肝动脉化疗栓塞治疗原发性肝癌并门静脉癌栓的临床研究

目的　探讨肝动脉化疗栓塞治疗原发性肝癌并门静脉癌栓的疗效及其意义。方法　 5 4例原发性肝癌并门静脉癌栓的住院患者 ,按不同的治疗方法分成 3组 :保守治疗组 (A组 10例 ) ,单纯肝动脉灌注 (TAI)组 (B组 18例 ) ;肝动脉灌注加栓塞 (TAI +TAE -LP)组 (C组 2 6例 )。结果　A组中位生存期 2 0个期 ,0 5 ,1,1 5年生存例数分别为 1,0 ,0 ;B组中位生存期 4 0个月 ,0 5 ,1,1 5年生存例数分别为 8,0 ,0 ;C组中位生存期 2 5个月 ,0 5 ,1,1 5年生存例数分别为 14 ,3,1。各组生存例数比较 ,差异有显著性 (P <0 0 5 )结论　原发性肝癌伴门静脉癌栓行肝动脉化疗栓塞可明显提高疗效 ,改善患者生活质量 ,延长生存期 ,其中以TAL +TAE -LP可进一步提高生活质量 ,延长生存期     

不同剂量碘油肝动脉栓塞术治疗原发性肝癌

目的探讨应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的疗效,并对其进行比较研究。方法1987年8月～1999年12月12年间276例原发性肝癌被分为两组治疗组167例,应用常规导管或球囊导管超选择至肿瘤供血动脉,阻断其血流,使注射碘油时不产生逆流,将全部动脉肿瘤血管、病变周围正常的细小动脉及肝实质和门静脉分支栓塞;对照组109例,应用一般导管,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉。结果治疗组中,栓塞全部动脉肿瘤血管、病变周围正常的细小动脉及肝实质167例,门静脉分支栓塞109例。1、2、3、4、5年生存率分别为98.8%(165/167)、79.9%(107/134)、48%(47/98)、36.6(26/71)、25.5%(12/47);对照组中,仅栓塞了部分或全部动脉肿瘤血管,1、2、3、4、5年生存率分别为79.9%(87/109)、45.5%(40/88)、21.3%、(13/61)、10.2%(5/49)、3.1%(1/32)。两组病人1、2、3、4、5年生存率经统计学处理有极显著差异(P<0.01-0.001),两组病人均无严重合并症发生。结论应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。     

Transcatheter arterial chemotherapy with and without embolization in patients with hepatocellular carcinoma

OBJECTIVE: This study compared the antitumor effect, adverse effects and survival between transcatheter arterial embolization (TAE) and transcatheter arterial infusion chemotherapy (TAI) in patients with hepatocellular carcinoma (HCC). METHODS: The study population consisted of 168 consecutive patients with advanced HCC treated with transcatheter arterial treatments using cisplatin suspended in lipiodol. Among these, 74 patients were treated with TAE, and the remaining 94 patients were treated with TAI. RESULTS: There were no significant differences in any baseline characteristics except hemoglobin, platelets, albumin, and glutamic pyruvic transaminase. Complete or partial tumor response was achieved in 54 patients (73%) in the TAE group and in 48 patients (51%) in the TAI group (p < 0.01). There were two treatment-related deaths caused by acute hepatic failure and acute renal failure in the TAE group. Nausea and deterioration of serum transaminase after TAE were significantly more severe than after TAI. Median survival time and survival rates at 5 years were 3.1 years and 25% in the TAE group, and 2.5 years and 18% in the TAI group (p = 0.37). CONCLUSION: TAE has a higher antitumor effect than TAI, but does not significantly improve the survival of patients with HCC.     

132例原发性肝癌灌注化疗及栓塞治疗疗效观察

目的 探讨影响肝动脉灌注化疗＋栓塞治疗疗效的因素。方法 １９９３年１月￣１９９７年１０月,对１３２例不能切除的原发性肝癌行选择性插管灌注化疗及栓塞治疗５９７次,肝动脉灌注化疗＋栓塞者１２２例,单纯灌注化疗１０例。结果 １,２,３年生存率分别为８１．８％、３６．４％和１８．２％,疗效较治疗初期有显著提高。肿瘤分期、栓塞剂及其用量、侧支循环的形成以及肝动脉超选择性插管是影响疗效的主要因素。结论 合理施     

肝动脉栓寒术治疗原发性肝癌的初步报告

Twenty patients with primary hepatic carcinoma (PHC) treated by hepatic arterial embolization in our department from Dec. 1986 to Mar. 1987 are reported. There were 15 males and 5 females. The ages ranged from 34 to 75 years with an average of 50.7. Preoperative diagnosis and localization of the tumor were done by AFP, B-us, CT and angiography (right lobe 15 cases, left lobe 1 case, both lobes 4 cases). Celiac and superior mesenteric angiography was carried out by femoral artery approach and then highly selective hepatic catheterization was utilized for hepatic arterial embolization. Antitumor agent (5-Fu, adriamycin), iophendylate and foamy gel sponge were used for peripheral and proximal embolization. Manifestations were improved in most of the patients after embolization, such as relief of abdominal pain, improvement of appetite, decrease of tumor size. Total necrosis of the tumor was found in 2 patients who underwent surgery 1 month after embolization. The side effects of the posthepatic embolization such as, nausea, vomiting, abdominal pain and fever could be relieved by symptomatic treatment. No severe complications, such as gangrene of the gall bladder, hepatic failure, liver abscess, intestinal necrosis or pulmonary embolization were found except 3 patients who died of renal failure after the procedure. The liver dys-function returned to normal within 2 weeks. Hepatic arterial embolization provides an alternative treatment for the patients with PHC who has compensated liver function without severe systemic diseases, especially renal endocrine problems and severe portal hypertension. They should have patent portal system as proved by angiography. The authors considered that this therapeutic embolization with hepatic chemotherapy infusion is safe and effective in the management of PHC. It may increase the resectability and provide palliative means for the advanced and terminal cases.     

抗人肝癌单克隆抗体的人体放射免疫定位及治疗

研究单抗Ｈｅｐａｍａ－Ⅰ在原发性肝癌患者中的导向定位及治疗效果。方法本研究包括３０个失去手术指征的原发性肝癌患者,其中１８例行放射免疫显像（ＲＩ）研究,１２例行放射免疫治疗（ＲＩＴ）研究,分别从肝动脉投与１３１Ｉ－ＨｅｐａｍａＩ９．２５ＧＢｑ（ＲＩ）及１８．５ＧＢｑ（ＲＩＴ）。结果接受该制剂后未见明显毒性反应,显像率为１４／１８,最佳显像时间在注射后９６小时,ＡＦＰ下降率为７５．０％,肿瘤部分缩小率６６．６％,与对照组比较,生存时间明显延长。结论单抗ＨｅｐａｍａＩ能在人体内认识原发性肝癌细胞,并能与之特异结合。核素碘标记的ＨｅｐａｍａＩ可作为治疗晚期肝癌的综合疗法之一。     

Selective Internal Iliac Artery Oxaliplatin Infusion: Another Facultative Treatment to Unremitting Hematuria in Stage T4 Bladder Carcinoma

OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma.METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin (100 mg/m2) and epirubicin (EPI 50mg/m2). Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment.RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7±1.8 days and that in the TAE group was 3.5±0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.1-3.Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group (t=2.51, P<0.01),and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups.CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.     

A case report--transarterial embolization for advanced gallbladder carcinoma with hepatic metastasis

A 75-year-old female presented with appetite and weight loss and epigastralgia. CT revealed a primary gallbladder carcinoma Stage IVb with multiple hepatic metastases. Gastrofiberscopy revealed an invasion to duodenal and bleeding from the tumor. For her poor performance status, it seems to be too difficult to undergo a general chemotherapy. So after gastrojejunostomy, transarterial embolization (TAE) was performed. She underwent 2 times TAE. There was a notable reduction in tumor size. But pulmonary metastases were found in bilateral lung. She died after 8 months. TAE may be useful for advanced gallbladder carcinoma with tumor vascularity.     

经肝动脉注射抗癌药物加载体溶液治疗中晚期肝癌实验和临床治疗研究

目的：探讨中晚期肝癌患者的临床治疗。方法：针对中晚期肝癌ＴＡＥ 禁忌证,单一药物灌注性化疗（ＴＡＩ）效果不满意现状,采用海藻酸钠和右旋糖苷做为抗癌药物载体溶液（ＳＡＤ）,进行了动物肝脏功能副损害、人体药动学实验和５０ 例ＴＡＥ禁忌证临床治疗研究。结果：１） 与ＴＡＩ比较,ＳＡＤ 有利于提高、延长抗癌药物于肿瘤组织有效浓度和作用时间（Ｐ＜ ０．０１）。２）治疗组１ 年生存率４５．３８ ％ ,平均生存期１１．６９ 个月;对照组１ 年生存率２３．０８％ ,平均生存期６．７４ 年月（Ｐ＜ ０．０１） 。３）ＳＡＤ 在肝动脉释药过程中引起一过性栓塞,但副反应较小,无严重栓塞并发症及死亡病例发生。结论：与ＴＡＩ比较,抗癌药物加ＳＡＤ 更具有积极、有效的治疗作用;临床治疗选择ＳＡ 浓度为６ ％ ～８％ 是安全可行的。     

超常规剂量碘油超选择TAE与常规TAE后Ⅱ期肝癌切除-27例手术病理及随访研究

目的评价术前应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的价值。方法1987年8月～1999年12月12年间27例原发性肝癌分为两组治疗组17例,应用常规导管或球囊导管超选择至肿瘤供血动脉,阻断其血流,使注射碘油时不产生逆流,将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞,栓后25天～121天手术切除;对照组10例,应用一般导管,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉,栓后20天～140天手术切除。对两组病人切除的标本均进行了详细的病理学研究,同时对全部病人随访3～8年。结果治疗组17例中11例肿瘤100%坏死,其余6例坏死率为85%～95%,3、5年生存率分别为88.2%(15/17)、45.5%(5/11),3例现生存6～8年;对照组10例中2例肿瘤完全坏死,另8例坏死率为75%～95%,3、5年生存率分别为60.0%(6/10)、14.3%(1/7)。结论术前应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。