极晚期肝癌冷冻治疗初探(附4例报告)

目的 探讨晚期肝癌冷冻治疗的可行性和临床经验。方法 对４例晚期肝癌患者施行了术中冷冻,４例中２例已有肝外转移,１例肿瘤占据第一,第二肝门且腹水,黄疸较重,１例２次手术后多数肝段切除后复发。结果 冷冻术后病情相对平稳,患者存活７￣１５个月。结论 冷冻治疗有不切肝,创伤小,术后免疫效果好等优点,对晚期肝癌患者有选择地施行冷冻治疗可延长生存时间及改善生活质量。     

综合治疗时代晚期肝癌治疗的全局观

晚期肝癌严重威胁我国人民的生命和健康.肝脏的解剖结构及生理功能决定了肝癌具有天然的化疗耐药的特点.目前已有多种靶向治疗药物获批用于晚期肝癌的一线和二线治疗.免疫治疗的出现使肝癌的治疗进入新的时代.靶向与免疫治疗药物在机制上具有协同作用,而且二者的联合使用已在临床上使更多的晚期肝癌病人获益.同时,在靶向联合免疫的全身治疗...     

复发性肝癌治疗方式的合理选择

<正>目前,肝切除手术依然是肝细胞癌治疗的首选方法,并已经获得良好的疗效,但是肝癌病人即使接受根治性切除手术,其术后5年复发率仍高达67.4%,存活率仅57.3%^[1]。因此,只有通过积极治疗复发性肝癌,才能提高HCC的整体治愈率。目前,临床对原发性肝癌诊治已达成共识,而对于复发性肝癌的治疗方式选择仍有争议。多数学者认为,复发性肝癌的治疗可参考原发性肝癌的相关策略,依据肝癌复发病灶的部位、大小、肝功能和全身情况,临床可选择治疗手段有再次手术切除、射频消融(radiofrequency ablation,RFA)、经导管动脉化疗栓塞(transcatheter arterial chemoemboliza?tion,TACE)、放射治疗、靶向治疗等^[2]。对于复发病人,如何合理选择治疗方案,以提高疗效、延长生存期,是目前临床研究的热点和难点^[3]。本文结合大量文献报道,分析复发性肝癌的各种治疗方式,并探讨如何合理选择和综合。     

TACE在肝癌治疗中的价值

原发性肝癌 (简称肝癌 )是我国最常见、预后最差的恶性肿瘤之一。目前一致公认根治性切除仍是治疗肝癌的首选方法和最有效措施。但由于肝癌发病隐匿 ,临床上不少病例确诊时已不适宜行手术切除 ,总体上手术切除率约为 2 0 % ;另外 ,肝癌手术切除后仍有较高的复发率 ,在这些复发的病人中有相当一部分病人也无法再行手术切除。对于上述这些不能手术切除的肝癌病人 ,采取非手术疗法可达到缓解病情 ,减轻痛苦甚至延长生命的目的。在众多的非手术疗法中 ,经导管肝动脉化疗栓塞 (transcatheterarterialchemoem bolization ,TACE)是一种应用较广泛…     

ԭ���Ըΰ�268���ۺ����Ʒ���

目的 为了进一步探讨和总结肝癌综合治疗的方法和疗效。方法 回顾性分析了近５年来收治的原发性肝癌２６８例的治疗方法和初步疗效。其中包括男２２９例,女３９例,平均年龄４１岁,肿瘤多属中晚期。手术１３７例,非手术１３１例,手术中包括规则与不规则切除、一期切除、二步切除和复发再切除及人体原位肝移植。非手术治疗包括ＴＡＣＥ、ＰＥＩ、ＤＤＳ、冷冻、中医中药、生物治疗、全身化疗等方法。结果 手术率为５１％（１３     

原发性肝癌TACE治疗的护理

<正>原发性肝癌是我国常见的恶性肿瘤之一,目前最有效且有可能根治的方法仍为手术切除,但大部分病例被发现时已属中晚期,已失去手术切除的治疗机会,不适合做肝切除的原发性肝癌患者,较好的治疗方法为采用肝动脉栓塞化疗(TACE)。TACE是在X射线导视下,将导管由股动脉插至肝动脉,从导管注射化疗药物和栓塞剂,使肝癌细胞缺血坏死,从而达到治疗的     

晚期肝癌治疗方案选择

正肝癌位列世界恶性肿瘤发病率第五位,致死率居恶性肿瘤第3位,东西方病例数均呈逐年上升趋势,尽管诊疗手段越来越先进,但治愈率及预后并无明显改善。特别是已失去手术切除、肝移植或局部消融等根治手段的机会,伴有黄疸、腹水及恶病质等表现的晚期或进展期肝癌(advanced hepatocellular carcinoma)患者,仍然缺乏行之有效的治疗手段,生存期短,治疗效果差,其临床治疗需得到更进一步关     

TACE联合氩氦刀冷冻治疗原发性肝癌临床分析

目的探讨肝动脉化疗栓塞术（TACE）联合氩氦刀冷冻治疗原发性肝癌的近期疗效。方法将77例中晚期肝癌随机分为二组：A组37倒,行TACE联合氩氦刀冷冻治疗;B组40例,单纯行TACE术。比较两组患者血清AFP水平以及半年和1年生存率。结果A组AFP下降比B组明显（P〈0．05）,A组患者1年生存率高于B组（P〈0．05）。结论TACE联合氩氦刀冷冻治疗原发性肝癌疗效优于单纯性行TACE治疗,是治疗中晚期肝癌的一种有效方法。     

深度冷冻治疗肝癌57例体会

目的 为增加不能手术切除肝癌病人的治疗机会，完善肝癌冷冻的治疗术。方法 总结１９９４年６月至１９９７年１２月我肝癌研究所采用ＬＣＳ－２０００型冷冻机治疗原发性肝癌５１例，继发性肝癌６例的治疗体会。所有病 列均为晚期肝癌。冷冻术中Ｂ超引导下确定肿瘤及冷冻针位置并监测冷冻范围。冷冻深度达－１９８℃，冻球超过肿瘤组织１ｃｍ。结果术中７２例未输血。术后均有发烧，平均恢复正常时间９天。术后ＳＧＰＴ较术前显著     

Multimodality treatment of locally advanced breast carcinoma

Forty patients with 41 locally advanced breast lesions at stages IIIA and IIIB and the inflammatory stage were treated with combined-modality therapy from July 1980 to August 1985. Treatment included induction chemotherapy consisting of three cycles of fluorouracil, doxorubicin hydrochloride, and cyclophosphamide, followed by mastectomy in those patients whose lesions were operable (n = 28), and resumption of chemotherapy. Nine patients received postoperative radiation therapy. The mean follow-up was 34 months. Greater than 50% reduction in tumor size was achieved in 72% of patients after three cycles of chemotherapy. Overall, local control was achieved in 85% of patients with 59% survival and 53% disease-free survival, while 10% of patients developed local recurrences. Excluding lymphedema of the upper extremity (n = 2) and inflammatory carcinomas (n = 4), local control was achieved in 96% of patients, with 75% survival and 68% disease-free survival, while 4% of patients developed local recurrences. The rate of disease-free survival was 71% in patients with partial response to chemotherapy, contrasted with 43% in patients who did not respond or only minimally responded to chemotherapy. Actuarial five-year survival, based on life-table analysis, was calculated to be 46% for the group overall, 58% for the group excluding lymphedema of the upper extremity and inflammatory carcinoma, and 56% for the 28 patients undergoing mastectomy.     

Surgical treatment of advanced hepatocellular carcinoma]

One hundred and thirty-two patients with hepatocellular carcinoma in stages III and IV were studied. Seventy-six patients who underwent hepatectomy were divided into three groups: relative curative resection (RC: n = 30), relative noncurative resection (RNC: n = 30) and absolute noncurative resection (ANC: n = 16). Fifty-six patients were treated by non surgical procedures such as hepatic arterial infusion, transcatheter arterial embolization, ethanol injection and hyperthermia. The cumulative survival rate of hepatectomy patients was significantly better than that of non-surgically treated patients. The most significant prognostic factor was the presence of the portal venous invasion. In the patients without tumor thrombi or with tumor thrombi found microscopically, the cumulative survival rates of both RC and RNC were significantly better than those of ANC and non-surgically treated patients, but in the patients with tumor thrombi found grossly, there was no difference between hepatectomy patients and non-surgically treated patients. These results indicate that surgical treatment for advanced hepatocellular carcinoma improve the prognosis of the patients without tumor thrombi found grossly.     

TACE联合卡瑞利珠单抗治疗中晚期肝细胞癌

目的 观察TACE联合卡瑞利珠单抗治疗中晚期肝细胞癌(HCC)的有效性和安全性。方法 纳入42例接受TACE联合卡瑞利珠单抗治疗的中晚期HCC患者(联合组),采用倾向性评分匹配法选择另外42例仅接受TACE治疗的中晚期HCC患者作为对照组,比较组间客观缓解率(ORR)及疾病控制率(DCR)差异;随访至2022年2月11日,记录患者总生存期(OS)、无进展生存期(PFS)及不良反应发生率。结果 联合组与对照组ORR分别为61.90%(26/42)及35.71%(15/42),DCR分别为92.86%(39/42)和69.05%(29/42),差异均有统计学意义(P均<0.05)。随访时间为2.5~26.2个月,中位时间为20.2个月;联合组中位OS(19.3个月)长于对照组(13.6个月),差异有统计学意义(P=0.009)。联合组发生死亡事件的相对风险(HR)为0.456,即加用卡瑞利珠单抗使死亡风险降低54.40%。联合组中位PFS(12.9个月)长于对照组(8.4个月),差异有统计学意义(P=0.029),联合组复发HR为0.579,即加用卡瑞利珠单抗使复发风险降低42.10%。联合组29例(29/42,69.05%)出现与卡瑞利珠单抗相关的反应性皮肤毛细血管增生症,但均为1级不良反应,未出现3/4级不良反应,无因不良反应而停药病例。结论 TACE联合卡瑞利珠单抗治疗中晚期HCC安全、有效。     

原发性肝癌的射频灭活治疗

目的 探讨射频灭活对中晚期原发性肝细胞肝癌的治疗效果。方法 回顾性分析2001年6月至2006年3月56例中晚期肝细胞肝癌患者行冷循环射频治疗的临床资料，患者按美国癌症学会肿瘤分期均为Ⅲ期、Ⅳ期。肿瘤直径平均9.3cm，采用超声引导下经皮射频治疗16例，开腹射频33例，腹腔镜射频5例，人工胸水辅助射频2例，术后随访时间6～62个月，采用Kaplan-Meier模型进行生存分析。结果 本组患者的平均生存期为11.99个月，中位生存期为4.5个月，半年、1年、2年的累积生存率分别为42.2%、23.3%、9.3%，在接受射频治疗的患者中，生存率与肝功能Child- Pugh分级及治疗方法 有一定关系。其中Child A级患者的平均生存期14.57个月，中位生存期为6.0个月；多点重叠射频患者的平均生存期为23.14个月、中位生存期为6.0个月。本组术后严重并发症发生率为12.5%，包括肝功能衰竭4例、胆漏1例、腹腔感染1例、肺部感染1例。结论 射频作为一种肿瘤局部灭活方法 ，可以改善患者生存质量，延长生存时间。     

晚期肝细胞癌免疫检查点治疗研究进展

以免疫检查点抑制剂(ICIs)为代表的免疫治疗掀起肿瘤治疗的革命,多种ICIs治疗肝细胞癌的早期临床研究数据显示其良好的应用前景,迎来了肝细胞癌的免疫治疗时代。近来一项ICIs联合抗血管生成治疗的Ⅲ期临床研究结果显示其疗效和安全性优于标准治疗,有望成为肝细胞癌新的一线标准治疗。目前ICIs联合放化疗、抗血管生成治疗及局部治疗的研究正在全世界开展,将进一步刷新肝细胞癌系统治疗的格局。     

胰腺癌的综合治疗

胰腺癌是消化系统常见的恶性肿瘤，目前多学科、多中心联合的综合治疗已经在许多方面取得了一定的进展，其综合治疗包括外科治疗、化疗、放疗、物理及生物治疗等。胰腺癌的治疗以手术为主，实行合理的手术切除可以改善病人的长期生存率及生活质量。放射治疗可分为与手术联合的辅助性放疗及姑息性放疗，术前放化疗，可以提高手术切除率，并减少肿瘤扩散，术中放疗可以缓解疼痛，提高生存率，术后辅助放化疗的作用仍有争议。化疗分为全身和区域性化疗，区域性化疗为选择性动脉给药，理论上有诸多优势，但仍需数据支持。物理治疗和生物治疗在胰腺癌的治疗中也已经得到广泛的重视。但只有建立以手术切除为主，联合放疗、化疗、物理及生物治疗的综合治疗体系，才有可能提高病人的长期生存率，改善病人的生活质量。     

Role of adjuvant treatment in liver transplantation for advanced hepatocellular carcinoma

The results of liver transplantation for advanced hepatocellular carcinoma have been disappointing because of high recurrence rates, leading to low long-term survival; this indication remains controversial in an era of organ shortage. To continue to offer this treatment possibility, efforts were made to reduce recurrence and improve survival. The first approach is to maintain a strict selection policy excluding patients with extraheptic disease. The second approach is to test the efficacy of perioperative adjuvant therapies in patients selected for transplantation. The reasons for recurrence include: (1) undetected preoperative micrometastases, (2) intraoperative dissemination by surgical manipulation, and (3) acceleration of tumor growth by immunosuppression. Preoperative treatment, which may include systemic chemotherapy or arterial chemoembolization, seems necessary to limit tumor progression during the waiting period. Systemic chemotherapy has been tested pre-, intra-, and postoperatively. It is considered essential postoperatively and should be used as soon as possible after surgery (i.e., in the 1st postoperative week). Several teams have performed pilot studies that included rather limited numbers of patients, and the results were compared with those for historic controls. Published results show that chemoembolization creates tumor necrosis in most instances. This is efficient in limiting tumor progression but the effect on recurrence and survival is unknown. All authors who used postoperative chemotherapy reported improved survival over controls, with 50%–60% 3-year survival and up to 50% 5-year survival. However, recent results suggest that late recurrence may occur. Chemotherapy was usually well tolerated, although leukopenia, sometimes severe, was observed in most patients. The use of granulocyte colony-stimulating factor seems useful to overcome this problem. Perioperative adjuvant treatments seem to prolong survival in patients undergoing liver transplantation for advanced hepatocellular carcinoma, but delayed recurrence remains possible. Further studies are necessary; these should ideally be multicentric, prospective, and randomized. Received for publication on June 2, 1997; accepted on July 3, 1997     

Multimodality tumor control and living donor transplantation for unresectable hepatocellular carcinoma

Liver transplantation (LT) is an acceptable mode of treatment for selected patients with unresectable hepatocellular carcinoma (HCC). However, due to the scarcity of cadaveric donor organs, it is considered desirable for patients to opt for living donor liver transplantation (LDLT) or, for those not being transplanted soon, to have some form of tumor control therapy. Such an approach in our program is analyzed and reported. At our institution, 42 LTs were performed between October 1999 and April 2003. Of these, 18 recipients (15 men, 3 women) had 27 HCC. The average number and size of HCC was 1.59 (1 to 4) and 2.31 (0.2 to 6.5) cm, respectively. Thirteen (72%) patients were transplanted primarily for the HCC, whereas five (28%) others were incidental HCC cases. Seven patients (5 LRLT, 2 cadaveric LT) were transplanted soon after listing, and thus did not require tumor control therapy. Six patients waited for 11 (6 to 19) months before LT. Three patients underwent microwave coagulation therapy, and one had additional alcohol injections. One patient received the novel PIAF (cisplatin, interferon, adriamycin, and 5-FU) chemotherapy regimen followed by selective internal irradiation (SIR) treatment. One patient received conformal radiation therapy and another received SIR treatment before LT. Besides 2 postoperative deaths, the remaining 16 patients have been well, with a mean follow-up of 20.4 (3.6 to 41.2) months. In conclusion, for patients with unresectable HCC, in areas with poor cadaveric donor rate, living donation should be the first option. If a suitable live donor is not available, aggressive multimodality therapy is recommended while waiting for cadaveric LT.     

Cytoreductive surgery in multidisciplinary treatment of advanced hepatocellular carcinoma

Background: Cytoreductive surgery (debulking surgery) as a multidisciplinary treatment approach for inoperable advanced hepatocellular carcinoma has been shown to prolong survival and provide symptomatic relief for good surgical risks patients in non‐randomized studies before. Methods: A non‐randomized comparative study was performed in a tertiary referral centre between January 2001 and December 2006. The outcome of a consecutive series of patients with inoperable advanced hepatocellular carcinoma who received cytoreductive surgery was compared with a control group of patients who received palliative treatment without surgery. Two techniques of cytoreductive surgery were used: (i) partial hepatectomy for the main tumour plus intraoperative local ablative therapy for the smaller tumour nodules in the liver remnant; and (ii) partial hepatectomy for the main tumour plus postoperative transarterial chemoembolization. Results: The overall survival of cytoreductive surgery group (n = 18) was significantly better than that of the palliative treatment group (n = 15) (3‐year overall survival, 54% vs 22%; median survival, 18 vs 11 months) (P =0.038). In the cytoreductive surgery group, there was no operative mortality. Postoperative morbidity rate was 16.7%. The mean hospital stay was 8 days. Conclusion: Cytoreductive treatment strategy for advanced hepatocellular carcinoma can be considered as one of the options in selected patients with low operative risks and reasonable liver function. Further prospective randomized trials are required to validate this aggressive surgical approach.