小肝癌根治后预防性动脉内化疗栓塞的必要性

报告39例小肝癌临床治疗结果,其中预防性动脉内化疗栓塞17例,对照组22例,旨在减少肝内复发、转移和进一步提高生存率。预防治疗组共行50次治疗,平均2.95±0.85次/人,最多7次。治疗组所有患者首次血管造影均未见明显的病灶。治疗组中,8例根治术后1月内持续 AFP>20μg/ml,进行预防肝动脉内化疗栓塞(碘化油3～5ml)。治疗组1,3,5年生存率为100%,91.5%,84.75%,对照组22例患者,在未检出病灶前均未行任何常规及动脉内化疗或栓塞。对照组为91.7%,63.5%,40.91%,两组生存率比较P<0.01。本研究显示预防性介入放射学处置可进一步提高小肝癌根治术后的生存率。     

肝动脉化疗,栓塞与肝静脉暂时闭塞治疗肝癌

本文报道在10例肝癌患者中运用肝静脉暂时闭塞和肝动脉内灌注化疗、栓塞的方法治疗取得较好疗效。7例甲胎蛋白阳性患者5例下降大于50%,2例转阴。4例肿瘤缩小>50%。2例合并肝动-静脉瘘者成功实行碘油栓塞,1例经治疗后肝动-静脉瘘消失。对肝功能的影响与普通介入治疗相同。消化道反应相对较轻。并可提高肿瘤局部药物浓度,延长药物作用时间。配合肝段动脉或靶血管的插管可进一步提高疗效,减少并发症。     

动脉灌注化疗并栓塞治疗肝癌的若干问题

经动脉灌注化疗并栓塞治疗肝癌（ＴＡＩＥ）是已经被公认的非手术切除的最佳疗法，这一疗法也已相当普及。但如何保证质量，进一步提高患者的生存期和生活质量，如下问题值得进一步探讨。一、ＴＡＩＥ治疗的间隔时间对于肿瘤来说ＴＡＩＥ间隔的时间越短越好，但化疗药物与栓塞剂对正常肝组织及机体免疫系统都会带来损害，机体需要一定时间的恢复，才能耐受再次治疗。间隔时间应根据肿瘤与机体全身情况而定，原则上是应用Ｂ超、ＣＴ检查，免疫指标与ＡＦＰ检测等手段密切随访复查，在机体得到最大程度的恢复，而肿瘤尚未明显发展的时候作再次…     

化疗栓塞与电化学加化疗栓塞治疗肝癌的比较研究

目的：比较介入化疗栓塞与化疗栓塞加电化学疗法联合治疗中晚期肝癌的疗效,通过分析,进一步探索治疗肝癌的更侍方案。方法：本文对６４例中晚期肝癌分组法治疗,化疗栓塞组（Ａ组）３６例,化疗栓塞加电化学联合治疗组（Ｂ组）２８例。通过临床资料分析,对比治疗疗效。结果：两者有效率分别为６４．２％、７２．１％,１、２年生存率分别为５５％、２２％和７１％、２１％。１年生存率有明显差异,２年生存率本文无明显差异。结     

选择性肝动脉灌注化疗及栓塞治疗原发性巨块型肝癌

原发性肝癌是临床常见的恶性肿瘤,恶性程度极高且进展迅速,发现时多属中、晚期。我们对19例原发性巨块型肝癌施行37次灌注化疗及栓塞(TACE),现总结如下。资料与方法本组19例,男15例,女4例,年龄33～77岁,平均54岁。其中 HBsAg 阳性9例,HCV 阳性3例,HBsAg 与 HCV 均阳性1例。全部病例均做胎甲球蛋白测定其值为29～400ng/ml。均做 B 超,CT,肿瘤位于肝右叶12例,肝左叶     

肝癌化疗药物栓塞术后副反应及并发症的临床观察

目的：观察７２例各型肝癌化疗药物栓塞术后副反应及并发症的发生民政部及防治方法。方法：采用Ｓｅｌｄｉｎｇｅｒ术经皮穿刺插管行选择性、超选择性肝Ａ化疗栓塞术,结果：肝区疼痛３６例（占５０％）,术后发热４１例（占５６．９％）,恶心呕吐２７例（占３７．５％）,腹胀２８（占３８．８％）,粘膜病变４５例（占６２．５％）上消化道出血１例（占０．７２％）,ＡＤＭ中毒１例（占０．７２％）。结论：粘膜病变是最常见的并发症,术中尽量超选择性操作是减少并发症的关键。     

动脉灌注化疗与栓塞治疗肝癌后胆囊声像图变化的分析

为了探讨动脉灌注化疗与栓塞治疗肝癌前后胆囊声像图发生变化的表现与机制，对４０例患者应用Ａｌｏｋａ ＳＳＤ－６２０，Ｔｏｓｈｉｋａｓａｌ－３８ＡＳ实时超声仪，在治疗前后进行系列检查，并对其表现进行分析研究，发现治疗后肿瘤控制、缩小占６５％，胆囊壁增厚占９５％，胆囊缩小，萎缩，显像不清占６２．５％，胆囊体积增大占１２．５％，结石形成占２０％，并发现胆囊的变化与治疗次数呈正相关。这是由于绝大多数胆囊动脉     

微囊肝动脉栓塞治疗肝癌

60年代以来,开始对那些无法手术治疗的肝癌采取肝动脉插管栓塞(THAE)和肝动脉内化疗药物灌注等方法治疗,显示有一定的效果。但是,由于栓塞剂的早期吸收、血管再通或侧循枝环迅速形成。使肿瘤重新获得血供,从而影响栓塞的抗癌效果;另外,动脉血流的快速冲刷作用和酶降解作用使肿瘤组织内药物浓度下降,化疗作用迅速消失,同时大量药物进入周围循环,产生严重的全身毒性反应。近年来,国外许多学者开始采取经选择性肝动脉插管的方法,将由不同物质制成的带药微囊(Microcapsules)     

肝癌合并门脉癌栓的化疗栓塞治疗

１２８例肝癌合并门脉癌栓病人经２次以上插管治疗，Ａ组肝动脉内灌注化疗药物，Ｂ组药物灌注加碘油栓塞，Ｃ组化疗加碘油及明胶海绵粒栓塞。三组１年生存率分别为２５．００％，２８．５２％，４１．７６％，平均生存７．２个月、８．４个月及１０．３个月。Ｃ组疗效最好，１例病人存活达７年，说明、门脉癌栓不应是肝动脉化疗栓塞的禁忌证，对没有严重肝硬化及肝功能损害的门脉癌栓病人均应进行化疗栓塞治疗。     

合并门静脉癌栓的原发性肝癌的影像学特征及其介入治疗

目的：评价不同影像手段对发现门静脉癌栓（ＰＴＴ）的敏感性与左右叶肝癌灶对门静脉侵犯程度的差异，以及门静脉受侵时介入治疗方案的选择，材料与方法，对２８例合并ＰＴＴ原发性肝癌进行了动脉化疗栓塞，此前分别作了Ｂ超，ＣＴ与血管造影，比较这些检查对发现ＰＴＴ的敏感性，同时将同期血管造影显示门静脉通畅的５６例原发性肝癌作为对照组，结果：２８例血管造影病列中２４例（８５．７％）门静脉显示清楚者均发现ＰＴＴ，Ｂ超     

Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy

Purpose

To test the hypothesis that same-day discharge of selected transarterial chemoembolization patients would not increase 30-day readmission rate compared with overnight observation.

Transarterial Chemoembolization of Unresectable Hepatocellular Carcinoma with Drug Eluting Beads: Results of an Open-Label Study of 62 Patients

The purpose of this study was to assess the safety and efficacy of doxorubicin-loaded beads (DC Beads) delivered by transarterial embolization for the treatment of unresectable hepatocellular carcinoma (HCC). This open-label, single-center, single-arm study included 62 cirrhotic patients with documented single unresectable HCC. Mean tumor diameter was 5.6 cm (range, 3–9 cm) classified as Okuda stages 1 (n = 53) and 2 (n = 9). Patients received repeat embolizations with doxorubicin-loaded beads every 3 months (maximum of three). The maximum doxorubicin dose was 150 mg per embolization, loaded in DC Beads of 100–300 or 300–500 μm. Regarding efficacy, overall, an objective response according to the European Association for the Study of the Liver criteria was observed in 59.6%, 81.8%, and 70.8% across three treatments. A complete response was observed in 4.8% after the first procedure and 3.6% and 8.3% after the second and third procedures, respectively. At 9 months a complete response was seen in 12.2%, an objective response in 80.7%, progressive disease in 6.8%, and 12.2% showed stable disease. Mean tumor necrosis ranged from 77.4% to 83.9% (range, 28.6%–100%) across three treatments. α-Fetoprotein levels showed a mean decrease of 1123 ng/ml (95% CI = 846–1399; p = 3 × 10^–11) after the first session and remained stable after the second and third embolizations (42 and 70 ng/ml decrease, respectively). Regarding safety, bilirubin, γ-glutamyl transferase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase showed only transient increases during the study period. Severe procedure-related complications were seen in 3.2% (cholecystitis, n = 1; liver abscess, n = 1). Postembolization syndrome was observed in all patients. We conclude that hemoembolization using doxorubicin-loaded DC Beads is a safe and effective treatment of HCC as demonstrated by the low complication rate, increased tumor response, and sustained reduction of α-fetoprotein levels.     

The Current Practice of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

Despite remarkable advancement in the surveillance and treatment of hepatocellular carcinoma (HCC) and the availability of novel curative options, a great proportion of HCC patients are still not eligible for curative treatment due to an advanced tumor stage or poor hepatic functional reserve. Therefore, there is a continuing need for effective palliative treatments. Although practiced widely, it has only recently been demonstrated that the use of transarterial chemoembolization (TACE) provides a survival benefit based on randomized controlled studies. Hence, TACE has become standard treatment in selected patients. TACE combines the effect of targeted chemotherapy with the effect of ischemic necrosis induced by arterial embolization. Most of the TACE procedures have been based on iodized oil utilizing the microembolic and drug-carrying characteristic of iodized oil. Recently, there have been efforts to improve the delivery of chemotherapeutic agents to a tumor. In this review, the basic principles, technical issues and complications of TACE are reviewed and recent advancement in TACE technique and clinical applicability are briefed.     

肝动脉栓塞术后Ⅱ期肝癌切除（附10例切除标本的病理研究）

笔者报告了１０例肝恶性肿瘤经肝动脉栓塞术后Ⅱ期切除，其中有４例患者在栓塞前无手术适应证。所有切除标本均进行了详细的病理研究。结果表明：３例肿瘤１００％坏死，其余坏死率为７５％～９０％。肿瘤卫星灶、门静脉瘤栓及包膜内浸润癌细胞均有不同程度坏死。另一显著所见是肿瘤包膜明显增厚。术后平均生存率和中位生存率分别为２４．８和２４．５个月。笔者认为：肝动脉栓塞术是将手术不能切除的大肝癌转化为可切除的有效方法；栓塞术至手术的间隔时间以３个月以上为最佳。笔者还对肿瘤栓塞后的病理变化进行分期，对手术可切除肝癌的术前栓塞的价值进行了探讨。     

中晚期肝癌化学免疫治疗与单纯TAE治疗疗效比较

本文采用肝动脉化学栓塞(TAE)后1～2周内行LAK/IL2的化学免疫治疗(Chemo-immu-notherapy CIT)中晚期肝癌(Mid-advanced HCC)42例(CIT组),TAE治疗2 7例为对照(TAE组)。结果:Ⅱ期HCC 2年生存率47.4％,Ⅱ期HCC部分缓解率(PR)和3个月、半年、1年生存率分别为39.1％、73.9％、56.5％和34.7％,显著高于TAE组Ⅱ期HCC二年生存率16.7％,(P<0.05)和Ⅱ期HCC部分缓解率为6.7％,三个月、半年、1年生存率40.0％,13.3％和6.7％,P<0.05;Ⅱ期HCC 1年内肝外转移率(25.5％)明显低于TAE组(66.7％,P<0.05)。表明化学免疫治疗能显著提高中晚期肝癌疗效。     

肝细胞癌化疗栓塞方法和肿瘤坏死

目的 评价地细胞癌肿瘤坏死与经动脉化疗栓塞（ＴＡＣＥ０方法的关系。材料与方法 观察１１７例手术观察的肝细胞癌肿块坏死和增长率,其中单纯手术５８例,４种ＴＡＣＥ后Ⅱ期手术切除５９例。结果 肝细胞癌ＴＡＣＥ后环死较自发坏死严重、范围广（Ｐ〈０．０１）,坏死程度和愉体积变化与ＴＡＣＥ方法密切相关（多全塞较单材料栓塞、单纯化疗改变明显,Ｐ〈０．０１）,但与ＴＡＣＥ和手术切除间期无显著相关（Ｐ〉０．０５）,     

肝动脉化疗栓塞术后残癌组织血管内皮生长因子表达的研究

目的研究肝细胞癌(HCC)经导管动脉化疗栓塞(TACE)后残癌组织血管内皮细胞生长因子(VEGF)的表达情况及其意义.资料与方法经病理证实的HCC63例,包括单纯手术切除42例(对照组),TACE术后行Ⅱ期手术切除21例(TACE组),TACE组患者手术前接受1～2次不等的TACE术治疗,均按统一规范标准给予化疗药物灌注 栓塞治疗,术中所用药物及栓塞材料为:5-Fu750～1500mg/次,顺铂80～120mg/次,吡柔比星20～40mg/次,羟基喜树碱20～30mg/次,40%超液化碘油20～30ml/次,明胶海绵1/5～1/3块/次.对手术切除标本进行免疫组织化学染色,其中TACE组取病灶边缘残存肿瘤部分,检测肿瘤组织VEGF的表达.结果 对照组VEGF阳性染色细胞数为138.26±65.24,TACE组残存肿瘤组织VEGF阳性染色细胞数为243.66±88.88,二者之间比较有显著性差异(t=5.34,P＜0.01),TACE显著上调了VEGF蛋白的表达.结论 TACE治疗后残癌组织存在丰富的肿瘤血供,残存肿瘤细胞VEGF表达明显升高,新生血管生成及VEGF的表达可能在栓塞后残癌组织血供重建中起到重要的作用.     

化疗栓塞方法和肝细胞癌组织反应

目的评价肝细胞癌肿瘤包膜、淋巴细胞浸润、纤维化、肝硬化等与经动脉化疗栓塞（TACE）方法的关系。方法观察117例手术切除的肝细胞癌肿瘤包膜、淋巴细胞浸润、纤维化、肝硬化程度,其中单纯手术58例,4种TACE后Ⅱ期手术切除59例。结果TACE组较单纯手术组,肝细胞癌包膜更厚、更完整,淋巴细胞浸润多,纤维化多（Ρ＜0.01）;包膜形成、纤维化与TACE方法、次数及手术间期密切相关（Ρ＜0.05）,淋巴细胞浸润与TACE方法、次数密切相关（Ρ＜0.05）,与手术间期关系不大（Ρ＞0.05）。肝硬化与治疗方法关系不大（Ρ＞0.05）,但与治疗次数相关（Ρ＜0.05）。结论多次、多材料联合栓塞TACE较单次、单材料栓塞、单纯化疗更易引起肝细胞癌包膜形成、淋巴细胞浸润、纤维化,超选择性插管可避免TACE对正常肝的损害。