巨块型肝癌介入治疗后引起的急性肾功能衰竭

目的探讨肝癌介入治疗引起急性肾功能衰竭(ARF)的原因、临床表现特点、治疗及预防。资料与方法对3例肝癌患者因介入治疗所致ARF的临床表现、实验室检查、治疗及转归进行回顾性分析、讨论。结果3例肝癌均为巨块型(直径分别为10．5cm、13．4cm、11．9cm),介入治疗后出现ARF的时问分别为术后第1d、第2d、第4d。经以血液透析为主的临床综合治疗后3例患者肾功能均恢复正常。结论肝癌介入治疗引起ARF的比例虽然较小,但仍应引起重视。术前对适应证进行严格控制、术中合理的栓塞化疗用药、术后积极有效的临床观察与治疗可减少介入治疗后ARF的发生率,一旦发生,及时进行血液透析是治疗的关键。     

原发性肝癌的介入治疗

原发性肝癌是最常见的恶性肿瘤之一。外科手术切除是公认的首选治疗方法，但因种种原因只有小部分患者才有机会手术。介入疗法在肝癌治疗中起着越来越重要的作用，包括肝动脉插管化疗栓塞（TACE）、化学灭活和热消融技术。经皮化学灭活介入治疗肝癌主要有经皮无水乙醇瘤内注射（PEIT）和经皮乙酸注射（PAIT）两种。射频疗法（PRFA）、微波固化（MCT）、激光疗法和高能聚焦超声治疗（HIFU）属于局部高温疗法，而氩氦刀则属于超低温冷技术。随着介入技术的发展，其并发症越来越少，疗效越来越好，介入疗法日益成为安全、高效的肝癌治疗方法。     

原发性肝癌TACE术后碘化油沉积与其血供相关性研究

目的：分析原发性肝癌经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)术后碘化油沉积与其血供的相关关系。方法：对比37例原发性肝癌TACE术前、术后螺旋CT双期增强扫描资料，分析其血供与碘化油沉积的数量、部位的相关关系。结果：原发性肝癌TACE治疗后碘化油主要沉积于动脉期明显强化的区域。肝动脉供血型肝癌碘化油沉积较好。易发生肿瘤组织变性坏死、肿瘤结节缩小。而肝动脉供血型肝癌伴发动静脉瘘形成、门静脉供血型、双重供血型及少血供肝癌碘化油沉积较差。结论：原发性肝癌血供与TACE术后碘化油沉积密切相关。     

烧伤后急性肾功能衰竭的治疗

目的：总结烧伤后肾功能衰竭的特点，评价治疗效果。方法：对我院烧伤科近7年收治的14例烧伤并发肾衰病例，从临床资料、治疗方法、疗效和预后综合分析。结果：11例经血液净化治疗，9例抢救成功，2例死亡。3例未行血液净化治疗，均死亡。结论：血液滤过是烧伤后肾衰治疗的首选方法，血液净化治疗能显著提高烧伤并发肾衰病人的成活率。     

原发性肝癌TACE治疗后影响发热的因素

目的 探讨影响原发性肝癌TACE治疗后发热程度的因素。方法 将102例TACE病例17项临床数据与治疗后发热时间作多元相关回归分析，判断影响发热的因素。结果 影响TACE治疗后发热的因素有碘油用量、腹水、加用明胶海绵、白蛋白水平、术前发热史、术前白细胞计数以及年龄等。结论 碘油用量是决定TACE治疗后发热的首要因素；明胶海绵会加重发热。治疗前的全身状态和肝脏的局部状态也是影响发热的重要因素。有些发热病例可能和潜在的感染有关。通过建立多元回归方程可以对发热的时间进行大致的预测。     

急性肾功能衰竭61例透析治疗体会

1987～1998年,我们采用血液净化技术救治急性肾功能衰竭(ARF)61例,效果较好。1　临床资料1.1　一般情况　本组男41例,女20例;年龄8～77岁,平均40.9岁。肾功能衰竭类型:(1)少尿型47例,占93.4%,少尿和无尿期时间1～63d,多尿期时间2～28d;(2)非少尿型4例,占6.5%。病因:药物所致15例,鱼胆中毒11例,尿路梗阻10例,肾小球疾病5例,急腹症术后3例,产后1例,感染性休克、肾及膀胱肿瘤、食物中毒、急性砷化氢和农药中毒各2例,蜂毒、独肾绞痛、肾血管血栓形成、细菌性痢疾、间日疟、胰头癌和原因未明各1例。并发症有多器官功能不全综合征(MODS)28例,高…     

微导管在原发性肝癌介入治疗中的临床应用

目的研究微导管在原发性肝癌化疗栓塞中的应用价值。方法将5FYashiro、Cobra、RH亲水超滑导管作为导引导管,利用同轴导管技术应用微导管对常规导管不能超选择的42例原发性肝癌患者行肝动脉化疗栓塞术。结果42例患者共使用微导管66次,操作成功64次,失败2次,成功率97%。治疗后三周复查肿瘤缩小>50%者12例(28.6%),肿瘤缩小<50%但>25%者22例(52.4%),肿瘤无明显变化8例(19.0%)。血清AFP下降>50%者28例(80.0%)。肝功能损害轻。全部患者术后无严重并发症。结论微导管操作简单、方便、超选择成功率高、疗效好、副反应少,具有十分重要的临床应用价值。     

战伤后急性肾功能衰竭的特点及防治

在现代局部战争中,对战伤的并发症研究是一个重要的课题,探讨战伤后急性肾功能衰竭的发病特点及制定相应的防治措施是保证部队战斗力及在“打得赢”条件下的一项重要任务。1战伤后和急性肾功能衰竭发病特点1.1发病率和死亡率急性肾功能衰竭(ARF)是战伤中严重而复杂的并发症,死亡率极高。在朝鲜战争中,受伤美军送往基地医院后的无尿性ARF发生率是0.5%,死亡率高达70%~90%〔1〕。虽然第一次采用了间隙性血液透析(IHD)技术,但死亡率仍高达80%,原因是当时透析膜采用纤维素膜〔2〕,而纤维素膜的缺点是生物相容性差,易凝血和激活补体引起与血液…     

加热栓塞剂介入治疗原发性肝癌的疗效观察简

目的：探讨热化疗及热碘油乳剂栓塞治疗原发性肝癌的临床效果。方法将55例经病理、影像学诊断、血清甲胎蛋白（AFP）检查确诊的原发性肝癌患者随机分为2组,加热组27例,采用热化疗（65℃）及热碘油（70℃）栓塞;常温组28例,采用常温（25.0±2.0）℃化疗药灌注及超液化碘油栓塞。所有病例术后定期做CT检查及AFP测定,观察对比肿瘤的客观疗效。结果2组病例在近期有效率、AFP值变化及12个月、18个月生存率等方面比较差异有统计学意义（P〈0.05）。肝功能及毒副反应比较差异无统计学意义（P〉0.05）。结论加热化疗药及栓塞剂介入治疗原发性肝癌疗效肯定,优于常规TACE。     

脾动脉栓塞在肝癌介入治疗中的应用

目的：探讨脾动脉栓塞在肝癌介入治疗中的应用价值。方法：对11例中晚期肝癌病人在进行肝动脉化疗栓塞的同时进行脾动脉栓塞治疗，观察病人血液白细胞、血小板计数及肝功能的变化情况和术后反应，判断治疗效果。结果：所有病人治疗后血液白细胞和血小板计数升高，肝功能恢复快，无严重并发症发生。结论：脾动脉栓塞应用于治疗肝癌可改善病人肝功能，控制脾功能亢进，促进血液白细胞、血小板升高，有助于病人的恢复。     

双源CT双能量成像在肝癌经皮肝动脉化疗栓塞术后复查中的应用价值

目的 评价双源CT(DSCT)双能量成像对肝癌经皮肝动脉化疗栓塞(TACE)术后病灶复查的应用价值.方法 对27例接受TACE治疗的原发性肝癌患者资料进行回顾性分析,27例均行常规肝脏平扫及动态三期增强扫描,其中动脉期图像由双能量扫描方式获得.采用2种方法观察,A法观察常规平扫、动脉期、门静脉期及延迟期图像,B法观察虚拟平扫、动脉期、门静脉期及延迟期图像,评价2种方法对栓塞病灶内部及其周围肝组织内强化信息的判断.以DSA结果为参照标准,计算A、B2法的敏感性、特异性等指标,采用x2检验比较两种方法的诊断能力.结果 27例TACE术后复查患者中共检出63个病变,DSA明确其中39个病变有强化,24个病变无强化.B法的敏感性为94.9％( 37/39),高于A法的74.4％( 29/39;x2=6.303,P＜0.05);B法的特异性为95.8％( 23/24),与A法的83.3％ (20/24)差异无统计学意义(x2 =2.009,P＞0.05).结论 以动脉期双能量扫描代替常规CT平扫与动脉期增强扫描,与常规CT动态增强相比,对TACE术后肝癌病灶的评估更加准确.     

Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma

Purpose The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of sequential transarterial chemoembolization (TACE) for patients with unresectable advanced hepatocellular carcinoma (HCC). Methods Twenty-one consecutive patients with unresectable T3 and T4 HCC were treated by sequential TACE (median time interval between treatments 7 weeks) up to six times with an emulsion of lipiodol, epirubicin, and cisplatin. All TACE procedures were performed as unilobar or whole-liver chemoembolization. Results An average of 3.9 TACE procedures were performed per patient. One primary and two secondary technical failures occurred. No procedural death was observed. After exclusion of the patient with the primary technical failure and 3 patients with extrahepatic disease, the survival rates for the remaining 17 patients at 6, 12, 18, and 24 months were 70.6%, 52.9%, 44.1%, and 33.1%, respectively. Conclusion Sequential TACE is a safe procedure in patients with unresectable advanced HCC and feasible in most cases. It seems to prolong the survival time compared with historical series of untreated patients.     

Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma

PURPOSE: The aim of this study was to assess the incidence, degree, and predictors of hepatic arterial damage (HAD) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 33 patients with unresectable HCC underwent TACE alone using a mixture of iodized oil, epirubicin, and gelatin sponge. A follow-up angiogram was available for 76 of 109 sessions, and HAD was evaluated at each subsegment of the hepatic artery using a three-grade scale (1, no or slight wall irregularity; 2, overt stenosis; 3, occlusion). Grades 2 and 3 were considered to indicate significant HAD. The predictors of HAD were analyzed by multivariate analysis. RESULTS: A total of 161 hepatic arteries were embolized from the lobar (n = 43), segmental (n = 40), subsegmental (n = 72), or more distal (n = 6) level. The follow-up period between the initial and last sessions ranged from 70 to 1505 days (median 497 days). Significant HAD occurred in 37 of 231 subsegmental hepatic arteries (16%) and in 16 of 33 patients (48%). The accumulated dose of epirubicin per artery (P = 0.001) and Child-Pugh score (P < 0.001) were significant predictors. CONCLUSION: TACE is more likely to induce HAD in cirrhotic patients with impaired liver function and when a high dose of the chemotherapeutic agent was used.     

小剂量药物热化疗栓塞治疗中晚期肝癌的疗效观察

目的：评价小剂量药物热化疗栓塞治疗中晚期肝癌的临床疗效。方法：84例中晚期肝癌患者分为两组，A组行小剂量药物热化疗栓塞术，B组行常规剂量化疗栓塞。结果：A组肿瘤缩小率优于B组，两者比较有显著差异。1、2、3、5年生存率A组为78．6％、52．4％、19．O％、9．5％，B组为61．9％、30．9％、9．5％、2．4％。结论：对中晚期肝癌进行小剂量药物热化疗栓塞既改善了近期症状，又提高了远期生存率，具有明显的临床疗效。     

Single-session combined radiofrequency ablation and transarterial chemoembolization in the treatment of hepatocellular carcinoma

Aim of the study

To evaluate the efficacy of the combined use of both transarterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) in a single session for the treatment of large (≥3?cm in diameter) hepatocellular carcinoma.

Computed tomography perfusion imaging for monitoring transarterial chemoembolization of hepatocellular carcinoma

PurposeTo prospectively monitor changes in tumor perfusion of hepatocellular carcinoma (HCC) in response to doxorubicin-eluted bead based transarterial chemoembolization (DEB-TACE) using perfusion-CT (P-CT).Methods and materials24 patients (54–79 years) undergoing P-CT before and shortly after DEB-TACE of HCC were prospectively included in this dual-center study. Two readers determined arterial-liver-perfusion (ALP, mL/min/100 mL), portal-venous-perfusion (PLP, mL/min/100 mL) and the hepatic-perfusion-index (HPI, %) by placing matched regions-of-interests within each HCC before and after DEB-TACE. Imaging follow-up was used to determine treatment response and to distinguish complete from incomplete responders. Performance of P-CT for prediction and early response assessment was determined using receiver-operating-characteristics curve analysis.ResultsInterreader agreement was fair to excellent (ICC, 0.716–0.942). PLP before DEB-TACE was significantly higher in pre-treated vs non-treated lesions (P < 0.05). Mean changes of ALP, PLP and HPI from before to after DEB-TACE were −55%, +24% and −27%. ALP and HPI after DEB-TACE were correlating with response-grades (r = 0.45/0.48; both, p < 0.04), showing an area-under-the-curve (AUC) of 0.74 and 0.80 respectively for identification of complete response.ConclusionHigh arterial and low portal-venous perfusion of HCC early after DEB-TACE indicates incomplete response with good diagnostic accuracy.     

131Ⅰ-美妥西单抗肝动脉灌注结合化疗栓塞治疗晚期原发性肝癌的疗效观察

目的 比较131Ⅰ-美妥西单抗动脉灌注结合化疗栓塞(LTACE)与常规肝动脉化疗栓塞(TACE)治疗晚期原发性肝癌的近期效果.方法 晚期肝癌患者72例,根据患者的要求分别采用LTACE治疗(LTACE组,29例)和常规TACE治疗(TACE组,43例).LTACE组经肿瘤供血动脉缓慢注入27.75 MBq/kg 131Ⅰ-美妥西单抗后间歇30 min,再以超液态碘油30 ml与表阿霉素40 mg混悬液栓塞直至血管铸型;TACE组经肿瘤供血动脉注入超液态碘油30 ml与表阿霉素40 mg混悬液栓塞直至血管铸型.治疗后,两组均行保肝和对症处理.疗效观察随访指标包括临床症状、体征缓解情况,肝、肾功能,外周血常规及CT和核素发射计算机辅助断层显像(ECT)的检查结果.计量资料行t检验;计数资料采用卡方检验和Fisher精确检验,两组生存率的比较采用Kaplan-Meier生存分析和log-rank检验.结果 治疗后,两组患者血浆白蛋白、丙氨酸转氨酶、总胆红素、白细胞、血小板及肌酐水平差异无统计学意义(治疗7 d后各指标比较的t值分别为0.250、0.907、0.629、0.005、0.250、0.453,14 d时分别为0.978、1.250、1.942、0.733、0.315、1.243;P值均>0.05).ECT扫描显示LTACE组肿瘤组织对131Ⅰ-美妥西单抗摄取良好率为55.17%(16/29).肿瘤大小两组治疗后病灶均有缩小,且组内差异有统计学意义(t=7.207,8.006,P<0.01),但治疗前LTACE及TACE组肿瘤大小(cm2)经对数转换后分别为(1.68±0.32)、(1.74±0.31);治疗后分别为(1.52±0.38)、(1.61±0.36),差异均无统计学意义(t=0.786,0.891,P值均>0.05).两组6个月的累计存活率分别为52%、76%,差异无统计学意义(X2=3.080,P>0.05).结论 131Ⅰ-美妥西单抗动脉灌注结合化疗栓塞治疗晚期原发性肝癌的短期结果与常规肝动脉化疗栓塞相比无明显差异,但确切疗效还有待大样本、多中心随机对照研究证实.     

全肝CT灌注扫描对于介入术后肝肿瘤活性的观察

目的经动脉导管化疗栓塞术(transarterial chemoembolization,TACE)治疗后患者进行全肝灌注扫描,比较增强CT、全肝灌注扫描和DSA三种检查技术对TACE治疗后肝癌瘤灶活性的检出率。方法 17例经过穿刺病理或血清学证实的肝细胞癌患者曾经行TACE介入治疗:患者于介入术后4周行全肝脏CT灌注扫描。明确经过碘油栓塞治疗的病灶44个被列入观察中。肝脏灌注分数(hepatic arterial fracture,HAF)灌注图高参数信号作为判定术后瘤灶存有活性的标准。分别采用增强CT、全肝CT灌注成像和DSA判定介入治疗后肿瘤活性,最后对不同影像技术的肿瘤活性检出率进行比较。结果 DSA造影的肿瘤活性检出率最高,达86.36%,CTP的检出率84.09%,而增强CT扫描的检出率70.45%最低。并且与前两者相比有显著性差异(P=0.016和0.031)。结论作为无创性检查手段,CTP的肿瘤活性检出力明显强于增强CT,并且接近DSA造影。因此,全肝CT灌注扫描是一种有价值的观测肝癌介入治疗疗效的无创医疗技术。     

Radiomic advances in the transarterial chemoembolization related therapy for hepatocellular carcinoma

Radiomics is a hot topic in the research on customized oncology treatment,efficacy evaluation, and tumor prognosis prediction. To achieve the goal of mining the heterogeneity information within the tumor tissue, the image features concealed within the tumoral images are turned into quantifiable data features.This article primarily describes the research progress of radiomics and clinicalradiomics combined model in the prediction of efficacy, the choice of treatment modality, and survival in tran...     

热碘油经微导管栓塞技术在肝癌介入治疗中的应用

目的研究应用热碘化油经微导管栓塞技术在肝癌介入治疗中的临床价值。方法26例结节型肝癌(原发性23例,转移性3例)接受了78次微导管栓塞术治疗。均施行瘤内热碘油(65℃)栓塞术,其中,载瘤动脉保护性血栓栓塞术3次,瘤内动-静脉瘘无水酒精栓塞术3次。结果26例均获得瘤体内完全性、充填性栓塞。3例病人发生上腹部不适,2例经手术切除证实瘤体完全坏死。随访14-26个月,所有病人均存活,未发生严重并发症。结论采用热碘化油经微导管栓塞技术治疗肝癌可明显提高治疗效果;充分超选到位、逐支栓塞、脉冲挤压式充填法和灵活的微导管应用技术是栓塞成功的关键。