肝动脉插管+B超引导下经皮经肝门静脉穿刺化疗栓塞治疗原发性肝癌15例报告

目的 :探讨肝动脉插管联合经皮肝穿刺选择性门静脉化疗栓塞 (TACE SPVE)治疗不能手术的中晚期肝癌的效果。方法 :对不能手术切除的中晚期肝癌 15例在TACE术后 1周 ,行超声引导下经皮经肝穿刺选择性门静脉化疗栓塞。结果 :TACE SPVE 15例共行 4 9次 ,治疗后肿瘤缩小 13例 ,AFP转阴 5例 ,二期手术 3例 ,1例肿瘤缩小 80 % ,AFP转阴。 1年生存率 80 % (8/ 10 )。结论 :TACE SPVE是治疗不能手术切除的中晚期肝癌的有效方法。     

肝癌合并门静脉高压症的一期外科治疗

 目的　探讨肝癌合并中重度门静脉高压症外科手术治疗的适应证、手术方式及术后肿瘤复发的防治。方法　回顾分析1999年6月至2009年6月经手术治疗的93例肝癌合并中重度门静脉高压症,其中行肝脏移植33例,行肝癌切除同时行脾切除、门奇静脉断流术39例,行开腹肝癌射频消融治疗同时行脾切除、门奇静脉断流术21例。结果　肝移植围手术期无死亡,常规肝部分切除同时行脾切除,门奇静脉断流术围手术期发生肝衰竭死亡1例;开腹肝癌射频消融治疗同时行脾切除、门奇静脉断流术无严重并发症发生。肝移植组术后1、2、3年生存率分别为93.9 %、72.7 %、69.7 %;肝癌切除组常规手术后1、2、3年生存率分别为94.9 %、66.7 %、53.8 %;肝癌射频消融组常规手术后1、2、3年生存率分别为95.2 %、66.7 %、47.6 %。两组生存率差异无统计学意义。结论　术前病情不同,各种治疗措施的疗效没有可比性,个体化治疗是肝癌合并门静脉高压症治疗的关键。肝脏移植是肝癌合并门静脉高压症的最佳治疗手段。     

乳管镜与美兰染色定位在乳管内肿物切除术中应用的比较

目的:比较乳管镜定位和美兰染色定位在乳管内肿物术中应用的价值。方法:23例乳管内肿物患者行术中美兰染色定位切除,53例行术中乳管镜定位切除,评价两种定位方法的效果。结果:一次性病灶切除率乳管镜定位组为96.2%(51/53),美兰染色定位组为78.3%(18/23),乳管镜组无一例发生乳腺局部变形,美兰染色定位组术后7例发生局部变形。结论:乳管镜定位指导乳管内肿物手术切除具有定位准确、手术损伤小、无乳腺变形等优点,提高了乳腺病变导管的诊断率,值得临床应用。     

术中超声对早期诊断消化道肿瘤肝转移的价值

目的探讨术中超声对早期诊断消化道肿瘤肝转移的价值。方法应用术中超声对176例确诊为消化道恶性肿瘤患者行术中肝脏超声检查,并与术前经腹壁超声、CT肝脏扫描以及外科手术探查等进行对比观察,所有肝内转移病灶均经手术切除或穿刺活检组织学确诊。全部病例于术后随访。结果176例消化道肿瘤于手术时发现肝内转移43例(24.4%),计81个结节。其中术中超声诊断率为97.7%,显著高于术前经腹壁超声的86.0%、CT扫描的79.1%和外科直接探查的69.8%(P＜0.05,P＜0.01),尤其是对24个直径＜2cm的结节,术中超声、术前超声、CT扫描和外科探查的诊断率分别为95.8%、58.3%、41.7%和25.0%,术中超声显著优于其他方法（P＜0.01）。结论术中超声对早期诊断消化道肿瘤肝内转移有极高的敏感性,对提高消化道肿瘤外科手术的治愈率,延长患者生存率有重要价值。     

手术切除大肝癌87例分析

[目的]探讨大肝癌切除的安全性和可行性。[方法]87例大肝癌病人,肿瘤平均直径10.6cm（6.8～15.5cm）,采用间歇阻断入肝血流进行肝肿瘤切除,其中一期切除56例,二期切除31例,二期切除的病人术前经肝动脉和门静脉化疗栓塞治疗（TACE＋PVCE）,肿瘤缩小后切除。[结果]87例肿瘤均顺利切除,肝门阻断时间平均15min,出血量平均840ml,4例术后死于肝功能衰竭和上消化道出血,术后1、3、5年生存率一期切除分别为71.7%、52.1%、46.7%,二期切除分别为72.4%、57.1%、42.9%。[结论]大肝癌经综合治疗后二期切除,仍是安全可行的。     

微波在肝癌外科治疗实验和临床中的应用研究

目的 :探讨微波固化治疗肝癌的有效性、免疫效应及临床应用价值。方法 :1皮下接种 Hepa瘤细胞株建立小鼠肝癌模型 ,将 70只荷瘤小鼠随机分为 :微波固化 (MTC)组和对照组。 2单针微波固化 12只活体兔肝 ,观察肝功能变化。 3微波固化切除肝癌 45例 ,与同期传统方法切除肝癌40例作对照 ;微波固化不能切除的肝癌 2 0例与同期行肝动脉结扎合并肝动脉和门静脉双插化疗不能切除的肝癌 2 0例作对照。结果 :1MTC组小鼠肿瘤固化灶内癌细胞呈凝固性坏死 ,对照组肿瘤内有大量癌细胞存在。 2 MTC组癌旁组织内 CD 8和 CD 4 细胞的密度明显高于对照组。 3微波对肝脏功能有影响。4微波肝切除平均每例术中出血量比传统方法少 ,术后 3年复发率 31.1% ,而传统方法为 46 .3% ;微波固化不能切除肝癌组术后 3年生存率为 11.1% ,对照组 3年生存率为 10 .5 %。结论 :微波固化治疗肝癌是一种安全有效的方法 ,并且可促进固化灶周围组织的免疫反应 ;微波固化切除肝癌 ,止血效果好 ,并发症少 ,可减少切缘复发 ,值得临床推广应用     

超声吸引刀结合双极电凝在肝癌切除术中的护理配合

目的　探讨超声吸引刀结合双极电凝在肝癌切除术中的应用以及相关护理配合的经验。方法　７７例患者应用超声吸引刀结合双极电凝行肝癌切除术,护理的关键是术中对超声吸引刀的管理和应用。结果　平均手术时间２.５～４ｈ,术中出血量２００～５００ｍｌ,无１例发生明显肝衰、术后大出血、胆瘘等严重并发症。超声刀的术前准备与检查、术中使用配合、术后清洗和保养确保了患者手术的安全,提高了手术的成功率。结论　超声吸引刀结合双极电凝行肝癌切除术效果满意,安全性好,护理的精心配合可提高手术的成功率。     

年龄及术前合并症对肝癌切除患者术后并发症的影响

目的:探讨高龄肝癌患者年龄及术前合并症等因素对术后并发症的影响。方法:回顾性分析2012年1月至2014年1月行肝脏部分切除术治疗的160例肝原发性恶性肿瘤患者(老年肝癌患者63例,非老年肝癌患者97例)的资料,分析年龄及术前合并症与术后并发症之间的关系。结果:高龄组术前高血压、心脏病、肺部疾病及多种合并症与对照组比较明显增高(P<0.05);高龄肝癌组伴有2种及以上合并症的患者29例,其中有21(72.4%)例患者出现了术后并发症,与其总体并发症发生率(28例,44.4%)比较差异有统计学意义(P=0.012)。非老年肝癌组中,47例伴有合并症的患者中,有15例(31.9%)出现了术后并发症,与高龄肝癌组的总体发生率比较差异无统计学意义（P=0.183)。在伴有高血压、心脏疾病、糖尿病和肺部疾病这4种术前合并症方面,有术后并发症的高龄组与无术后并发症的高龄组相比,差异有统计学意义(P<0.05)。结论:年龄不是老年肝癌患者术后并发症的独立因素,高血压、糖尿病、肺部疾病、心脏疾病等术前合并症是老年肝癌患者术后发生并发症的高危因素。     

乳管镜与美兰染色定位在乳管内肿物切除术中应用的比较

目的：比较乳管镜定位和美兰染色定位在乳管内肿物术中应用的价值。方法：23例乳管内肿物患者行术中美兰染色定位切除,53例行术中乳管镜定位切除,评价两种定位方法的效果。结果：一次性病灶切除率乳管镜定位组为96.2%（51/53）,美兰染色定位组为78.3%（18/23）,乳管镜组无一例发生乳腺局部变形,美兰染色定位组术后7例发生局部变形。结论：乳管镜定位指导乳管内肿物手术切除具有定位准确、手术损伤小、无乳腺变形等优点,提高了乳腺病变导管的诊断率,值得临床应用。     

Glisson蒂横断式精准肝切除与美蓝染色法在肝癌病人中的联合应用

目的 探讨Glisson蒂横断式精准肝切除与美蓝染色法在肝癌病人中的应用价值.方法 回顾性分析2009年1月至2010年5月我院对30例肝癌患者采用Glisson蒂横断式精准肝切除与美蓝染色法联合应用的临床资料.首先解剖出拟切除肝段的肝蒂,B超引导下从肝段门脉注入美蓝染色后阻断肝蒂,使拟切除肝段染色,按染色的界限行肝段切除.结果 Glisson鞘内注射美蓝染色的成功率为100%,30例患者均行精准肝切除,其中右半肝切除6例,左半肝切除6例,Ⅱ、Ⅲ段肝切除5例,Ⅲ段肝切除1例,Ⅴ、Ⅷ段肝切除3例,Ⅴ段肝切除3例,Ⅵ、Ⅶ段肝切除5例,Ⅶ段肝切除1例.手术均顺利完成.手术时间为(125±32)min,出血量为(250±55)ml.术后并发症:中等量(800～2 500ml)腹腔积液2例,并发症发生率为6.7%(2/30).住院时间为(19±5)d.结论 Glisson蒂横断式精准肝切除与美蓝染色法的联合应用对肝实质离断过程中的切面选择具有引导作用,有助于提高肝切除的精准性,能最大程度地减少术后并发症,提高肝癌切除的安全性.     

Radiofrequency ablation combined with percutaneous ethanol injection in the treatment of hepatocellular carcinoma and portal vein neoplastic thrombosis

In the last ten years new techniques, such as percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA), have been developed for the treatment of hepatocellular carcinoma (HCC). Portal vein involvement is a complication of HCC and the role of surgical resection for HCC with tumor thrombi in the portal veins is controversial. Here we present the case of a 58-year-old man, with Child's class A cirrhosis and a focal lesion of HCC with thrombosis of the segmental portal branch extending into the right portal vein. We treated the nodule with RFA and the portal tumor thrombosis with ethanol injection. Twenty-two months after the combined treatment, an enhanced spiral CT scan showed complete necrosis of the nodule and color/power Doppler ultrasound demonstrated the complete patency of the right portal vein.     

A case of Vp3 hepatocellular carcinoma with a good QOL after multidisciplinary treatments

A 74-year-old male was examined with abdominal CT scan because of general fatigue. Abdominal CT scan indicated enhanced tumors, 9x8 cm in size in subsegment 6/7 and 5 mm in size in subsegment 3. Tumor thrombus was observed in the right portal branch to the main portal vein. We diagnosed the patient with Vp3 hepatocellular carcinoma. A right hepatectomy with extraction of portal venous thrombus was performed. Unresectable tumor was treated with one shot arterial infusion (epi-ADM 40 mg) and TAE 3 times at an interval of three months. The side effect was only a fever and the QOL was good under the treatment. But a tumor in S1 had developed, and the patient died at about 12 months after the operation.     

超声引导下经皮肝穿刺门静脉插管治疗肝癌

目的:探讨B超引导下经皮肝穿刺门静脉插管的可行性、操作技术及其在肝癌介入治疗中的应用价值。方法:在超声引导下,选用微创穿刺器械,对31例肝癌患者进行经皮肝穿刺门静脉插管及药盒系统植入。结果:31例(100%)患者经皮肝穿刺门静脉插管获得成功,未出现严重并发症。结论:采用超声引导经皮肝穿刺门静脉插管是一种可供选择的门静脉插管方法。     

Safety and Efficacy of Sequential Transcatheter Arterial Chemoembolization and Portal Vein Embolization prior to Major Hepatectomy for Patients with HCC

Objective: To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE)and portal vein embolization (PVE) before major hepatectomy for patients with hepatocellur carcinoma (HCC).Methods: In this retrospective case-control study, data were collected from patients who underwent sequentialTACE and PVE prior to major hemihepactectomy. Liver volumes were measured by computed tomographyvolumetry before TACE, and preoperation to assess degree of future remnant liver (FRL) hypertrophy and tocheck whether intro- or extrohepatic metastasis existed. Liver function was monitored by biochemistry afterTACE, prior to and after major hepatectomy. Results: Mean average FRL volume increased 32.3-71.4% (mean55.4%) compared with preoperative FRL volume. After TACE, liver enzymes were elevated, but returned tonormal in four weeks. During PVE and resection, no patient had intro- or extrohepatic metastasis. Conclusion:Sequential TACE and PVE is an effective method to improve resection opportunity, expand the scope of surgicalresection, and greatly reduce postoperative intra- and extrahepatic metastasis.     

Prognostic analysis for treatment modalities in hepatocellular carcinomas with portal vein tumor thrombi

Objective: To assess prognostic aspects of treatment modalities for cases of hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT). Method: 121 treated cases were retrospectively divided into five groups: 1 (liver transplantation); 2 (transcatheter arterial chemoembolization); 3 (hepatectomy plus thrombectomy); 4 (hepatectomy plus thrombectomy combined with adjuvant chemobiotherapy via portal vein); and 5 (conservative treatment). The Kaplan-Meier method with difference in survival estimated by Log-rank test was used to compare between groups. Result: Groups 1-5 had a significantly differing median survival times of 7, 7, 10, 16, 3 months (P<0.05), respectively. One- and three-year survival rates were 30.0% and 10.0%, 20.0% and 0.0%, 47.0% and 22.0%, 70% and 20%, and 12% and 4%. Conclusion: Surgical resection combined with adjuvant chemotherapy via the portal vein is an effective and safe treatment modality for hepatocellular carcinoma with portal vein tumor thrombi.     

Use of transportal balloon catheter occlusion of the portal triad in prevention of bleeding during liver resection

BACKGROUND: Operative blood loss is among the most important factors determining the prognosis of patients undergoing hepatic resection. The best method for preventing bleeding is preliminary selective vascular occlusion of lobar, sectoral, or segmental portal triads, although not always technically feasible. METHOD: Transportal occlusion of the portal triad with a balloon catheter was used in 35 hepatectomies for various tumors. RESULTS: In 27 out of 35 resections, there was absence or minimal bleeding from afferent vessels (portal vein, hepatic artery). In the remaining eight cases, there was significant bleeding from the hepatic artery. In these cases, transportal occlusion of portal triad was combined with a temporary interruption of the hepatic artery after the dissection of the hepatoduodenal ligament. The average intraoperative blood loss was 350-1,500 ml. CONCLUSION: The use of a balloon catheter occlusion of the portal triad during liver resection is often technically feasible. It facilitates temporary occlusion of hardly accessible portal veins in the hepatic hilus without their prior exposure and minimizes bleeding.     

微波固化针在不规则肝脏切除治疗肝癌中的应用

目的:探讨微波固化针在不规则肝脏切除术中的应用价值.方法:回顾性分析我科2011年9月至2013年9月联合微波固化针所施行的68例不规则性肝切除患者的临床资料(微波固化+不规则性肝切除组,A组),与肝切除数据库中同样行不规则肝切除患者进行配对(单纯不规则切除组,B组),并对两组对比分析.结果:两组围手术期均无死亡病例.微波固化在不规则肝脏切除术中无需行肝门阻断,手术时间、出血量、补血量、术后住院时间明显少于单纯行不规则性肝切除术,术后并发症少,恢复快(P＜0.05).而术后肝功能恢复情况两组并无显著差异(P＞0.05).结论:微波固化针在不规则性肝切除术中的应用是安全有效的.在掌握传统方法阻断肝门切肝的基础上,使用微波固化针沿预切除线行微波固化带,可显著减少手术出血量,缩短肝门部阻断及总体时间,且患者术后康复较快.     

Percutaneous transhepatic portal vein stenting for portal hypertension caused by local recurrence of intrahepatic cholangiocarcinoma

A 62-year-old woman underwent an extended left hepatectomy with a combined resection of portal vein and extrahepatic bile duct for intrahepatic cholangiocarcinoma (ICC). After 7 years, she presented with repeated tarry black stool and severe anemia. The source of bleeding was not identified on upper and lower gastrointestinal endoscopy. Computed tomography (CT) revealed a small hypodence lesion at portal hepatis, by which portal vein (PV) stenosis was induced in the absence of sufficient development of portal venous collateral. Positron emission tomography revealed an accumulation of fluorodeoxy glucose around PV obstruction. Based on these findings, we diagnosed that the local recurrence of ICC, which resulted in mesenteric hypertension and small bowel varices. Therefore, portal stent placement was carried out under percutaneous transhepatic portgraphy to maintain portal blood flow. An uncovered expandable metallic stent was inserted into the stenotic region. Portgraphy after the stent replacement showed a relief of the PV stenosis and disappearance of the collateral pathways. After this procedure, the patient had no additional episode of gastrointestinal hemorrhage. Our experience suggests that stent placement for postoperative PV stenosis is recommended as a useful treatment for gastrointestinal bleeding caused by portal hypertension that is less invasive.     

Anticancer effect of UFT in intrahepatic recurrence with tumor embolus in the left portal vein after hepatectomy of hepatoma--a case report

A 65-year-old man was diagnosed as having hepatoma (HCC) in the area of S5 and S8. Anterior segmentectomy was performed on September, 1984. TAE (Sandwich therapy) via r. hepatic artery was performed for the intrahepatic recurrence one and half years after hepatectomy. However, the tumor embolus in the l. portal vein with intrahepatic recurrence occurred, and intraarterial infusion chemotherapy (IAC) using CDDP 150 mg was performed via proper hepatic artery. The decrement of AFP value was observed for a short time after IAC therapy. Therefore, UFT 300 mg daily, was administered. For two and half months after UFT administration, the elevation of AFP value continued from 665 ng/ml to 4150 ng/ml, and decreased rapidly below 20 ng/ml in the following 2 months. The tumor embolus in the l. portal vein was remarkably reduced on computed tomogram examination. This case suggests the usefulness of UFT for the intrahepatic recurrence with tumor embolus in the portal vein after hepatectomy for HCC.     

Ⅲ Ⅳ型肝门胆管癌扩大肝切除临床疗效分析*

目的:探讨扩大肝切除对Bismuth-Corlette Ⅲ、Ⅳ型肝门胆管癌的临床疗效。方法:回顾性分析蚌埠医学院第一附属医院2008年1 月至2015年5 月61例Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者的临床资料。其中扩大肝切除组行半肝及以上肝切除和（或）联合尾状叶切除术22例;局限肝切除组行肝门区不规则肝切除术39例。结果:扩大肝切除组患者相比局限肝切除组手术时间长、术中出血量多。扩大肝切除组患者并发症发生率低于局限肝切除组患者;扩大肝切除组无围手术期死亡患者,局限肝切除组有2 例围手术期死亡患者;扩大肝切除组R 0 切除21例,R 0 切除率为95.5%（21/ 22）,局限肝切除组R 0 切除20例,R 0 切除率为51.3%（20/ 39）,差异具有统计学意义（P < 0.05）;扩大肝切除组1、3、5 年生存率分别是77.27% 、36.36% 、13.64% ;局限肝切除组1、3、5 年生存率分别是69.23% 、20.51% 、1.64% ,差异具有统计学意义（P < 0.05）。 结论:Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌扩大肝切除可以有效提高患者的R 0 切除率和生存率,改善患者的预后。