经皮股动脉导管药盒系统介入治疗肝细胞癌的临床应用

目的探讨经皮股动脉导管药盒系统介入治疗肝细胞癌的临床疗效及并发症。方法从1999年1月到2001年3月应用经皮股动脉植入导管药盒系统（PCS）对45例肝细胞癌患者进行化疗和碘油栓塞治疗，回顾性分析临床疗效及并发症。结果PCS介入治疗肝细胞癌的有效率为66．7％（30／45）。患者1、2、3年生存率为75．6％（34／45），33．3％（15／45），17．8％（8／45）。弪皮股动脉导管药盒植入术的并发症包括1例切口感染及切口延迟愈合，4例PCS堵塞和1例留置导管尖移位。所有并发症经适当处理后无严重后遗症。结论经皮股动脉导管药盒系统植入术对介入治疗肝细胞性肝癌是1种安全有效技术。     

经皮动脉导管药盒系统栓塞化疗治疗原发性肝癌的临床分析

目的:探讨经皮动脉导管药盒系统(PCS)栓塞化疗原发性肝癌的临床疗效及不良反应.方法:将84例原发性肝癌患者随机分为治疗组和对照组.治疗组45例肝癌患者经皮股动脉穿刺插管植入PCS后,常规每月1次经PCS栓塞化疗,同时经PCS每天注入顺铂(DDP)30mg～40mg,连续3天;注入5-氟脲嘧啶(5-Fu)0.5g～0.75g,连续5天;注入羟基喜树碱(HCPT)10mg,连续10天;10天为1疗程,每4周重复1次,共3～4个疗程.对照组39例肝癌患者常规每月1次经皮股动脉穿刺插管栓塞化疗,每月1次灌注HCPT30mg～40mg、DDP 80mg～100mg、5-Fu 1.0g～1.5g,并行栓塞化疗,每4周重复1次,共3～4疗程.结果:治疗组45例患者CR 1例,PR 30例,NC 11例,PD 3例,近期有效(CR+PR)率68.89%;对照组39例患者CR 0例,PR 18例,NC 15例,PD 6例,近期有效(CR+PR)率46.15%;两组比较有显著性差异(P＜0.05).两组毒副反应主要为胃肠道反应和骨髓抑制,两组比较无差异(P＞0.05).结论:经PCS栓塞化疗(介入治疗)原发性肝癌近期疗效高,毒副反应小,且手术操作简便、安全有效,是治疗肝癌的一条有效途径.     

经皮经股动脉植入药盒系统治疗晚期胃癌的临床疗效

目的　探讨药盒在晚期胃癌治疗中的临床价值。方法　无法外科手术的胃癌 18例 ,依据化疗途径不同分两组 :A组 10例 ,采用经皮经股动脉植入药盒 ,术后经药盒 1周或 2周化疗 1次 ,B组 8例 ,采用术中动脉插管化疗 ,每 1周或 2周化疗 1次。结果　A、B两组有效率 (CR PR)分别为 5 0 %和 37 5 %(P <0 0 5 ) ,A组 6个月、1年、2年生存率分别为 10 0 %、5 0 %、2 0 %,B组分别为 75 %、37 5 %、12 5 %(P <0 0 1) ,A组患者的生存质量明显改善 ,消化道反应、肝胆骨髓毒性均较B组低。结论　经药盒间断性化疗治疗晚期胃癌可明显改善患者的生存质量 ,提高生存率。     

经皮动脉导管药盒系统栓塞化疗治疗原发性肝癌的临床分析

目的探讨经皮动脉导管药盒系统(PCS)栓塞化疗原发性肝癌的临床疗效及不良反应。方法将84例原发性肝癌患者随机分为治疗组和对照组。治疗组45例肝癌患者经皮股动脉穿刺插管植入PCS后,常规每月1次经PCS栓塞化疗,同时经PCS每天注入顺铂(DDP)30mg～40mg,连续3天;注入5氟脲嘧啶(5Fu)0.5g～0.75g,连续5天;注入羟基喜树碱(HCPT)10mg,连续10天;10天为1疗程,每4周重复1次,共3～4个疗程。对照组39例肝癌患者常规每月1次经皮股动脉穿刺插管栓塞化疗,每月1次灌注HCPT30mg～40mg、DDP80mg～100mg、5Fu1.0g～1.5g,并行栓塞化疗,每4周重复1次,共3～4疗程。结果治疗组45例患者CR1例,PR30例,NC11例,PD3例,近期有效(CR+PR)率68.89%;对照组39例患者CR0例,PR18例,NC15例,PD6例,近期有效(CR+PR)率46.15%;两组比较有显著性差异(P<0.05)。两组毒副反应主要为胃肠道反应和骨髓抑制,两组比较无差异(P>0.05)。结论经PCS栓塞化疗(介入治疗)原发性肝癌近期疗效高,毒副反应小,且手术操作简便、安全有效,是治疗肝癌的一条有效途径。     

肝动脉介入治疗加（减）全身化疗治疗转移性肝癌的临床观察

目的　分析肝动脉介入治疗加 (减 )全身化疗治疗转移性肝癌。方法　对 16 4例转移性肝癌进行回顾性研究 , 组 10 0例 ,采用肝动脉介入治疗加 (减 )全身化疗 ; 组 6 4例 ,采用单纯静脉化疗 ,观察两组疗效、生存情况 ,并进行统计分析对比。结果　 组 CR2 6 .0 % ,PR5 8.0 % ,有效率 84.0 % ; 组 CR6 .3% ,PR18.8% ,有效率2 5 .0 % , 组疗效显著高于 组 (P<0 .0 1)。生存率 1～ 5年 组分别为 85 .6 %、42 .6 %、2 6 .4%、3.6 %、2 .4% ; 组分别为 2 6 .0 %、15 .0 %、8.0 % ,4～ 5年生存率均为 0。 组生存率显著高于 组 (P<0 .0 1)。结论　肝动脉介入治疗加 (减 )全身化疗是非手术治疗转移性肝癌较为有效的方法。     

经皮股动脉插管植入药盒系统治疗晚期肝癌的疗效观察

目前,随着介入技术的发展,经导管肝动脉栓塞化疗(TACE)的广泛应用,使肝癌的近期疗效得到明显的提高,但单次TACE有时难以根据肿瘤细胞代谢特点及药动力学用药[1].我们自2001年6月以来采用经皮股动脉插管植入药盒系统(PCS)治疗各种晚期肝癌30例,现报告如下.     

经皮植入药盒腹主动脉灌注给药治疗晚期直肠癌初步观察

目的 研究经皮植入药盒腹主动脉灌注给药治疗晚期直肠癌的临床疗效及不良反应，探索晚期直肠癌较合理的治疗方法。方法 对16例晚期直肠癌病人采用大剂量醛氢叶酸(CF)静脉滴注，继之经皮经左锁骨下动脉植入药盒导管系统腹主动脉持续48小时灌注5—氟脲嘧啶(5—Fu)，配合榄香烯乳灌注治疗。结果 完全缓解(CR)l例，部分缓解(PR)9例，稳定(NC)6例。总有效率(CR PR)62．5％。主要不良反应为恶心、呕吐、口腔粘膜炎、骨髓抑制及腹泻，上述不良反应大多数为I～Ⅱ度，经常规对症治疗后好转。结论 经皮植入药盒腹主动脉灌注5—Fu及榄香烯乳配合静脉滴注CF，治疗晚期直肠癌疗效较好，药盒导管系统的长期留置克服了常规介入治疗需反复多次插管，难以系统用药的缺点，给药方便，不良反应轻。     

肝动脉介人治疗加(减)全身化疗治疗转移性肝癌的临床观察

目的分析肝动脉介入治疗加(减)全身化疗治疗转移性肝癌.方法对164例转移性肝癌进行回顾性研究,Ⅰ组100例,采用肝动脉介入治疗加(减)全身化疗;Ⅱ组64例,采用单纯静脉化疗,观察两组疗效、生存情况,并进行统计分析对比.结果Ⅰ组CR 26.0%,PR 58.0%,有效率84.0%;Ⅱ组CR 6.3%,PR 18.8%,有效率25.0%,Ⅰ组疗效显著高于Ⅱ组(P＜0.01).生存率1～5年Ⅰ组分别为85.6%、42.6%、26.4%、3.6%、2.4%;Ⅱ组分别为26.0%、15.0%、8.0%,4～5年生存率均为0.Ⅰ组生存率显著高于Ⅱ组(P＜0.01).结论肝动脉介入治疗加(减)全身化疗是非手术治疗转移性肝癌较为有效的方法.     

含羟基喜树碱方案经肝动脉灌注栓塞治疗原发性肝癌38例

目的　观察羟基喜树碱 (HCPT)联合方案经肝动脉灌注栓塞治疗手术无法切除的原发性肝癌的效果。方法　按Seldinger法经皮股动脉穿刺插管或手术置入肝动脉植入式药泵后 ,给予HCPT +5 Fu+MMC +碘化油行化疗栓塞治疗 38例原发性肝癌。结果　有效率 (CR +PR) 4 2 .1% (16 38) ,半年生存率为 84 2 % ,1年生存率为 5 2 6 % ,毒副作用以消化道反应和骨髓抑制、发热为主。结论　含HCPT方案经肝动脉灌注栓塞化疗对中晚期原发性肝癌疗效确切 ,副反应轻     

转移性肺癌镂空放疗技术及疗效初步总结

目的 :评价放射治疗在多发性转移性肺癌中的价值。方法 :对 2 3例多发性转移性肺癌运用镂空式挡块放疗。每野每次Dm 3Gy ,每天 1次 ,每周 5次 ,每野总DT5 0～ 6 5Gy。以近期疗效、远期疗效评价放疗效果 ,以肺功能评价副作用。结果 :多发性转移性肺癌运用镂空式挡块放疗后 ,CR 13% (3/2 3)、PR 6 5 % (15 /2 3)、NR PD 2 2 % (5 /2 3)、未作放疗组CR 5 % (1/2 1)、PR 2 1% (2 4 /2 1)、NR PD 71%(15 /2 1)、放疗组CR PR显著优于未作放疗组 (P <0 0 1)。远期疗效 :放疗组中位生存期 18个月 ,未放疗组中位生存期 9个月。 1年生存率放疗组 6 7% (16 /2 4 ) ,未放疗组 38% (8/2 1)。 18个月生存率放疗组 16 % (6 /2 4 ) ,未放疗组 4 % (1/2 1)。放疗后 1年生存率放疗组显著优于未放疗组 (P <0 0 1)。放射治疗前后 ,肺功能未发现明显改变。结论 :镂空式铅模治疗多发性肺转移有效 ,副作用轻 ,在改善生存质量同时 ,部分提高了生存时间     

Arterial infusion of combination chemotherapy consisting of adriamycin and mitomycin C for liver metastases of breast cancer

Forty-nine patients with liver metastases of breast cancer were treated with arterial infusion involving simultaneous use of adriamycin: 30-50 mg and mitomycin C: 10-20 mg through the hepatic artery by Seldinger catheter. Of 45 evaluable patients, there were 5 complete and 12 partial responses (CR + PR: 38%), 21 no change and 7 cases of progressive disease. The median duration of response was 5 months. The median survival time was 7.5 months in all cases, 8.7 months for responders and 6.4 months for non-responders. Leukopenia less than 4 X 10(3)/mm3 was observed in 73% of cases, thrombocytopenia less than 100 X 10(3)/mm3 in 35%, and a decreased hemoglobin value of more than 2 g/dl in 4%, but these were well tolerated. Nausea (53%), vomiting (43%), fever (12%), abdominal pain (6%) and liver toxicity (2%) were observed, but these were manageable. We conclude that this arterial infusion therapy is a useful treatment modality for controlling liver metastases of breast cancer.     

Clinical outcome of intra-hepatic arterial infusion therapy for multiple liver metastases from colorectal cancer

Weekly infusion of high-dose 5-FU through the hepatic artery after resection of colorectal cancer was compared with resection alone in patients with multiple liver metastases. Twenty-seven patients (Group I) underwent hepatic artery infusion chemotherapy and 74 patients (Group II) underwent resection alone. The average survival time was 17.9 months in Group I and 8.5 months in Group II. One CR and 7 PR were achieved with arterial infusion therapy and the response rate was 29.6%. One- to three-year survivals were better in Group I than Group II.     

A clinical study of hepatic arterial infusion chemotherapy with low-dose CDDP and 5-FU for liver metastases

We followed patients who underwent hepatic arterial infusion chemotherapy with low-dose CDDP+5-FU for liver metastases from colorectal cancer in the outpatient setting. A catheter was inserted from the femoral artery into the proper hepatic artery using the interventional technique. Two complete response (CR) and seven partial response (PR) were achieved, but later 2 of these patients had lung metastases. We conclude that this therapy may be effective, but control of extrahepatic lesions is necessary for life prolongation.     

Arterial infusion therapy with implantable port for inoperable hepatobiliary tumors

PURPOSE: To assess the clinical utility of arterial infusion therapy with implantable port for inoperable malignant hepatobiliary tumors. MATERIALS AND METHODS: Twenty-seven patients with advanced hepatobiliary tumors (M:F = 14:13, mean age 63.6, 11 cases with metastases from colon cancer, 4 cases from gastric cancer, 5 cases with gallbladder cancer, 3 cases with cholangiocarcinoma, 2 cases with cholangiocellularcarcinoma, 1 case with hepatocellular carcinoma and 1 with pancreatic cancer) were treated with arterial infusion ports which were placed via left subclavian artery or femoral artery. The regimens used were FEM for 5 cases, EEP for 2 cases and FP for 20 cases. RESULTS: Overall mean survival date was 241.8 days. The numbers of cases with CR, PR, NC and PD were 1, 6, 10 and 10, respectively, and the effective rate was 25.9%. Mean survivals of cases with cholangiocellularcarcinoma, metastases from gastric cancer and colon cancer were 715 days, 324.3 days and 245.9 days, respectively. Severe gastrointestinal side effects (> grade 3) were not observed. Serious bone marrow suppressions were frequently observed with FEM and EEP, but were rare with FP (10%). DISCUSSION: Arterial infusion therapy with implantable port is clinically useful for advanced cholangiocancer and metastases from the gastrointestinal system. This system contributes to the quality of life of patients, since the infusion procedure is simple and can be archived in the outpatient clinics.     

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.     

消化道肿瘤肝转移介入治疗的临床疗效

目的　评价消化道肿瘤肝转移患者经肝动脉介入治疗的临床疗效及价值。方法　对92例消化道肿瘤肝转移患者经肝动脉介入治疗 316次。化疗药物选用EADM、PDD、MMC、CF、5 Fu联合方案 ,加超液化碘油单独或加明胶海绵栓塞。结果　近期疗效以CT检查结果作为评价标准 ,总有效率为 45 .7% ,平均生存期为 19.6个月。本组 0 .5 ,1,2 ,3,5年生存率分别为 95 .7%、73.8%、30 .9%、17.6 %和 9.9%。 9例肝内孤立性转移者疗效最好 ,平均生存期 31.2个月。综合治疗可提高疗效 ,全组无严重副作用或并发症。结论　经肝动脉介入治疗是治疗消化道肿瘤肝转移瘤的较好方法 ,其不仅能提高疗效 ,而且能改善患者的生活质量。     

Preliminary clinical evaluation of low-dose cisplatin and continuous infusion of 5-FU (LFP) chemotherapy after weekly high-dose 5-FU therapy for the treatment of liver metastases from colorectal cancer

In this study, we evaluate the efficacy of low-dose cisplatin and continuous 5-FU infusion systemic chemotherapy (LFP therapy) for the treatment of unresectable and recurrent liver metastases from colorectal cancer after weekly high-dose 5-FU therapy via the hepatic artery (WHF therapy). At the start of chemotherapy, 12 patients with multiple extrahepatic lesions were treated with the LFP therapy (LFP group), and 18 patients with none or a few extrahepatic lesions were treated with the WHF therapy followed by the LFP therapy (LFP after WHF group). In the LFP group, the response rate was 50.0% (PR 6) and the one-year survival rate was 50.0%. On the contrary, in the LFP after WHF group, the response rate was 38.9% (CR 1, PR 6) and the one-year survival rate after LFP started was 46.0%. We conclude that the LFP therapy may be effective for the treatment of liver metastases from colorectal cancer even after the WHF therapy.     

雷替曲塞奥沙利铂肝动脉灌注栓塞与静脉给药治疗结直肠癌肝转移的疗效及安全性比较

目的:比较雷替曲塞奥沙利铂肝动脉灌注栓塞与静脉给药治疗结直肠癌肝转移的疗效及安全性。方法:采用非盲法随机对照试验。试验组24例,雷替曲塞奥沙利铂肝动脉灌注栓塞,雷替曲塞3mg/m2肝动脉灌注化疗15min以上,奥沙利铂130mg/m2、碘化油(5~12)ml混合为混悬液进行栓塞10~15min,28天为1周期;对照组24例:雷替曲塞3mg/m2,静脉滴注,15min以上,d1,奥沙利铂130mg/m2,静脉滴注,4h,d1,28天为1周期。结果:试验组CR+PR 66.6%,TTP 10.5个月,对照组CR+PR 45.8%,TTP 4.5个月,两组相比差异有统计学意义（P<0.05）;两组在毒副反应方面主要为血液学毒性和消化道反应,试验组优于对照组。结论:雷替曲塞奥沙利铂肝动脉灌注栓塞治疗结直肠癌肝转移相对于全身化疗毒副反应轻,其疗效确切是安全有效的一种治疗方案。     

Outcomes of home anti-cancer chemotherapy--estimation of hepatic arterial infusion chemotherapy for patients with multiple liver metastases

A total of 18 patients (13: colon cancer, 5: gastric cancer) with multiple liver metastases (H3) underwent hepatic arterial infusion chemotherapy (HAI) using an implanted arterial port with portable syringe pumps in our outpatient clinic. Clinical perspective: overall response rate was 22.2% (CR: 1 case, PR: 3 cases (1 case: hepatectomy after HAI), NC: 12 cases, PD: 2 cases), however, 7 of 12 cases of NC were long NC (more than 6 months). No major complications with HAI were experienced. Patient Perspective: After HAI in our outpatient clinic, the 50% survival was 341 days, 50% hospital free days were 319 days and home stay rate was 92.9%. Societal Perspective: cost and hospital stay days were significantly reduced. Home anti-cancer chemotherapy using HAI for gastrointestinal cancer patients with multiple liver metastases was safe and efficient from the viewpoint of medical outcomes.     

超选择肝动脉栓塞化疗联合外引流治疗高位胆管癌

目的采用经皮肝穿刺胆管引流及超选择肝段动脉栓塞化疗方法治疗高位胆管癌伴肝内转移,观察其疗效和并发症.方法12例高位胆管癌均先行PTCD,再行超选择肝段动脉栓塞化疗术,术后保肝等综合治疗.结果本组12例高位胆管癌患者中,完全缓解(CR)2例,占16.7%;部分缓解(PR)7例,占58.3%;有效率(CR+PR)为75%,无严重并发症.结论超选择肝段动脉栓塞、化疗联合经皮肝穿刺胆管引流术治疗高位胆管癌伴肝内转移,疗效显著,是一种较好的姑息性治疗方法.