经导管动脉栓塞和经皮乙醇注射联合治疗肝细胞癌

为了使大的肝细胞癌(HCC)完全坏死,作者研究了15例单发的巨大(直径3.0～9.0cm)的有包膜的HCC经导管动脉栓塞(TAE)及经皮乙醇注射(PEI)联合治疗后的疗效。列入研究的标准为:①病变单发且直径大于3cm。②US可见。③无门脉瘤栓。肝外转移或腹水证据。所有病人都有肝硬化。所有病例HCC的诊断均经活检或切除标本的病理证实。通过选择性插管进入肝动脉并注射碘油与     

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。     

肝节段动脉栓塞治疗原发性肝癌

目的：研究以无水乙醇碘油乳剂作栓塞剂，行肝节段动脉栓塞术治疗原发性肝癌。材料和方法：观察４例无水乙醇碘油乳剂选择性栓塞正常狗肝动脉前后的门脉血流动力学改变。采用同一栓塞剂，行肝节段动脉栓塞术治疗原发性肝癌患者３４例。依肿瘤的类型、血供特点分别采用３种不同的栓塞技术：同轴导管法、直接法或药物辅助法。结果：实验性肝动脉栓塞后，门脉造影表现出局部门脉分支的阻塞性改变。镜下见肝实质内栓塞剂沉积区域的门脉分支内有滴状的无水乙醇碘油乳剂。临床治疗３４例后均无严重并发症出现，随访３～１８个月，２４例非手术患者中有６例出现局部复发，目前尚存活２１例；１０例患者接受二期手术，术后病检４例肿瘤完全坏死，其余６例包括子灶、包膜浸润癌灶均可见明显坏死，均未发现弥漫性肝损害。结论：行肝节段动脉栓塞术，能使肿瘤所在部位达到动门脉双重栓塞，且并发症少，对于病灶局限的原发性肝癌是一种很好的治疗手段。     

经肝动脉化疗栓塞治疗原发性肝癌肝静脉与下腔静脉癌栓的疗效观察

目的 研究经肝动脉化疗栓塞(THAE)对原发性肝癌肝静脉及下腔静脉癌栓的治疗作用.方法 对28例影像学检查发现肝静脉下腔静脉癌栓的原发性肝癌患者,行肝动脉血管造影和THAE治疗.结果 25例癌栓血管造影呈条纹征,THAE治疗后平均生存期不足半年.3例癌栓呈结节条状肿瘤染色,其中2例显示瘤栓供血动脉血管,THAE治疗后主瘤灶缩小、癌栓消退,2例二期手术切除,已分别存活151月、30月,1例已带瘤生存50月,3例现生活工作正常.结论 THAE对原发性肝癌患者肝静脉及下腔静脉癌栓呈结节条状者的治疗具有非常积极的作用.     

肝癌节段性栓塞化疗与常规栓塞化疗的比较研究

目的 比较节段性栓塞化疗与常规栓塞化疗治疗肝癌的临床效果及其对肝的影响。方法 ３８例肝癌行节段性栓塞化疗,６３例行常规栓塞化疗。两组病例在肿瘤大小,部位,数目,临床分期,肿瘤血供,肝功能,是否合并肝硬化,化疗药物剂量及治疗次数等方面无显著性差异。节段组６例,常规组１０例分别于栓后４－８周行手术切除。     

肝癌门脉瘤栓的介入治疗

原发性肝癌的血管造影表现中，肿瘤类型、血供、肿瘤典色、肿瘤血管、门脉瘤栓、肝内转移等征象影响THAE疗效和病人的预后。我院试用经肝动脉化疗栓塞治疗肝癌门脉瘤栓取得了一定的疗效。现将我院经治的10例肝癌患者门脉瘤栓的造影表现和介入治疗效果总结如下。     

肝癌并门脉主干癌栓的介入治疗及其预后的影响因素

分析肝癌并门脉主干癌栓患者预后的影响因素,评价不同介入方法的疗效。方法１８２例肝癌并门脉主干癌栓患者行２次以上介入治疗,２６例单纯肝动脉内化学药物灌注,４２例化疗加碘油栓塞,１１４例化疗加碘油明胶海绵栓塞,对其预后因素进行Ｃｏｘ回归模型分析。     

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。     

恶性肿瘤治疗的新途径——碘苯脂抗癌药乳剂并明胶海绵栓塞疗法

选择性动脉内灌注化疗药物及选择性动脉栓塞疗法是治疗恶性肿瘤的两种重要方法,但只对主要癌结节有效而对其余小癌结节(小的肝内转移)、门静脉癌栓和肝包膜内浸润则几乎无效,因而不是     

肝动脉高灌注在肝细胞癌伴门静脉癌栓介入治疗中的意义

目的：分析肝细胞癌（HCC）合并门静脉主干癌栓致肝动脉高灌注异常表现,探讨其在判断癌灶的范围、肝脏血流动力学异常、从而选择正确的介入治疗方案中的意义。方法：搜集因HCC合并门静脉左支、右支或/和主干癌栓首次行肝动脉灌注化疗栓塞术（TACE）的病例共69例,根据肝动脉DSA动脉期、实质期癌变和非癌变肝组织境界及血供对比,分为无、轻度、重度肝动脉高灌注,并据此判定癌变和非癌变组织血供状况而选择不同的介入治疗方案。所有病例随访1年以上,大部分病例行2～7次介入治疗。结果：无肝动脉高灌注30例,给予常规TACE术;轻度肝动脉高灌注28例,行肿瘤供血动脉节段性碘油乳剂栓塞;重度肝动脉高灌注11例,仅行肝固有动脉内灌注化疗术。三组病例3、6、12个月生存率分别为100%,96.67%,66.67%;92.86%,71.43%,32.14%;81.82%,36.36%,0%,三组间差异均有统计学意义（P〈0.05）。结论：肝动脉高灌注征在判定HCC并门静脉癌栓患者门静脉血供受侵程度、指导介入方案的选择、介入栓塞治疗预后方面有着重要的临床意义。     

兔VX2肝癌动脉栓塞治疗前后血供变化与病理分析

目的：探讨兔VX2肝癌经导管肝动脉碘化油栓塞术前后的血供变化及病理特征。方法：将36只荷VX2肝癌实验兔随机分为实验组（A组,n=24）、假手术组（B组,n=6）及空白对照组（C组,n=6）。均于接种后第14、15天分别行CT扫描及肝动脉、门静脉DSA检查,A组同时行经导管碘化油栓塞肿瘤供血动脉,C组于DSA后处死。A、B组于第21、22天分别行CT平扫及DSA检查,并于DSA后处死。结果：CT及DSA检查证实35例（97．22％,35／36）为富血供肿瘤,且主要由肝动脉供血,仅1例为门静脉供血。第3周时A、B组DSA均示仍为肝动脉供血,无门静脉供血。栓塞后肿瘤组织主要由凝固性坏死及周边残存癌组织组成。结论：兔VX2肝癌大多数为富血供肿瘤且主要由肝动脉供血。经动脉碘化油栓塞不能完全阻断肿瘤血供,残癌组织仍为肝动脉供血,肝癌组织中的门静脉仅仅是解剖上的血流通过,并不参与肿瘤血供。     

Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

Objective

To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations.

Materials and Methods

We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 ± 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups.

Results

Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess.

Conclusion

Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.     

肝动脉化疗栓塞结合门静脉癌栓内注药治疗原发性肝癌伴门静脉癌栓临床疗效的初步观察

目的 探讨肝动脉化疗栓塞结合经皮穿刺门静脉癌栓内注药治疗原发性肝癌伴门静脉痛栓的临床价值.方法 30例不能手术切除病灶的原发性肝癌伴门静脉癌栓患者,采用完全随机方法分成A、B组,A组14例,B组16例.治疗前A、B组患者的肝功能Child-Push分级A级均为9例,B级分别为5例和7例(χ~2=0.201,P>0.05);Ⅱ型癌栓A组8例,B组9例,Ⅲ型A组6例,B组7例(χ~2=0.002,P>0.05);A、B两组患者术前丙氨酸氨基转移酶(ALT)中位数分别为58.7和70.5 U/L(W=191.5,P>0.05);总胆红素(TBIL)中位数分别为21.4和21.7 μmol/L(W=203,P>0.05);白蛋白(ALB)中位数分别为35.3和37.5 g/L(W=214,P>0.05);甲胎蛋白(AFP)中位数分别为680和873μg/L(W=179.00,P>0.05),两组相比差异均无统计学意义.A组以肝动脉化疗栓塞治疗肝内原发肿瘤灶,经皮穿刺门静脉癌栓内注药治疗门静脉癌柃;B组单纯肝动脉化疗栓塞治疗.采用Kaplan-Meier计算两组患者的中位生存期,log-rank法检验组间差异.结果 患者治疗后的中位生存期,A组14.0个月、B组4.0个月,两组差异具有统计学意义(χ~2=11.728,P<0.01).患者3、6和12个月的生存数,A组分别为11、10和7例,B组分别为10、3、0例.2组均未见与治疗相关的严重不良反应.结论 与单纯肝动脉化疗栓塞相比,肝动脉化疗栓塞结合经皮穿刺门静脉癌栓内注药治疗,可以显著延长伴有Ⅱ、Ⅲ型门静脉癌栓的原发性肝痛患者的中位生存期.     

原发性肝癌伴门静脉癌栓的外科治疗

目的:探讨原发性肝癌伴门静脉癌栓(PVTT)外科治疗的方法及疗效。方法:27例均行肝癌连同PVTT切除或经门静脉断端取栓或切开主干取栓。术后18例同时行肝动脉及门静脉化疗,单纯行5例肝动脉插管化疗栓塞术(TACE),未做化疗4例。结果:术后1、3、5年生存率分别为66.7%(18/27)、29.63%(8/27)、11.11%(3/27)。结论:外科手术是治疗肝癌合并PVTT的有效方法,术后辅以门静脉化疗及TACE术能明显提高治疗效果。     

Transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma invading the portal veins: therapeutic effects and prognostic factors

PURPOSE: This retrospective study was undertaken to evaluate the therapeutic effects of transcatheter hepatic arterial chemoembolization on hepatocellular carcinoma (HCC) invading the portal veins and to identify prognostic factors. MATERIALS AND METHODS: Sixty-one patients underwent chemoembolization. The HCC had invaded the main portal vein in 23 patients, a first-order branch in 25 patients and a second-order branch in 13 patients. The hepatic arteries feeding the tumors were embolized with gelatin sponge after a mixture of iodized oil and anticancer drugs was injected via these vessels. Tumor response was evaluated by measuring tumor sizes on CT images. A reduction in maximum diameter of 25% or more was considered to indicate response to chemoembolization. Significant prognostic factors were identified by univariate and multivariate analyses. RESULTS: Tumor size was reduced by 25% or more in 26 patients (43%). The 1-, 3- and 5-year survival rates were 42, 11 and 3%, respectively, with mean survival of 15 months in all patients. In the univariate analysis, the following six variables were significantly associated with prognosis: (i) tumor response; (ii) ascites; (iii) accumulation of iodized oil in tumor thrombi; (iv) in main tumors; (v) Okuda classification; and (vi) tumor size. In the multivariate analysis, the first three of these factors showed significantly independent values for patient prognosis. CONCLUSION: Chemoembolization appears to be an effective treatment for HCCs invading the portal venous system. The prognostic factors identified here are expected to be helpful in classifying patients with HCCs invading the portal veins and should serve as useful guidelines for chemoembolization in clinical practice.     

肝癌合并动静脉瘘的处理方法探讨

目的：研究肝癌介入治疗中对肝癌合并肝动脉肝静脉瘘和肝动脉门静脉瘘的处理方法。方法：对5例肝动脉肝静脉瘘患者（A组）先行在瘘口附近多点，多次的经皮无水酒精注射消融术（PEI）后，再行经导管肝动脉栓塞术（TAE）。对26例肝动脉门静脉瘘者（B组）则将超微导管头端越过瘘口后进行栓塞，再用带毛钢圈或无水乙封闭瘘田，结果：A组动脉脉瘘消失及明显减少40例，无效10例。在消融后TAE碘油沉积良好的38例中，37例PEI在4次以上，B组26例经1－2次治疗后，全部达到中止门静脉分流的目的，表现为TAE碘油沉积良好25例，门静脉压力明显下降，其中腹力减水23例，上消化道出血的2例均于术后1d止血。结论：上述2种方法处理肝癌合并动脉脉瘘后，能令碘油药物更好地在肿瘤内沉积，避免或减少了碘油导致肺梗死或门静脉压力进一步升高的危险性，提高了肝癌介入治疗的效果。     

肝动脉化疗栓塞及注射32P-胶体、无水乙醇综合序贯介入治疗原发性肝癌疗效分析

目的　评价肝动脉化疗栓塞（ＴＡＣＥ） 及Ｂ 超引导下注射３２Ｐ胶体、无水乙醇（ＰＥＩ） 综合序贯介入治疗原发性肝癌的临床价值。方法　５１ 例中晚期肝癌分为２ 组,２３ 例综合序贯应用ＴＡＣＥ＋ ３２Ｐ＋ ＰＥＩ治疗,２８ 例单纯应用ＴＡＣＥ 治疗。结果　综合序贯组肿瘤缩小率、肿瘤完全坏死率、ＡＦＰ下降率分别为９１ ．２９ ％ 、８０ ．００ ％ 、８７ ．５ ％ ,而单纯ＴＡＣＥ组分别为３９．２７％ 、３０ ．４３％ 、４１ ．４６ ％ ,两组比较有显著性差异（ Ｐ＜０ ．０１）,６ 个月、１、２ 、３ 年生存率综合序贯组分别为９５．６５ ％ 、８６．９５％ 、５６ ．５２ ％ 、２０．７３ ％ ,而单纯ＴＡＣＥ 组分别为６４．２８％ 、３９．２８ ％ 、１７ ．８５ ％ 、００ ．００ ％ （Ｐ＜ ０．０１） 。结论　ＴＡＣＥ＋ ３２Ｐ＋ ＰＥＩ的综合序贯介入治疗是提高中晚期原发性肝癌患者生存率的有效方法。     

Transcatheter arterial embolization followed by percutaneous ethanol injection in the treatment of hepatocellular carcinoma

Purpose The aim of this study was to evaluate the effectiveness of transcatheter arterial embolization (TAE) followed by percutaneous ethanol injection (PEI) in the treatment of large hepatocellular carcinoma (HCC) lesions.Methods Fifteen patients with HCC were treated by means of TAE followed by 6–16 ethanol injections. In 10 patients, the HCC was solitary (3–8 cm); 3 patients had 1, and 2 patients had 2 daughter nodules (3 cm or smaller) in addition. In 12 of 15 main tumors and in 4 of 7 daughter nodules, a tumor capsule was observed by computed tomography or magnetic resonance imaging.Results Combined treatment with TAE and PEI resulted in complete necrosis of 12 of 15 main tumors and 7 of 7 daughter nodules on biopsy. Treatment failure (incomplete necrosis) occurred in 3 unencapsulated main tumors. The 1-year survival rate in 10 patients was 100%.Conclusion The combination of TAE and PEI proved to be an effective treatment for large HCC, including those with 1–2 small daughter nodules. The presence of a tumor capsule significantly correlates (p < 0.05) with a favorable outcome of treatment.     

肝癌合并门静脉癌栓的金属内支架、TACE、PVC三联治疗

目的 探讨经皮穿肝门静脉内支架置入术和经皮穿刺门静脉化疗术(PVC)及经皮穿刺肝动脉化疗栓塞术(TACE)三种方法 联合治疗肝癌合并门静脉癌栓的疗效. 资料与方法 动脉造影观察肝肿瘤血供和门静脉癌栓情况;经皮穿刺门静脉,在癌栓部位置入支架;再从门静脉和肝动脉内灌注化疗和抗肿瘤血管生长药物以及栓塞剂. 结果 本组12例中晚期患者,支架通畅时间2～22 月,中位通畅期5月.治疗后3个月、6个月、12个月、12个月以上生存率分别为91.7%(11/12)、83.3%(10/12)、50%(6/12)、25%(3/12). 结论 肝癌合并门静脉癌栓应用经皮穿肝门静脉内支架置入术、PVC术、TACE术是一种有效的联合治疗方法 .