvant setting, and we will discuss its potential place in current and future patient management.     

一氧化氮对供肝肝动脉缺血后肝细胞凋亡的影响

目的　探讨肝动脉缺血 (HAI)对肝脏组织损伤的影响及其机制。方法　将家兔按有无再灌注后HAI分为HAI组和对照组。在兔肝自体原位移植模型基础上 ,应用原位末端标记 (TUNEL)技术、免疫组化法和硝酸还原酶法 ,检测肝细胞凋亡指数 (AI)、bcl 2蛋白表达和肝组织中一氧化氮 (NO)生成水平。结果　HAI组再灌注后各时点肝细胞AI均高于对照组 ;bcl 2蛋白表达阳性细胞于再灌注后较灌注前增多 ,但HAI组与对照组比较 ,各时点均无明显差异 (P >0 .0 5 ) ;再灌注后NO浓度较灌注前降低 ,而且再灌注早期HAI组明显低于对照组 (P <0 .0 5 )。结论　HAI可通过进一步降低缺血再灌注后NO水平而加重肝细胞凋亡损伤 ,阻碍供肝功能的恢复 ,是移植术后供肝功能不全和并发症发生的关键因素之一。     

Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma

AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion:group 1,vascular occlusion was achieved by the Pringle maneuver (n=20);group 2,by hemihepatic vascular occlusion (HVO) (n=20);and group 3,by BIOwHAC (n=19).We compared the procedures among the three groups in term of operation time,intraoperative bleeding,postoperative liver function,postoperative complications,and length of hospital stay.RESULTS:There were no statistically significant differences (P > 0.05) in age,sex,pathological diagnosis,preoperative Child’s disease grade,hepatic function,and tumor size among the three groups.No intraoperative complications or deaths occurrred,and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding,hepatic function change 3 and 7 d after operation,the incidence of complications,and length of hospital stay.BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO;the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).CONCLUSION:BIOwHAC is convenient and safe;this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.     

中药复方肝欣合剂抗肝纤维化作用的临床研究

目的:观察中药复方肝欣合剂对慢性乙型肝炎及肝纤维化的疗效。方法:选择慢性乙型肝炎肝功能及肝纤维化指标异常的患者80例,随机分成两组,治疗组患者口服中药复方肝欣合剂,对照组患者口服强肝丸,观察治疗后肝功能和肝纤维化指标的变化。结果:两组患者血清ALT、TBil、HA、LM和PCⅢ均有明显降低,Alb亦有明显提高,两者相比较有统计学意义(P<0.05或P<0.01)。结论:中药复方肝欣合剂具有明显的抗肝纤维化作用。     

应用18F-FDG PET/CT检查评价肝泡型包虫病肝内病灶活性研究*

目的 观察¹⁸-氟脱氧葡萄糖(¹⁸F-FDG)PET/CT检查对肝泡型包虫病(HAE)患者治疗前后肝内病灶活性的评价作用。方法 2016年6月～2018年6月我院收治的109例HAE患者,按体质量服用阿苯达唑脂质剂10 mg·d^-1·kg^-1,治疗6个月。所有患者均于治疗前后行¹⁸F-FDG PET/CT检查,分析病灶边缘带最大标准放射性摄取值(SUV_max)。结果 在109例患者中,治疗前PET/CT检查显示HAE病灶多呈混杂密度占位灶,形状不规则,内见钙化灶、液化性坏死区,边界不清晰,多呈侵袭性生长,病灶边缘带见放射性药物分布影,且高于肝脏,病灶内部未见明显放射性分布;在阿苯达唑脂质剂治疗后6个月,PET/CT检查显示75例病灶周边放射性浓聚现象消失或明显降低,34例病灶边缘带放射性分布较治疗前轻度变淡;109例患者在阿苯达唑治疗后病灶边缘增殖浸润带SUV_max值为(3.6±1.4),显著低于治疗前【(4.9±1.9),P＜0.05】。结论 应用¹⁸F-FDG PET/CT检查能够帮助评估HAE病灶活性,从而指导药物治疗。     

用肝细胞生长因子治疗25例重症肝炎的临床观察

本文用肝细胞生长因子（HSS）加综合治疗方法对25例重症肝炎患者进行了治疗，并对20例重症肝炎病人仅用综合疗法进行对照观察。结果提示：经2个疗程治疗后，治疗组血清转氨酶，胆红素及凝血酶原时间好转例数及恢复正常例数均明显高于对照组（P＜0．05）。但在两个疗程时间内，其白，球蛋白比例改善例数在二组间未见有差异（P＞0．05）。对照分析还显示，治疗组病人的总体治疗有效率（100％）明显高于对照组（45％）（P＜0．05）。提示肝细胞生长因子治疗重症肝炎病人有较好疗效，是一种较好的治疗药物。