胃肠道癌肝转移DSA表现与肝动脉化疗栓塞近期疗效的关系

目的 探讨胃肠道癌肝转移数字减影血管造影（DSA）表现与肝动脉化疗栓塞（TACE）近期疗效的关系。方法 胃肠道癌肝转移患者255例,经病理组织学检查确诊为腺癌,原发灶均被切除,所有患者在TACE中均先进行肝动脉DSA,根据肝内转移瘤的动脉供血情况、瘤体的染色程度,将转移瘤的血供类型分为3种：富血供、中等血供和乏血供,并判定肝转移瘤的DSA表现及其与TACE近期疗效的关系。结果 255例患者中富血供者34例、中等血供者69例、乏血供者152例;富血供者中有效者（CR+PR）25例,中等血供中有效者（CR+PR）17例,乏血供者中有效者（CR+PR）31例;富血供型与中等血供型、乏血供型组间近期疗效的差异均有统计学意义（P＜0.01）,而中等血供型与乏血供型近期疗效的差异无统计学意义（P＞0.05）。所有患者行TACE后均出现不同程度的恶心、呕吐、肝区不适或疼痛,未出现肝功能衰竭,未见相关的严重并发症发生。结论 胃肠道癌肝转移瘤的血供类型以乏血供型为主;TACE对胃肠道癌肝转移瘤富血供者的疗效明显优于中等血供和乏血供者,对于中等血供型和乏血供型肿瘤应结合非血管性介入治疗的方法,以提高疗效。     

Response, survival, and prognostic factors after hepatic arterial chemoembolization in patients with liver metastases from cutaneous melanoma

We reviewed the medical records of 42 patients with cutaneous melanoma metastatic to the liver who underwent hepatic artery chemoembolization (HACE) at our institution. HACE resulted in radiologic response (38.9%) or disease stabilization (47.2%) in most patients. The median overall survival (OS) and time to progression (TTP) of liver disease were 7.7 and 6 months, respectively. Patient's age, lactate dehydrogenase (LDH) levels, type of treatment, number of extrahepatic metastatic sites, and response to therapy were found to be significant predictors of OS after HACE. Prolonged survival was seen in patients who responded to HACE (p = .034).     

肝动脉化疗栓塞与静脉化疗治疗结直肠癌肝转移的疗效

目的 通过比较TACE术与静脉化疗2种治疗方法对结直肠癌肝转移的近、远期疗效,从而探讨有效的治疗手段.方法 回顾性分析自2002年1月至2008年12月在广西医科大学肿瘤医院进行TACE、静脉化疗治疗的62例结直肠癌肝转移患者,其中TACE组17例,静脉化疗组45例,对比其近期疗效和随访其生存状况.结果 TACE组和静脉化疗组的近期有效率分别为64.7%、33.3% (P＜0.05).1年生存率分别为82.4%、59.6%;2年生存率分别为32.4%、19.3%;3年生存率分别为12.9%、7.4%;5年生存率均为0%(P均＞0.05).结论 对于不能或不愿手术的结直肠癌肝转移病人,TACE术或静脉化疗是可选择的有效治疗方案.TACE术较静脉化疗在近期疗效上显示出一定的优势,但在延长生存期上则无差别.     

术后复发性肝癌的介入治疗疗效分析

目的分析肝动脉化疗栓塞(TACE)治疗术后复发性肝细胞肝癌的生存率及影响因素。方法对行TACE治疗的130例术后复发性肝细胞肝癌患者进行回顾性分析,计算此类患者治疗后的生存率及生存时间,分析影响其生存的相关因素。结果全组130例总的1,3,5年生存率为83.0%、45.5%和17.6%,中位生存时间2.4年。单纯TACE治疗94例,其1,3年生存率分别为76.4%和37.1%,中位生存期2.1年;TACE联合瘤内无水酒精注射(PEI)治疗36例,1,3年生存率分别为100.0%和66.5%,中位生存期为3.5年。TACE联合PEI治疗组的生存率和生存期均显著优于单纯TACE治疗组(P<0.05),死亡风险显著低于单纯TACE治疗组(P<0.05);复发瘤直径>5cm和有远处转移者的死亡风险,显著高于肿瘤直径≤5cm和无远处转移者(P<0.05)。结论TACE联合PEI治疗,可显著提高术后复发性肝癌患者的生存率,延长生存期。     

胃肠癌肝转移经肝动脉栓塞及皮下药盒持续灌注化疗的疗效初探

目的本研究观察经肝动脉栓塞化疗和(或)肝动脉插管持续灌注化疗治疗晚期胃肠癌肝转移的临床疗效.方法 22例无外科手术指征的晚期胃肠癌肝转移患者经肝动脉介入治疗共72次,单采取Seldinger法肝动脉内插管皮下埋置药盒持续灌注化疗48次,或先用吡柔比星(THP)60 mg/m2和DDP 50 mg/m2加入超液化碘油10～30 ml进行肝动脉栓塞化疗再联合肝动脉持续灌注化疗共24次.肝动脉插管灌注的方案:CF 200 mg/m2,d1,d14,静脉滴入;顺铂(DDP)50 mg/m2,d1,或用奥沙利铂100～130 mg/m2,d1,从皮下药盒处缓慢推入;5-Fu 2 000～2 500 mg/m2,d1,d14,装入美国百特公司的便携式输液泵持续动脉灌注48 h.结果总有效率(完全缓解 部分缓解)为59.0%.肿瘤负荷＜30%者的有效率为77.8%,明显高于肿瘤负荷＞30%者(46.2%,P＜0.005).本组患者主要不良反应为肝功能损害、发热及胃肠道反应等,经相应对症处理可缓解.结论经肝动脉栓塞及插管持续化疗是治疗胃肠癌肝转移的安全有效方法,值得临床推广.     

A case of hepatic metastases from uveal melanoma treated effectively by transcatheter arterial chemoembolization with cisplatin and degradable starch microspheres

A 37-year-old male presented with hepatic metastases from uveal melanoma after the enucleation of an affected eye. Hepatic metastases were thought to be the critical factors determining prognosis, so transcatheter arterial chemoembolization (TACE) was performed for local control of the hepatic metastases. The first TACE with cisplatin (CDDP) and gelatin sponge (GS) did not have much success because fine feeding arteries to the main hepatic tumor on the caudate lobe branched out from the hepatic artery, and GS particles were not distributed in the tumor vessels. We used degradable starch microspheres (DSM) as finer obstructing material for the next treatment, and hepatic metastases were treated effectively with repeated CDDP/DSM-TACE.     

Management of peritoneal and hepatic metastases from gastrointestinal stromal tumors

The management of peritoneal and hepatic metastases from gastrointestinal stromal tumors is a challenging clinical problem. Currently available systemic therapeutic agents have very limited activity in this particular disease. Patients with disease confined to a single organ/region are therefore managed either by surgery or regional therapy e.g. intraperitoneal therapy or hepatic arterial chemoembolization, whereas those with multiple sites of involvement should be enrolled on experimental trials of new agents.     

注射用薏苡仁提取物联合TACE术治疗转移性肝癌的临床疗效分析

目的:观察注射用薏苡仁提取物联合经导管肝动脉化疗栓塞术(transcatheter arterial chemoemboliza-tion,TACE)对转移性肝癌的疗效及安全性以及治疗前后血清血管内皮生长因子(vascular endothelial growthfactors,VEGF)的变化及疗效的关系。方法:将62例转移性肝癌患者随机分为治疗组及对照组,每组各31例。治疗组:采用注射用薏苡仁提取物+TACE术。对照组:单纯用TACE术。两组均至少治疗2个周期。结果:治疗组有效率为61.3%(19/31),对照组45.2%(14/31),(P>0.05);治疗组疾病控制率(disease control rate,DCR)为80.6%(25/31),对照组为54.8%(17/31),P<0.05。治疗组1年生存率为67.7%(21/31),对照组38.7%(12/31),(P<0.05);治疗组中位无进展生存期(PFS)为7.0月,对照组为5.1月,(P<0.05);治疗组生活质量改善率74.2%(23/31),对照组48.4%(15/31),治疗组明显高于对照组,差异有统计学意义(P<0.05);血清VEGF治疗组治疗后下降显著(P<0.05);对照组治疗前后血清VEGF水平对比无显著性差异(P>0.05);治疗组治疗后血清VEGF水平较对照组治疗后水平明显低下,差异有统计学意义(P<0.05);两组不良反应均为Ⅰ-Ⅲ级,治疗组乏力、食欲下降及右上腹疼痛症状较对照组偏低。结论:注射用薏苡仁提取物联合TACE术治疗转移性期肝癌能提高疾病控制率,并降低血清VEGF水平,延长中位无进展生存期及1年生存率,改善临床症状、提高生活质量。     

Incidence of recurrence after hepatic resection and prophylactic hepatic arterial infusion chemotherapy for liver metastases from colon cancer

We studied recurrence after hepatic resection and prophylactic hepatic arterial infusion chemotherapy for liver metastases from colon cancer, retrospectively. Eighty-six patients underwent curative hepatic resection for liver metastases, and 41 of them received arterial infusion chemotherapy. Eight patients (20%) developed only remnant liver metastases, 6 patients (15%) had hepatic and extrahepatic recurrences, and 10 patients (24%) developed only extrahepatic recurrences. Regional therapy including hepatic resection for residual liver metastases should be indicated for recurrences after hepatic arterial infusion chemotherapy.     

Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma.

In many patients with liver metastases from islet cell or carcinoid tumor, vascular occlusion therapy results in prolonged control of symptoms, biochemical response, and also tumor regression. Chemotherapy agents were added to evaluate safety and efficacy. Thirty patients with liver metastases from either carcinoid tumor or islet cell carcinoma underwent sequential vascular occlusion therapy combined with chemotherapeutic agents. In patients with carcinoid tumor, a combination of cisplatin (150 mg) and doxorubicin (50 mg) was used. In patients with islet cell carcinoma, a combination of 5-fluorouracil (350 mg) and streptozotocin (1000-2000 mg) was used. Sixteen patients had carcinoid tumor and 14 had islet cell carcinoma. Biochemical response was observed in 12 of 16 (75%) carcinoid patients and 9 of 10 (90%) islet cell patients. The overall partial response rate was 37% (11/30 patients). Partial response occurred in 4 of 16 (25%) patients with carcinoid tumor and 7 of 14 (50%) with islet cell carcinoma. The median duration of partial responses was 24 months (range, 6-63+ months). The median survival of all patients was 15 months (range, 2-67+ months). No treatment-related deaths occurred. Our data suggest that the addition of these chemotherapeutic agents to vascular occlusion, although safe, has no additional benefit.     

肝癌术后肝动脉化疗栓塞治疗患者肿瘤复发的影响因素分析

目的 探讨影响肝癌术后经导管肝动脉化疗栓塞治疗(TACE)患者肿瘤复发的危险因素.方法 选择并收集200例肝癌患者的年龄、性别等一般人口学特征和临床特征资料并对患者进行随访追踪,采用Logistic逐步回归分析法分析肿瘤复发的影响因素.结果 在200例患者中130例有肿瘤复发,占65.0％.Logistic逐步回归分析结果显示,血管癌栓(OR=3.796;95％CI:1.871～7.702)、侵透肝被膜(OR=3.340;95％CI:1.067～10.451)、肝硬化(OR=2.790;95％CI:1.771～4.396)、包膜完整性(OR=2.048;95％CI:1.273～3.298)和最大癌结节直径(OR=1.739;95％CI:1.014～2.980)是肝癌术后TACE治疗患者肿瘤复发的危险因素.结论 肝癌术后TACE治疗患者的肿瘤复发率较高,术前有无血管癌栓、侵透肝被膜和肝硬化,包膜是否完整,以及肿瘤的直径等均会影响肿瘤复发,临床需要加强患者术后复诊和康复治疗.     

Pulmonary embolism after transcatheter arterial chemoembolization

Metastatic hepatic tumours can be treated with hepatic transcatheter arterial chemoembolization (TACE). Common complications associated with TACE include hepatic insufficiency, fever, and pain. However, pulmonary embolism is rarely documented as a fatal adverse effect. We report a case of pulmonary embolism following TACE in a renal cell carcinoma patient with liver metastases. Total recovery is noted after the effective treatment.     

以肝动脉化疗栓塞为主治疗原发性肝癌研究进展

肝动脉化疗栓塞(TACE)是目前应用最广泛的原发性肝癌(HCC)的非手术治疗方法,同时也存在很多限制和不足,提高肝癌总体疗效依赖于综合治疗已成为共识,发挥各种治疗方法的优势,避免其缺点,增加其协同作用,可在一定程度上提高肝癌总体疗效.     

胃肠道间质瘤肝转移治疗进展

胃肠道问质瘤(GIST)常见的转移器官是肝脏。GIST肝转移以外科治疗为主,术后3年、5年生存率分别可达58%和30%以上。生物靶向制剂治疗以伊马替尼为代表,但有部分患者耐药。其他靶向治疗药物如SU11248、RAD001、AMG706正在临床试验中,以解决伊马替尼耐药问题。伊马替尼新辅助和辅助治疗试验仍在进行中。介入治疗对GIST肝转移为有效的姑息疗法,肝移植也有一定效果。总之,外科联合生物治疗有望成为GIST肝转移个体化治疗的突破。     

胃肠道间质瘤肝转移治疗进展

胃肠道间质瘤（GIST）常见的转移器官是肝脏。GIST肝转移以外科治疗为主,术后3年、5年生存率分别可达58％和30％以上。生物靶向制剂治疗以伊马替尼为代表,但有部分患者耐药。其他靶向治疗药物如SU11248、RAD001、AMGT06正在临床试验中,以解决伊马替尼耐药问题。伊马替尼新辅助和辅助治疗试验仍在进行中。介入治疗对GIST肝转移为有效的姑息疗法,肝移植也有一定效果。总之,外科联合生物治疗有望成为GIST肝转移个体化治疗的突破。     

肝动脉栓塞化疗和经皮肝穿刺冷冻联合治疗肝癌

目的 研究肝动脉栓塞化疗（TACE）和经皮肝穿刺冷冻（PHCT）联合治疗肝癌的近期疗效和安全性。方法 30例不能手术切除的肝癌病人行1－3个周期TACE的,予PHCT治疗。结果 综合治疗后1个月复查,综合治疗的肿瘤,缩小≥50％为36．4％（12／33）,单纯TACE的肿瘤,缩小≥50％为25．0％（2／8）。术后血AFP和CEA水平均有不同程度下降。术后不良反应轻。结论 TACE和PHCT联合治疗肝癌为一种较好的综合治疗方法。     

Studies of Selective Arterial Perfusion plus Chemoembolization on Hepatic Metastasis from Rectal Cancer

OBJECTIVE To develop an effectual method for treating hepatic metas-tasis from rectal cancer. METHODS A randomized control study of celiac artery perfusion plus transcatheter hepatic arterial chemoembolization (TACE) (observation group) and intravenous chemotherapy (control group) for 99 cases with hepatic me-tastasis from rectal cancer was performed. The perfusion was repeated once at 4 weeks after the first treatment of 52 cases in the observation group, and it was subsequently repeated at an interval of 2 or 3 months. Using intrave-nous administration, the perfusion was repeated once every 3 weeks with 47 cases in the control group. RESULTS Three months after treatment, the patients in the observation group who showed a relief or elimination of a former superior abdominal pain amounted to 70.6%, and those with a diminution of their intrahepatic mass reached 55.8%. In the control group, the patients with a relief or disappear-ance of hepatalgia reached 20%, and those with a diminution of their intrahe-patic mass reached 10.6%. The 1, 2 and 3-year survival rates were 80.8%, 46.2% and 25.0% in the cases of the observation group and 61.7%, 19.1% and 4.3% in the control group, respectively. CONCLUSION For the patients who failed to receive a surgical opera-tion on their hepatic metastasis from rectal cancer, celiac artery perfusion plus TACE is a more effective regimen for improvement of the clinical symp-toms and extension of the survival time, compared to intravenous chemo-therapy, and is a better choice for palliative therapy.     

Indication for hepatic resection after hepatic arterial infusion chemotherapy for multiple liver metastases of colorectal cancer

The indications for hepatic resection after hepatic arterial infusion chemotherapy (HAI) for unresectable metastatic liver tumor of colorectal cancer were analyzed from the surgical outcome of hepatic resections in 23 cases of hepatic resection after HAI. The mean duration of HAI until hepatic resection was 7.4 months (5-14 months). The total dose of 5-FU was 25.7 +/- 8.0 g for a CR + PR group and 14.0 +/- 3.5 g for a NC + PD group. There was a significant difference between two groups (p < 0.01). The group in which serum CEA level normalized after HAI (the normal CEA group) included 7 patients, and the group in which serum CEA level did not normalize (the high CEA level group) had 9 patients. The total dose of 5-FU was 30.0 +/- 7.6 g in the normal CEA level group and 19.1 +/- 6.9 g in the high CEA level group. There was a significant difference between the two groups. The 3-year survival rate was 40.0% in the group with the duration of HAI for longer than 8 months (n = 10) and 0% in the group with the duration of HAI for shorter than 8 months (n = 7). The 3-year survival rate was 66.7% in the normal CEA level group (n = 3) and 0% in the high CEA level group (n = 8). The surgical outcome was better in the HAI for longer than 8 month and normal CEA groups.     

肝动脉栓塞化疗联合无水酒精治疗结肠癌肝转移

目的：探讨肝动脉栓塞化疗（TACE）联合无水酒精注射（PEI）在治疗结肠癌肝转移的实用价值。方法：选择近年来收治的结直肠癌肝转移50例患者,分为全身化疗组（20例）和TACE＋PEI组（30例）。应用流式细胞仪检测患者治疗前后外周血CD3＋、CD4＋、CD8＋、CD19＋、CD16＋CD56＋和CD4＋/CD8＋的变化,评价其对免疫功能的影响;同时复查患者治疗3月后AFP的情况,分析其生存率。结果：TACE＋PEI组治疗后免疫功能评价（CD3＋、CD4＋、CD16＋CD56＋和CD4＋/CD8＋）较治疗前有显著性差异（P〈0.05）,全身化疗组治疗后较治疗前无统计学意义（P〉0.05）;TACE＋PEI组治疗后AFP含量为（54.37±6.35）ng/ml,与全身化疗组（287.21±5.82）相比有统计学差异,并且平均生存时间也较全身化疗组显著延长（P〈0.05）。结论：动脉栓塞化疗联合无水酒精可明显改善患者免疫功能,无水酒精瘤内注射操作简单,效果好,宜推广。     

Treatment of hepatic metastases by percutaneous hepatic arterial infusion.

Better palliation for patients with hepatic metastases requires improved quality and duration of survival with a low complication rate and acceptable expense. Eligible patients between 1967 and 1977 were treated with a program of systemic chemotherapy until progression of hepatic metastases, then hepatic arterial infusion and subsequent maintenance on systemic chemotherapy. The angiography department was able to place the infusion catheter into the common hepatic artery percutaneously in 85% of all patients. The reasons for failure appeared related to anatomic variations and not to the physical characteristics of the liver cancer. A group of 24 patients with colorectal cancer and another group of 28 patients with 13 different primaries were treated. The colorectal cancer patients attained a median treatment time of 8 months before hepatic arterial infusion, and 9 more thereafter. The median survival of 17 months is much better than that reported for systemic chemotherapy alone. In a group of 28 patients with various primaries treated in the same way, the median survival time was 10 months. The nature of complications and the 6% incidence were the same in both groups. In summary, this is a modality yielding improved quality of life and longer survival with a low complication rate and acceptable costs.