S-TOCE与HIFU联合治疗小肝癌的DSA与CT表现初步探讨

目的：探讨节段性肝动脉碘油抗癌药物栓塞化疗（S－TOCE）与高强度聚焦超声（HIFU）联合治疗小肝癌的DSA与CT表现特点。方法：9例单结节小肝癌,接近S－TOCE治疗18次,平均2次／例,其间接受HIFU治疗10次,平均1次／例。随访6月－12月以上,观察其DSA和CT表现并计算肿缩缩小率。结果：9例均获得肿瘤局部完全性充填性栓塞,肿瘤血管消失,碘油聚集致密,边缘清楚。本组治疗后肿瘤体积缩小率均大于20％,最好的一例达80％。结论：S－TOCE与HIFU联合治疗小肝癌,是一种最新的非手术切除的有效治疗方法,CT和DSA是联合治疗后复查和评价疗效的重要影像学手段。     

TACE联合瘤体内碘油药物注射在原发性肝癌治疗中的应用价值

目的探讨肝动脉栓塞(TACE)联合瘤体内碘油药物注射在原发性肝癌治疗中的应用价值。方法 53例原发性肝癌TACE后1个月内在局部麻醉下行CT引导瘤体内碘油药物注射治疗,并在治疗后1个月后采用多期增强CT评估肿瘤是否被碘油充填,没有完全充填的立即继续上述联合治疗,较大肿瘤经过三次联合治疗后,再次进行评估。结果经过1~3次联合治疗后,完全碘油充填率达90.6%(48/53),肿瘤碘油不完全充填率9.4%。肿瘤最大径在50mm以下者完全碘油充填率97.22%(35/36);最大径超过50mm的完全充填率76.47%(13/17)。1年内无患者死亡,5例存活1年占9.43%,9例存活2年占17.00%,23例存活3年占43.40%,9例存活4年占16.98%,7例存活超过5年占13.21%;累计生存率:1年100%,2年90.57%,3年73.58%,4年30.19%,5年13.21%,术后无严重并发症。结论 TACE联合瘤体内碘油药物注射是对原发性肝癌的有效、微创、恢复快的主要治疗方法。     

中晚期肝癌肝动脉化疗栓塞508例疗效分析

目的 探讨中晚期肝癌肝动脉化疗栓塞的疗效及影响疗效的因素。方兴未艾508例不能切除的原发性肝癌行选择性肝动脉插管灌注化疗和栓塞治疗共2025次，其中行选择性肝动脉管灌注化疗栓塞治疗448例，单纯灌注化疗60例。结果 选择性肝动脉插管灌注化疗栓塞1、2、3年生存率分别为81.3%、38.6%、21.6%；单纯灌注化疗1、2、3年生存率分别为54.3%、21.3%、9.6%。肿瘤分类、栓塞剂及用量、门静脉是否有癌栓、倒支循环的形成、碘油沉积情况及栓塞术和方法选择是否是影响疗效的主要因素。结论 选择性肝动脉插管灌注化疗栓塞中可作为中晚期肝癌的常见治疗，远期疗效明显优于单纯灌注化疗。     

TOCE联合HIFU治疗原发性肝癌疗效的CT评价

目的用CT评价TOCE联合HIFU治疗原发性肝癌的疗效。方法46例接受TOCE联合HIFU治疗的原发性肝癌为研究组,比较治疗前后的CT表现;随机选出同期46例单纯TOCE治疗的患者为对照组,进行对比分析。结果研究组37例(37/46,80.4％)病灶体积缩小,缩小率为(27.25±19.89)％;对照组28例(28/46,61.8％)病灶体积缩小,缩小率为(11.89±15.96)％。研究组栓塞灶周边复发5例,对照组15例。研究组肝内转移灶15例,对照组16例。在已栓塞灶瘤体大小变化及局部复发方面,前者优于后者,在肝内转移方面无明显差异。结论TOCE联合HIFU是治疗原发性肝癌的一种有效方法,CT在其疗效及预后判断中具有重要价值。     

肝动脉栓塞化疗联合经皮注射无水乙醇治疗巨块型肝癌

目的 评价肝动脉化疗栓塞（TOCE）后经皮穿刺注射无水乙醇（PEI）治疗原发性巨块型肝癌的临床价值。方法 18例巨块型肝癌患者先行TOCE,2周后再行2－3次PEI。结果 18例患者6、12、24、36个月生态率分别为100％、94.4%、22.2%、11.1%。结论 TOCE后PEI是进一步提高巨块型肝患生存率的有效方法。     

无水乙醇肝段栓塞联合TACE治疗小肝癌20例

目的:探讨无水乙醇肝段栓塞联合TACE治疗小肝癌的可行性及临床疗效,以改进小肝癌介入栓塞治疗方法,减少并发症。方法:将5F RH导管作为导引导管,利用同轴导管技术将微导管超选入肿瘤动脉,对20例小肝癌患者行肝段性化疗栓塞术。结果:全组共19(95%)例患者获得瘤体内完全充填性栓塞,全组病灶直径缩小50%以上14例(70%),缩小25%以上3例(15%)。全组随访12~36个月(平均29个月),18例存活,所有患者治疗后肝功能损害轻微,未发生严重并发症。结论:本治疗方法操作简单、方便、超选择成功率高、疗效好、副反应少,可以明显提高存活率,具有十分重要的临床应用价值。     

大剂量碘油与常规TACE治疗巨块肝癌的对比研究

目的探讨大剂量碘油栓塞治疗巨块型肝癌的临床疗效及不良反应。方法79例巨块型肝癌患者,肿块大小为7～18cm。分为A组:常规经肝动脉化疗栓塞组39例(TACE组)一次碘油用量10～20ml。B组:经肝动脉化疗并大剂量碘油栓塞组40例(大剂量组)。一次栓塞治疗中碘油用量为20ml以上。结果TACE组,有效率(CR PR)71.7%(28/39);1～3年生存率为:66.7%(26/39)、33.3%(13/39)、0。大剂量组,有效率(CR PR):87.5%(35/40);1～3年生存率:75%(30/40),45%(18/40),7.5%(3/40)。有效率及生存率两组比较有显著差异。2组均未出现严重的并发症及肝功能损害。结论大剂量碘油栓塞巨块型肝癌的疗效优于常规TACE,肝功能较好的巨块型肝癌适合用大剂量碘油栓塞治疗。     

双侧髂内动脉插管化学栓塞术治疗妇科恶性肿瘤

目的　观察双侧髂内动脉插管化疗药物灌注及栓塞治疗妇科恶性肿瘤的疗效。方法　对 2 8例妇科恶性肿瘤进行双侧髂内动脉插管灌注化疗药物并进行栓塞。结果　 2 8例患者共 81次介入治疗 ,最少 1次 ,最多 6次。CR 2例 ,PR11例 ,MR 9例 ,SD 1例 ,PD 3例 ,无法评价疗效 2例。有效率 (CR PR)为 5 0 .0 % ( 13/ 2 6 )。半年存活 2 3例 ,占 88.5 % ;1年存活 19例 ,占 73.1% ;2年存活 8例 ,占 30 .8%。结论　髂内动脉插管化疗药物灌注及栓塞术对妇科中晚期恶性肿瘤可限制其发展 ,减轻痛苦 ,延长生命 ,提高生存质量 ,为一种有效的姑息疗法     

TACE在原发性肝癌伴门静脉癌栓术后治疗中的作用

目的 :研究TACE在原发性肝癌伴门静脉癌栓术后治疗中的作用及影响其疗效的因素。方法 :随访 4 0例原发性肝癌伴门静脉癌栓术后病人 ,其中 2 1例病人术后行TACE治疗。比较两组病人的肿瘤复发时间和生存期。单因素和多因素分析影响术后TACE疗效的因素。结果 :原发性肝癌伴门静脉癌栓单纯手术切除病人的肿瘤平均复发时间 6 .1个月 ,中位生存时间10 .3个月 ,其半年、1、2、3年生存率分别为 4 5 .9%、4 .2 %、0 %、0 %。术后行TACE的病人肿瘤平均复发时间 11.1个月 ,中位生存时间 2 0 .7个月 ,其半年、1、2、3年生存率分别为 6 2 .2 %、5 6 .3%、35 .6 %、2 8.5 % ,明显高于单纯手术病人 (P <0 .0 5 )。单因素分析提示肿瘤大小、细胞分化、化疗栓塞次数是影响术后TACE疗效的主要因素。多因素分析提示细胞分化、化疗栓塞次数影响术后TACE的疗效。结论 :TACE推迟原发性肝癌伴门静脉癌栓术后的肿瘤复发时间 ,延长病人的生存期。肿瘤细胞分化 ,化疗栓塞次数是影响术后TACE疗效的主要因素。     

洛铂与碘油化疗栓塞联合射频消融术治疗原发性肝癌的近期疗效观察

目的观察洛铂与碘油化疗栓塞联合射频消融术治疗治疗原发性肝癌的近期疗效。方法对40例原发性肝癌患者行肝动脉栓塞化疗术(TACE),化疗栓塞药物为洛铂+碘化油,对病灶行射频消融。检测治疗前后血清甲胎蛋白(AFP)变化,于4周后评价近期疗效。结果治疗总有效率为80.0%。治疗后AFP值显著下降(P0.01),16例恢复至正常值。结论洛铂与碘油化疗栓塞联合射频消融治疗原发性肝癌近期效果良好,安全有效。     

TOCE联合HIFU治疗原发性肝癌的DSA检查及意义

目的：评价TOCE联合HIFU治疗原发性肝癌的DSA表现及意义。方法：50例原发性肝癌患者接受TOCE联合HIFU治疗,比较治疗前后的DSA表现。随机选出同期50例单纯TOCE治疗的患者进行对照研究。结果：研究组与对照组治疗后肿瘤血管减少、消失、不变及增多分别为76％（38／50）8％（4、50）;16％（8／50）、0;60％（30／50）、4％（2、50）;30％（15／50）、6％（3／50）（P＜0．05）。病灶体积缩小分别为76％（38／50）和58％（29／50）（P＜0．05）。新病灶形成分别为4例和6例,侧支开放为2例和3例。结论：TOCE联合HIFU是治疗中晚期原发性肝癌的一种有效的治疗方法,DSA可以准确判断治疗后肿瘤大小;血供情况,早期发现复发及转移灶,在判断疗效及决定是否再治疗中具有重要价值。     

Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia

BACKGROUND AND STUDY AIMS: Endoscopic resection of esophageal squamous-cell neoplasia with curative intent is considered to be a safe and effective alternative treatment to radical surgery in cases where the neoplasia is intraepithelial or limited to the mucosal layer. These patients are at risk for recurrent malignancy in the preserved esophagus, however. We conducted a prospective study to evaluate the efficacy and safety of endoscopic resection and to analyze variables associated with recurrence in patients with mucosal or intraepithelial squamous-cell neoplasia. PATIENTS AND METHODS: Between December 1997 and September 2005, 65 patients (mean age +/- standard deviation [SD] 62.9 +/- 9.5 years), 12 with high-grade intraepithelial neoplasia (HGIN) and 53 with mucosal squamous-cell cancer, were included in our study and were treated using endoscopic resection. Details of patient and tumor characteristics were documented prospectively. All patients were included in a staging protocol including high-resolution endoscopy with Lugol staining, endoscopic ultrasound, computed tomography, and abdominal ultrasound. Endoscopic resection was performed using a ligation technique. The data acquired were subjected to univariate and multivariate analysis. RESULTS: A total of 179 resections were performed (mean number of resections +/- SD per patient, 2.8 +/- 1.8): 11/12 patients with HGIN (91.7%), and 51/53 patients with mucosal cancer (96.2%) achieved a complete response during a mean follow-up period of 39.3 +/- 22.8 months; three patients were still under therapy at the end of the study period. Recurrence of malignancy after achieving a complete response was observed in 16 patients (26%), but these patients all achieved another complete response after further endoscopic treatment. Independent risk factors for recurrence was multifocal carcinoma (RR 4.1, P = 0.018). Tumor-related deaths occurred in two patients (3%), and eight patients died as a result of co-morbidity. Complications were seen in 15/65 patients (23%, all esophageal stenoses). The 7 year survival rate calculated for all groups was 77%. CONCLUSIONS: According to the results of long-term follow-up in this study, endosocopic resection appears to be an effective and safe method of curative treatment in patients with HGIN and mucosal squamous-cell carcinomas of the esophagus. Multifocal carcinoma and T1m1 tumors seem to be highly associated with recurrence.     

Small hepatocellular carcinoma: therapeutic effectiveness of percutaneous radio frequency ablation therapy with a LeVeen needle electrode.

OBJECTIVE: To evaluate the therapeutic effectiveness of percutaneous radio frequency ablation of small (< or =3-cm) hepatocellular carcinoma with a LeVeen needle electrode. METHODS: Thirty patients (mean age, 65.7 years) with 32 hepatocellular carcinomas (range, 1.2-3.0 cm; mean, 2.3+/-0.5 cm) underwent percutaneous radio frequency ablation to the center of the hepatocellular carcinoma after expansion of the inner needles. The manufacturer's recommended radio frequency ablation protocol was used. Posttreatment contrast-enhanced color Doppler sonography, contrast-enhanced computed tomography, and fine-needle biopsy were performed to assess the radio frequency ablation-induced coagulated necrosis. RESULTS: Severe intratreatment pain made us abort radio frequency ablation in 2 patients. Complete tumor necrosis was achieved in 1 treatment session with 1 needle electrode insertion in 28 (93.4%) of 30 nodules (28 patients). We found no residual focus on both color Doppler sonography and computed tomography after any of the sessions. In follow-ups ranging from 3 to 15 months (mean, 8.4 months), no local recurrence was found in cases with complete tumor ablation. CONCLUSIONS: Radio frequency ablation with the LeVeen needle electrode was effective, obtaining complete coagulated necrosis with a safety margin when used for the treatment of small hepatocellular carcinomas.     

高强度聚焦超声治疗原发性肝癌即时超声造影评价并指导补充治疗的疗效观察

目的 探讨高强度聚焦超声(HIFU)治疗原发性肝癌即时超声造影评价并指导补充治疗的临床应用价值.方法 55例原发性肝细胞癌患者(68个病灶)随机分为A、B两组,其中A组30例(38个病灶)治疗前及治疗后10 min进行超声造影检查,并对未完全灭活的病灶针对性地行HIFU补充治疗;B组25例(30个病灶)为对照组.观察治疗的安全性及治疗后两组患者临床症状、甲胎蛋白、影像学等各项指标的变化,并比较两组患者的远期疗效.结果 HIFU治疗后即时超声造影发现A组19个病灶未完全灭活并补充治疗.全部患者均无严重并发症出现.治疗后A、B两组患者甲胎蛋白值下降率分别为86.7%(26/30)、64.0%(16/25);肿瘤完全坏死率分别为97.3%(37/38)、60.0%(18/30);半年、1年生存率分别为100%、90.0%和76.0%、68.0%;两组差异均具有统计学意义(P＜0.05).结论 HIFU治疗原发性肝癌即时超声造影评价并指导补充治疗有利于病灶的完全灭活,可以缓解症状,改善生活质量,延长生存期,具有较好的临床应用价值.     

经尿道膀胱肿瘤电切术联合吡柔比星膀胱内灌注治疗浅表性膀胱肿瘤的疗效观察

目的：探讨经尿道膀胱肿瘤电切术及术后使用吡柔比星膀胱内灌注治疗浅表性膀胱肿瘤的临床疗效。方法：75例浅表性膀胱肿瘤均采用经尿道膀胱肿瘤电切术（TURBT）,术后使用吡柔比星膀胱内灌注治疗。结果：所有病例均一次完整切除。随访2年,58例未再次复发,12例1年内再次复发,5例2年内再次复发。结论：TURBT联合吡柔比星即刻膀胱灌注治疗浅表性膀胱肿瘤手术简单,疗效好,患者痛苦小,恢复快,值得临床推广。     

Endoscopic mucosal resection for advanced sessile adenoma and early-stage colorectal carcinoma

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate the efficacy and outcomes of treatment by endoscopic mucosal resection (EMR) of patients with high-grade dysplasia (HGD) or carcinoma. PATIENTS AND METHODS: Between January 1995 and January 2002, 50 patients (35 men, 15 women) were treated by EMR for 52 sessile polyps. The median size of the polyps was 27.5 mm (range 10-60). The "lift and cut" EMR technique was used. If the lesion was poorly differentiated or infiltrated the muscularis mucosae to more than 1000 microm, the patient was referred for colectomy. In the other cases, follow-up was proposed. RESULTS: Complications occurred in 9.6 % of cases and were always treated conservatively. The rate of endoscopically complete resection was judged to be 98.1 %. Argon plasma coagulation was applied to the margins of the lesion in 21.6 % of cases. Histological examination showed 38 HGDs and 14 carcinomas. Seven patients had a lesion reaching the deep or lateral margin; four were referred for surgery; two patients for whom surgery would have been high risk were followed up, and both developed local recurrence; and one patient was followed up, without recurrence, because infiltration was less than 1000 microm. A total of 43 patients were followed up after complete excision. Two patients died during follow-up; neither death could be reliably attributed to colorectal carcinoma. Seven patients were lost during the follow-up. For 34 patients, information from a mean follow-up of 17.3 months (6 - 57) was available and recurrence was observed in five cases (15 %). CONCLUSIONS: EMR appears to be a safe and efficient treatment of HGD and early colorectal cancer. However, correct analysis of submucosal infiltration is essential to assess the completeness of the resection.     

肝动脉化疗栓塞治疗中晚期肝癌

摘要:目的:通过230例原发性肝癌的介入治疗,研究其疗效及影响因素。材料与方法:回顾性分析230例肝癌肝动脉化疗、栓塞的临床随访资料。结果:总疗效为症状缓解占69.1％,肿瘤缩小占62.6％,AFP下降44.8％。半年、1、2、3年生存率分别为80.9％、51.3％、30％、18.7％。对比分析了肿瘤的大小、门脉癌栓的有无及治疗方法等影响疗效的有关因素。结论:肝癌的介入治疗疗效明显优于其他非手术疗法,早中期、单个肿瘤、直径<10cm、无门脉癌栓或肝动静脉瘘、治疗2次以上及栓塞完全者,疗效明显优于对应组。综合治疗将会进一步提高肝癌化疗栓塞的疗效。     

冷循环射频消融治疗多灶性转移性肝癌的疗效评价

目的评价冷循环射频消融治疗多个病灶的转移性肝癌的效果.方法对20例病人的42个转移性肝癌灶进行了58次冷循环射频消融治疗.射频采用单极电极输出,单探头或集束探头(2～4个)组合,每个病灶治疗1～3次.结果治疗后肿瘤有不同程度缩小,完全坏死30个(71.4%),大部坏死12个(28.6%),无严重并发症.结论冷循环射频消融技术简单、安全、有效,可作为不能手术切除的多灶性转移性肝癌的微创治疗方法.