经皮下埋藏全植入式输注泵治疗中晚期肝癌

经皮下埋藏全植入式输注泵治疗中晚期肝癌温州医学院附属二院普外科（３２５０００）郑志强，陈公高全植入式药物输注泵埋入皮下治疗中晚期肝癌，国外从７０年代开始应用于临床（１，２）。国内从１９８８年开始有陆续报道。我院自１９９１年４月开展用皮下全植入式输注泵...     

肝癌微创治疗的并发症

本文就肝癌的微创治疗,包括肝动脉灌注化疗栓塞术(transcatheter arterial chemoembolization,TACE),射频消融毁损(radiofrequency ablation,RF),经皮瘤内无水酒精注射(percutaneous ethanol injection,PEI ),冷冻(cryosurgery)的并发症进行综述.     

肝癌冷冻治疗的并发症及其防治

肝癌冷冻治疗的并发症及其防治河南洛阳解放军１５０医院外一科（４７１０３１）孙高斌，陆文煜我国每年发生肝癌病人约ｌｌ万人，占全世界肝癌病人总人数的４０％，因此肝癌外科治疗在我国有重要意义。但目前到医院就诊的病人大部为分晚期肝癌，不能手术切除，只能综合治...     

肝癌的分离灌注

人体器官的完全分离灌注越来越引起各学科学者们的关注 ,同时也为肿瘤的治疗开辟了一个新天地。目前 ,肢体的无法切除的肉瘤 ,黑色素瘤的分离灌注已取得了很好的临床疗效。而肝癌 (以转移癌为主 )的分离灌注 (isolatedhepaticperfusion ,IHP)也在外科领域取得了一定的临床疗效〔1～ 10〕。如德国 ,日本 ,荷兰等国的外科学者 ,均报道过一次性的肝癌的分离灌注治疗 ,提出肝癌的IHP治疗可显著地控制肿瘤 ,延长病人的生存期。但是 ,外科的局限是创伤大 ,无法重复进行治疗。随着介入放射学的发展 ,微创 ,可重复的肝癌的分离灌注技术已渐成雏形…     

腹壁皮下放置输液器局部灌注化疗药物治疗中晚期肝癌14例临床分析

本文报道采用腹壁皮下放置输液器局部灌注化疗药物治疗中晚期肝癌１４例，表明经门静脉和肝动脉同时插管化疗效果较好，尤其在缺少介入放射设备的基层医院本方法有一定实用价值和优点。     

经皮门脉穿刺灌注治疗肝癌术后门脉癌栓

经皮门脉穿刺灌注治疗肝癌术后门脉癌栓江苏省昆山市第一人民医院普外科（２１５３００）陈健门静脉癌栓是肝癌术后复发的常见表现，其治疗效果较差。我院近年共收治肝癌术后复发门静脉癌栓５例，并施行超声引导下经皮门静脉灌注化疗，近期疗效明显，现报告如下：临床资料...     

巨大肝癌术后并发症及其护理

手术是治疗巨大肝癌(≥10 cm)的有效手段之一。但手术复杂、创伤大、并发症多。我科1989年1月至2002年6月施行巨大肝癌切除手术58例,术后发生并发症22     

肝癌区域性治疗的新突破——肝脏隔离灌注化疗

我国的肝癌患者约占全世界的 5 0 % ,其死亡率占恶生肿瘤死亡率的第二位。长期以来 ,手术切除一直是肝癌的首选治疗方法 ,但临床诊断明确的肝癌患者多数已属中晚期 ,可行手术切除者不足 2 0 %。近年来随着细胞生物学、影像学、介入放射学的发展 ,各种区域性化疗方法应运而生并迅速发展 ,为肝癌的开辟出新的领域。肝脏隔离灌注 (isolated liver perfusion IL P)化疗作为新近开展起来的技术为肝癌区域性化疗注入了新的活力。1　肝脏隔离灌注化疗的国内外研究进展要是通过阻断肝脏周围血管 ,将肝脏循环隔离于体循环之外 ,然后采用体外循环装…     

中晚期肝癌的导管治疗

中晚期肝癌的导管治疗巩照华赵文英郝春志周轶廖博贤肝癌的化疗栓塞术，在目前肝癌治疗中有其重要的价值，其方法优于其他方法。近几年已被广泛应用，本院自１９９５年元月至１９９７年元月共收治中晚期肝癌４７例，现就其方法及疗效报告如下：材料和方法１一般资料：本组...     

埋植式药泵在肝癌治疗中的应用

目的　探讨对不能切除的肝癌患者术中应用埋植式药泵治疗的临床意义。方法　对2 8例肝癌患者 ,术中作肝动脉和门静脉插管并皮下埋植药泵 ,术中、术后经药泵进行肝脏局部灌注化疗取得了较好的疗效。结果　本组治疗后有效率为 6 4.2 % ,其中生存时间小于 6个月 15例 ,6～12个月 10例 ,12个月以上 3例其中 1例存活 2 2个月以上。结论　肝动脉局部灌注化疗对不能手术切除的晚期肝癌 ,作为治疗手段不失为一种有效的方法。     

Morbidity of adjuvant hepatic arterial infusion pump chemotherapy in the management of colorectal cancer metastatic to the liver

BACKGROUND: Surgical resection remains the treatment of choice for patients with colorectal cancer metastatic to the liver. Hepatic arterial infusion pump (HAIP) chemotherapy in combination with surgical resection has been demonstrated in a recent study to improve disease-free and overall survival for patients with colorectal cancer metastatic to the liver. Other reports, however, have indicated significant toxicity related to HAIP chemotherapy in the form of biliary sclerosis. Thus, the value of adjuvant HAIP chemotherapy following hepatic resection or ablation remains controversial. The aim of this study was to examine the survival and toxicity in a single institutional experience with adjuvant HAIP chemotherapy. METHODS: Review of a prospective hepatobiliary database was performed. HAIP were placed in the standard technique following resection and/or radiofrequency ablation (RFA) of all liver metastases. Patients received floxuridine (FUDR) via the HAIP at standard doses. Complications were graded according to a standard 5-point grading scale. Statistical analysis was performed by chi(2) test. RESULTS: Thirty-four of 86 patients underwent placement of HAIP at the time of hepatic resection or ablation between January 1999 and November 2002. The HAIP group demonstrated a significantly greater (P <0.05) number (median 5 vs. 2) and size (median 5 cm vs. 3 cm) of hepatic lesions compared to the group without HAIP. The HAIP group experienced a greater frequency of complications (53% vs. 33%), with 6 (18%) patients in the HAIP group demonstrating biliary sclerosis. There were no deaths within 30 days of surgery. Median survival was similar in both groups (HAIP 20 months, no HAIP 24 months). CONCLUSIONS: Patients in the HAIP group had significantly worse overall predictors of outcome in metastatic colorectal cancer, yet the median overall survival in both groups was similar. However, adjuvant HAIP chemotherapy was associated with significantly greater morbidity. Given the availability of newer active systemic agents and regimens, the value of adjuvant HAIP chemotherapy remains controversial.     

超选择置泵灌注化疗在大肠癌中的应用

目的　评价术中超选择靶区动脉置泵 ,术后皮下泵内反复区域性灌注化疗药物治疗大肠癌的临床疗效。方法　对我院 2 93例大肠癌患者 ,经术中选择性肿瘤供血动脉内置泵 ,术后泵内灌注化疗药物的疗效进行回顾性分析 ,其中根治性切除 2 14例 ,晚期不能手术切除 79例。结果　根治性切除组 1年、3年、5年生存率分别为 10 0 %、84 .6 %、57.5% ,局部复发率和肝转移率分别为 13.6 %、12 .1% ;不能手术切除组完全缓解 4例 ;部分缓解 6 2例 ;稳定 13例 ,治疗有效率 (PR CR)为 83.5% ,置泵术后 0 .5年、1年、2年生存率分别为 96 %、86 .6 %、4 4.6 %。结论　超选择动脉置泵灌注化疗是治疗大肠癌的有效方法 ,它可以降低局部复发率和肝脏转移率 ,提高患者生存率。     

Accurate continuous drug delivery at low infusion rate with a novel microvolumetric infusion pump (MVIP): pump design, evaluation and comparison to the current standard

Infusion devices for continuous and precise drug administration are indispensable tools in anaesthesia and critical care medicine. Problems such as start-up delays, non-continuous flow and susceptibility to hydrostatic pressure changes at low infusion rates resulting in accidental bolus release or prolonged flow interruption are inherent to current infusion technology. In order to improve precise drug delivery, an innovative technical concept has been realised in a novel microvolumetric infusion pump (MVIP) device. The MVIP principle includes repeated filling and emptying of a non-compliant microsyringe without the use of valves. The performance of the MVIP prototype has been evaluated and compared with standard syringe infusion pump assemblies. The novel MVIP concept has thereby proven to eliminate most problems during infusion start-up, steady state flow and vertical pump displacement, and has the potential of revolutionising infusion technology and setting a new dimension in patient safety.     

Complications of continuous intraperitoneal insulin infusion with an implantable pump

AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications. METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with "brittle" T1DM who started CIPII between January 1, 2000 and June 1, 2011, and were treated in the only centre inThe Netherlands providing CIPII treatment (Isala clinics, Zwolle) were eligible for inclusion. Outcomes were defined as operation-free period (OFP), rate and type of complications. Subanalyses were made between patients starting CIPII from 2000 to 2007 and from 2007 onwards in order to study possible changes over time in complications and/or OFP. The OFP was calculated as the time from initial implantation to the date of first documented re-operation. If patients had not experi- enced an operation, their data were recorded at the date of last follow up or death. Kaplan-Meier curves were constructed to visualize the OFP. A (two-sided) P value of less than 0.05 was considered statistically significant. RESULTS: Fifty-seven patients were treated with CIPII, although one patient was excluded from analyses because of self-induced complications. In the remaining 56 patients, 70 complications occurred during 283 patient years. Catheter occlusion (32.9%), pump dysfunction (17.1%), pain at the pump site (15.7%) and infections (10.0%) were the most frequent complications. This resulted in a median OFP of 4.5 years (95% confidence interval 4.1-4.8 years) without any difference between the time periods. Fifty re-operations were performed because of complications, one per 5.6 patient years, with a decrease in pump dysfunction (P = 0.04) and pump explantations (P = 0.02) after 2007. In total, 9 episodes of ketoacidosis occurred during follow up and there were 69 hospital re-admissions, with a median duration of 6 d. CIPII was ceased in five patients due to recurrent infections (n = 2), pain (n = 1), inadequate glycaemic control (n = 1) or by own choice (n = 1). No CIPII related mortality was reported. CONCLUSION: The OFP has been stable over the last decade. No CIPII related mortality was reported. A significant decrease in pump dysfunction and explantation was seen after 2007 compared to the period 2000-2007. CIPII remains a safe treatment modality for specific patient groups.     

皮下植泵灌注药物预防原发性肝癌术后复发

目的: 对比分析皮下植泵灌注化疗药物降低原发性肝癌术后肝内复发率,提高生存率的效果.方法: 95例原发性肝癌切除术后,同时皮下植泵,泵导管植入肝动脉、门静脉,术后定期通过药泵灌注化疗药物至肝脏(A组);行单纯肝癌切除术72例(B组);肝癌切除术加静脉化疗65例(C组).随访3年,比较3组的术后复发率和生存率.结果: 原发性肝癌术后皮下植泵组与对照组比较,术后3年的肝内复发率显著降低(P<0.01),生存率显著提高(P<0.01).结论: 皮下植泵定期灌注化疗是防止原发性肝癌术后肝内复发,提高生存率的有效方法.     

Prophylactic portal infusion chemotherapy as adjuvant therapy for the prevention of metachronous liver metastasis in colorectal cancer

The DNA ploidy and DNA indices (DI) of 414 patients with colorectal cancer were analyzed, and the incidence of patients with metachronous liver metastasis was found to be significantly higher in those with aneuploid tumors and a DI above 1.5 than in those with aneuploid tumors and a DI below 1.4, or in those with diploid tumors and a DI equal to 1.0. Next, to confirm the effectiveness of administering prophylactic portal infusion chemotherapy (PPIC) as adjuvant therapy for the prevention of metachronous liver metastasis in colorectal cancer, a randomized controlled trial of PPIC was performed on 110 consecutive patients with primary colorectal cancer who had undergone curative resection. Although the incidence of patients with metachronous liver metastasis in the two study groups was not significantly different at 3.3% in the PPIC group and 10.3% in the control group, the incidence in the patients with aneuploidy and a DI above 1.5 was significantly lower in the PPIC group than in the control group. These findings suggest that colorectal cancer with aneuploidy and a DI above 1.5 may have a strong tendency to metastasize to the liver, and that prophylactic portal infusion chemotherapy may be effective for preventing metachronous liver metastasis in such patients.     

The suppression of postoperative liver metastasis caused by the continuous intraportal infusion of angiogenesis inhibitor FR-118487 in a rabbit colon cancer model

P < 0.05). However, leakage of the colonic anastomosis and body weight loss were limited to the FR-3 group. These results suggest that the continuous intraportal infusion of FR-118487 at 1 mg/kg/day suppressed liver metastases by inhibiting angiogenesis, without producing any adverse effects. (Received for publication on Oct. 3, 1996; accepted on May 12, 1997)     

微量注射泵垂直位移对给药精度影响的实验研究

目的探讨微量注射泵发生垂直位移对给药精度的影响,为制定微量注射泵操作规范提供参考。方法应用QA-IDS输注设备检测仪检测在1mL/h、25mL/h、50mL/h 3种流速下,微量注射泵依次改变与其输出端之间的垂直位移,经过0m、0.65m、-0.65m,再到0m的瞬时流量和累计流量,计算流量误差和缺失体积。结果微量注射泵位移升高时,瞬时流量增大,阶段和全程实际流量高于预测值;位移降低时,瞬时流量减小,阶段和全程实际流量低于预测值。随着流速的提高,流量体积变化相对误差减小。结论微量注射泵给药时,垂直位移可导致流量波动,较低流速给药时微量注射泵垂直位移更易造成流量改变,采用微量注射泵给药过程中应尽可能避免其垂直位移。