暂时阻断胃十二指肠动脉介入治疗原发性肝癌(附13例报告)

在肝动脉化疗栓塞治疗原发性肝癌(TACE)过程中，作者遇到了肝固有动脉走行特殊，而难以使导管超选至供瘤血管的13例病人，行胃十二指肠动脉暂时阻断，取得了满意效果。     

肝癌患者介入治疗术的护理

目的探讨对肝癌患者介入治疗术疗效影响的临床护理。方法分析并总结64例接受肝动脉栓塞化疗（TACA）手术前后的护理，术前主要介绍手术的一般过程，微创性，使患者克服恐惧心理；术后强调绝对卧床24h，患肢制动12h，严密观察发热、疼痛、恶心、呕吐等术后不良反应，并给予相应的护理措施。结果58例患者出现发热（90％），60例患者出现疼痛（93．8％），34例出现明显的胃肠道症状（53％），给予相应的护理措施均得以缓解。结论手术前后给予正确的指导和护理，有利于提高TACA的手术疗效。     

原发性肝癌肝外动脉供血的介入治疗

目的探讨原发性肝癌伴有肝外动脉供血的形成机制及介入治疗的方法。方法 41例原发性肝癌患者经肝动脉灌注化疗栓塞术（TACE）前常规行腹腔动脉造影,根据造影检查结果,结合术前B超、CT和/或MRI等影像学检查所示的癌灶位置及分布情况,选择性探查膈下动脉、肠系膜上动脉、胃左动脉、胃十二指肠动脉及肋间动脉等。结果 41例肝外动脉供血来源于肠系膜上动脉16例（39%）,右膈下动脉13例（31.7%）,左膈下动脉2例（4.9%）,胃左动脉6例（14.6%）,胃十二指肠动脉2例（4.9%）,右肋间动脉2例（4.9%）。肝外动脉供血支的超选择插管成功率为90.2%。随访6～24个月,生存时间1年以上者29例（70.7%）,生存时间2年以上者20例（48.8%）。结论了解肝癌肝外动脉供血特点和形成机制,对于临床准确和彻底阻断肝癌多动脉供血,提高TACE的疗效具有十分重要的意义。     

原发性肝癌肝动脉栓塞化疗术后生存分析

目的 分析原发性肝癌患者肝动脉栓塞化疗(TACE)术后影响预后的因素.方法 对67例TACE患者的临床资料进行回顾性分析.对影响因素行多因素Cox逐步回归分析,应用Kaplan-Meier法计算累积生存率,log-rank检验方法检验.结果 本组总体0.5、1.0、1.5、2.0年累积生存率分别为98.0%、84.7%、51.2%、15.0%;中位生存时间16个月.单因素Cox模型分析对影响预后有统计学意义的变量有血清HBsAg、术前血清甲胎蛋白(AFP)、术前与术后血清AFP差值占术前血清AFP百分比(AFP差值比)、凝血酶原时间(PT)、门静脉癌栓、碘化油沉积情况、肿块类型、临床分期.但多因素Cox逐步回归分析后仅AFP差值比、肝功能Child-Pugh分级、碘化油沉积情况、门静脉癌栓为影响预后有统计学意义的因素.结论 AFP差值比、肝功能Child-Pugh分级、碘化油沉积情况、门静脉癌栓是原发性肝癌患者TACE预后的独立影响因素,可作为预测疗效的有效指标.     

TACE联合PVC治疗原发性肝癌的疗效观察

目的:观察肝动脉化疗栓塞(TACE)联合门静脉化疗(PVC)治疗原发性肝癌的疗效.方法:选取本院2018年1月至2020年5月原发性肝癌患者59例,采用队列研究方法,分为观察组(接受TACE联合PVC治疗)和对照组(仅接受TACE治疗);观察组23例,其中伴有门静脉癌栓5例;对照组36例,其中伴有门静脉癌栓8例.术后电...     

原发性肝癌127例介入治疗的临床研究

目的:探讨肝动脉插管化疗联合碘油行介入治疗对原发性肝癌的治疗效果。方法:对127例原发性肝癌患者进行了经肝动脉超选灌注化疗联合碘油栓塞。结果:112例患者经2次～5次的介入治疗后有明显好转,其中21例经4次介入治疗后临床症状消失,肿块消失,AFP<20μg/L,超过一个月疗效评价CT;97例临床症状明显改善,肿块缩小50%以上者为54例,AFP下降至20μg/L～400μg/L之间,超过1月疗效PR;127例疗效评价标准按全国统一的实体瘤客观疗效通用标准测量,总有效率达79%。结论:经肝动脉插管化疗联合碘油对原发性肝癌有明显的治疗效果。     

肝动脉化疗栓塞术介入治疗原发性肝癌的预后影响因素分析

目的 分析影响肝动脉化疗栓塞术(TACE)介入治疗原发性肝癌(PLC)预后的相关因素.方法 选取2017年4月至2019年5月在我院行TACE介入治疗的PLC患者88例,术后随访1年,统计患者预后情况,并收集患者基线资料,包括年龄、病理学类型、TNM分期、门静脉栓子、肝内转移、甲胎蛋白(AFP)水平等,分析影响PLC预...     

原发性肝癌介入治疗护理方法探讨

目的：探讨肝癌患者经肝动脉化疗栓塞术治疗的护理要点。方法？通过观察原发性肝癌患者肝动脉化疗栓塞术后的病情变化,对不良反应及并发症的护理、心理、饮食等方面进行分析并提出护理方法。结果？经过精心治疗和护理,患者治疗顺利,无严重不良反应和并发症,患者病情得到明显改善。结论？有效的术前及术后护理,对提高治疗效果,预防和减少并发症有重要意义。     

手术联合血管内介入治疗原发性肝癌外科的临床价值

[目的]探讨手术联合血管内介入治疗原发性肝癌外科的临床应用价值. [方法]在本文对收治的原发性肝癌患者采用手术联合血管内介入治疗. [结果]观察组患者在治疗1年生存率达100.00%,两年生存率达92.59%,3年生存率达70.37%,4年生存率达11.1l%;中位生存期为42.1月;平均生存期为41.8月.生存率、中位生存期和平均生存期均明显高于对照组(P＜0.05).表明手术联合血管内加入疗法治疗原发性肝癌的临床效果明显好于单纯的手术治疗. [结论]在术前行TACE有利于争取手术机会和手术根治,而术后应用则可以减少复发,有利于提高患者的生存率和生存期,手术切除联合血管内介入治疗是提高原发性肝癌整体疗效、存活率和生存期的重要方法,具有重要的临床应用价值.     

肝动脉化疗栓塞联合蒽环类化疗药介入治疗原发性肝癌84例疗效观察

原发性肝癌在我国是一种常见的恶性肿瘤,其死亡率居所有肿瘤的第二位[1],该病发病隐匿,大多数患者发现时已是中晚期.肝动脉化疗栓塞是治疗原发性肝癌的主要手段,但该方法易损害正常肝组织和肝功能,疗效并未达到临床预期[2],而关于肝动脉化疗栓塞联合蒽环类化疗药物的研究甚少.本院通过对42例原发性肝癌患者给予肝动脉化疗栓塞联合蒽环类化疗药物介入治疗,取得了良好疗效,现报告如下. 1 资料与方法 1.1一般资料 回顾性分析2010年6月-2012年6月在本院接受治疗的84例原发性肝癌患者,男51例,女33例,年龄(59.7±12.8)岁.     

血必净注射液对肝癌TACE术后患者缺血/再灌注损伤以及血浆内毒素的影响

目的探讨血必净注射液对肝癌经导管肝动脉栓塞化疗(TACE)术后患者缺血/再灌注(I/R)损伤和血浆内毒素的影响。方法选取2013年9月至2017年1月期间我院收治的84例肝癌TACE术后患者,随机分为两组各42例。对照组患者行常规保肝治疗,观察组患者在此基础上加用血必净注射液治疗。比较两组TACE术后不同时间点的IR损伤和血浆内毒素、血管内皮生长因子(VEGF)水平。结果 TACE术后3 d,观察组的凝血酶原时间(PT)显著长于对照组,血小板(PLT)、血浆内毒素水平显著低于对照组(P<0.05);两组的VEGF水平比较无统计学差异(P>0.05)。TACE术后7 d,观察组的PT显著长于对照组,纤维蛋白原(Fbg)水平显著高于对照组,PLT、血浆内毒素、VEGF水平均显著低于对照组(P<0.05)。结论血必净注射液能有效改善肝癌TACE术后患者的血浆内毒素、VEGF水平,并改善患者的I/R损伤。     

Infiltrating Mammary Carcinoma with Osteoclast-like Giant Cells

Mammary carcinoma with osteoclast-like giant cells is an uncommon variant. The following case examines a 36-year-old woman incidentally found to have a left breast mass on routine physical exam. Initial ultrasound-guided core biopsies revealed infiltrating mammary carcinoma with focal mucinous features, for which a left breast lumpectomy and sentinel lymph node biopsy were performed. The sentinel lymph nodes were positive for metastatic mammary carcinoma with osteoclast-like giant cells on permanent section corresponding to the lumpectomy breast specimen, thus a left completion axillary node dissection was subsequently performed.     

The Cost-Effectiveness of Selective Internal Radiation Therapies Compared With Sorafenib for Treating Advanced Unresectable Hepatocellular Carcinoma in the United Kingdom

ObjectivesTo assess the cost-effectiveness of selective internal radiation therapy (SIRT) compared with sorafenib for the treatment of patients with advanced hepatocellular carcinoma in the United Kingdom, including a selected subgroup of patients who have been identified as benefiting from treatment with SIRT.MethodsA de novo economic model was developed comparing SIRT with sorafenib using data from two large randomized controlled trials. The model structure comprised a decision tree representing the outcome of the work-up procedure, transitioning into a 3-state partitioned survival model to project long-term survival outcomes. Cost-effectiveness in a post hoc defined subgroup with low tumor burden and good liver function was explored.ResultsAt list price, SIRT was predicted to be less costly but less effective than sorafenib with an estimated saving of £156 089 per quality-adjusted life-year forgone, with cost savings of £4589 and 0.029 fewer quality-adjusted life-years than sorafenib. Accounting for existing confidential discounts for sorafenib, two SIRTs were cost-effective at a £30 000 willingness-to-pay threshold compared with sorafenib when a discount for the technologies was introduced. In the subgroup with low tumor burden and good liver function, SIRT may be associated with greater survival benefits and cost savings.ConclusionsAccounting for confidential discounts, on average, SIRT technologies represent value for money in the whole advanced hepatocellular carcinoma population, being less effective but less costly than sorafenib. Results from a subgroup with low tumor burden and good liver function suggest that the cost-effectiveness of SIRTs may be maximized in this group, but further research is required to demonstrate the validity of effectiveness benefits.     

Enhancing the Efficacy of Hepatocellular Carcinoma Chemotherapeutics with Natural Anticancer Agents

Hepatocellular carcinoma (HCC) is a common cancer worldwide. A majority of HCC patients present with an unresectable or metastatic HCC and systemic therapy with cytotoxic agents provides marginal benefits. Some evidence suggests that certain natural phyto-chemical compounds used in conjunction with chemo-therapeutic agents could enhance therapeutic efficacy by sensitizing cells to treatment.     

肝脏恶性肿瘤术后化疗患者的临床护理

目的探讨肝脏恶性肿瘤术后化疗的有效和可行的护理方法,提高肝脏恶性肿瘤临床治疗效果。方法总结接受肝脏恶性肿瘤术后化疗的28例患者,通过加强静脉注射、口腔护理及心理护理,从而提高患者的治疗质量和生活质量。结果 28例肝脏恶性肿瘤术后化疗患者,通过给患者详细介绍护理的目的和方法,做好心理护理,至今存活26例,最长37个月,死亡2例,死亡原因均为肿瘤转移。结论对肝脏恶性肿瘤患者术后辅助化疗患者做好心理护理,营养支持及早预防,可有效减轻患者痛苦,提高肝脏恶性肿瘤术后化疗患者的治疗质量和生存质量,延长患者生存期。     

Nutritional Epigenetics and the Prevention of Hepatocellular Carcinoma with Bioactive Food Constituents

Hepatocellular carcinoma (HCC) is an aggressive and life-threatening disease often diagnosed at intermediate or advanced stages, which substantially limits therapeutic approaches to its successful treatment. This indicates that the prevention of HCC may be the most promising strategy in reducing its incidence and mortality. Emerging evidence indicates that numerous nutrients and nonnutrient dietary bioactive components can reduce the occurrence and/or delay the development of HCC through modifications of deregulated epigenetic mechanisms. This review examines the existing knowledge on the epigenetic mechanism-based studies in in vitro and in vivo models of HCC on the chemopreventive potential of epigenetic food components, including dietary methyl-group donors, epigallocatechin-3-gallate, sodium butyrate, resveratrol, curcumin, and sulforaphane, on liver carcinogenesis. Future direction and potential challenges in the effective use of bioactive food constituents in the prevention of HCC are highlighted and discussed.     

原发性肝癌伴门静脉癌栓的放射治疗研究

目的 探讨立体定向适形放疗联合介入治疗对原发性肝癌伴门静脉癌栓的治疗效果及其应用的价值。方法 2012年8月至2014年8月我科收治37例肝癌伴门静脉癌栓患者行肝动脉插管化疗(介入)+立体定向适形放疗,与同期单纯介入肝癌癌栓患者(45例)比较,研究两组间肿瘤缓解率、1年生存率、总体生存时间等差异。结果 立体定向适形放疗+介入较之单纯介入治疗,能有效控制杀灭肿瘤细胞,有效控制肿瘤生长(59.45% vs.31.11%,P <0.05),显著提高1年生存率(29.73% vs.8.89%,P < 0.05)。结论 立体定向适形放疗+介入是治疗肝癌伴门静脉癌栓的有效手段,可以显著改善预后,延长总体生存时间。