脑恶性肿瘤超选择性动脉化疗并发症分析

目前脑恶性肿瘤在治疗上仍以综合治疗为主要手段 ,化疗是综合治疗的方法之一。传统的静脉全身化疗由于受到剂量的限制 ,肿瘤局部摄取量低 ,全身毒副反应大 ,影响其疗效。而经股动脉插管至颈内动脉灌注化疗 ,可将药物有效浓度灌注到肿瘤组织内 ,减轻全身毒性反应 ,延长药物在肿瘤内的滞留时间 ,有效发挥化疗药物的杀伤作用。但其不足的是颈内动脉插管导管口在眼动脉开口以下 ,大部分化疗的病人常常会出现眼部并发症 ,严重者甚至失明。近年来 ,随着神经介入技术的迅速发展 ,微导管的应用 ,采用超选择将微导管插至眼动脉开口以上进行灌注化疗 ,…     

细辛脑治疗慢性支气管炎疗效观察

目的：观察细辛脑治疗慢性支气管炎的疗效。方法：将慢性支气管炎120例随机分为观察组及对照组各60例,对照组采用常规抗感染、止咳化痰、纠酸平喘治疗;观察组（细辛脑组）病人在常规治疗基础上加用细辛脑16mg,2次／天。结果：观察组显效率为61．7％,总有效率为959／6,临床控制时间平均14．83天;对照组显效率43．39／6,总有效率88．3％,临床控制时间平均18．98天,两组比较,显效率及总有效率差异显著（P〈0．05）。结论：常规疗法加细辛脑治疗慢性支气管炎疗效显著。     

经颈动脉灌注尼莫司汀和依托泊苷治疗脑恶性胶质瘤164例

目的评价经颈动脉灌注尼莫司汀(ACNU)+依托泊苷(VM-26)联合对复发性脑胶质瘤的疗效及安全性。方法治疗组为幕上颈内动脉供血范围的复发性脑胶质瘤164例,肿瘤同侧颈总动脉ACNU、VM-26联合灌注化疗。对照组为复发性脑胶质瘤26例,口服司莫司汀(CCNU)治疗结果颈动脉灌注治疗的CR、PR高于对照组(P<0.05);生存期也长于对照组(P<0.05)。结论。经颈动脉灌注ACNU、VM-26治疗复发性脑胶质瘤疗效高,副作用小,安全可靠,可作为常规化疗手段。     

肺癌脑转移动脉内化疗中甘露醇的应用价值研究

目的 :进一步了解和认识甘露醇开放血脑屏障 ,对肺癌脑转移瘤动脉内化疗的应用价值。方法 :15例病人 ,男 11例 ,女4例。年龄 37～ 71岁 ,平均 5 2 .5岁。所有病人 ,均为肺腺癌。随机分为二组 ,甘露醇组 8例 ;非甘露醇组 7例。采用 Seldinger插管技术 ,经股动脉插管 ,将导管送到病变侧的颈内动脉或一侧椎动脉。部分病人到眼动脉水平以上 ,进行超选化疗。化疗药使用 VM-2 6。剂量为 15 0 mg/人 /次。每次化疗间隔 3～ 5周。甘露醇组 ,化疗前给予 2 0 %甘露醇 2 0 0～ 2 5 0 ml。结果 :(1)疗效。甘露醇组和非甘露醇组的比较 ,前者完全缓解 1例 ,部分缓解 2例 ,稳定 3例 ,病变进展 2例 ,有效率为 75 % (6 / 8)。后者完全缓解 1例 ,部分缓解 1例 ,稳定 3例 ,病变进展 2例。有效率为 71.4% (5 / 7)。统计结果 :两者疗效无统计学差异 ,相差不显著。 (2 )并发症 ,经颈内动脉灌注甘露醇时 ,多数病人同侧眼眶有烧灼感 ,2例化疗后白细胞曾低于 1.5× 10 1 2 / L。个别病人有短暂的恶心、呕吐现象。脱发常见。结论 :(1)动脉插管介入化疗 ,对于治疗脑内转移性肿瘤具有较好的疗效。安全、可靠。 (2 )甘露醇对脂溶性化疗药物 (VM- 2 6 )的脑内转移瘤疗效作用不大。     

动脉导管栓塞化疗病人疼痛的护理

目的：探讨动脉导管栓塞化疗治疗恶性肿瘤病人疼痛并发症的护理措施。方法：对296例行动脉导管栓塞化疗治疗恶性肿瘤病人疼痛并发症精心护理。结果：动脉导管栓塞化疗治疗有效率82％。术后出现疼痛不良反应，经对症治疗、护理均消失。结论：动脉导管栓塞化疗治疗恶性肿瘤是手术不能切除或术后复发的首选方法，经过细致、周到的护理，术后不同程度的疼痛均取得满意的效果。     

胸腔内置管引流并灌注顺铂治疗恶性胸液的疗效观察

目的：观察胸腔内置管持续引流胸液后灌注顺铂治疗恶性胸液的疗效。方法：将病人分为治疗组和对照组。治疗组置入中心静脉导管引流胸液后，灌注顺铂40mg加0．9％生理盐水40ml，连续3次和5次后评价疗效。对照组除采用常规胸穿抽液外，其余处理及疗效评价均相同。结果：治疗3次和5次的有效率，治疗组分别为86．2％和100．0％。而对照组分别为30.6％和53．2％。治疗组的有效率显著高于对照组，P＜0．001。结论：胸腔内置入中心静脉导管灌注顺铂治疗恶性胸液疗效确切，操作简单，值得进一步推广。     

移植肾动脉狭窄的经皮血管成形术

目的：探讨移植肾动脉狭窄（ＴＲＡＳ）的经皮血管成形术（ＰＴＡ）。材料和方法：经对侧股动脉或左肱动脉入路，使用５Ｆ普通球囊导管和２．６Ｆ微球囊导管，分别对８例ＴＲＡＳ行ＰＴＡ术。结果：经股动脉行ＰＴＡ成功４例，另４例改由肱动脉入路获成功。其中，４例行普通球囊导管扩张，另４例采用微球囊导管扩张或预扩后行普通球囊导管扩张。肾动脉狭窄率由治疗前的８４％—９７％降至１２％—３０％。无并发症。术后疗效：显效率６２．５％（５／８），有效率８７．５％（７／８）。结论：ＰＴＡ可安全有效地治疗ＴＲＡＳ。经肱动脉入路和微球囊导管的使用有助于提高手术成功率。     

经导管动脉内灌注尿激酶治疗急性脑动脉阻塞

目的 :探讨动脉血管内溶栓治疗急性脑动脉阻塞的疗效和价值。方法 :在DSA机下采用超选择性动脉插管灌注尿激酶治疗 48例急性脑动脉闭塞疾患。平均发病时间 2 9.6h ,尿激酶用量 80 0 0 0～ 3 0 0 0 0 0IU ,灌注时间持续 45～48min。结果 :6例患者即刻完全再通 ,3 8例部分再通 ,4例未通 ,临床有效率为 91.6%。结论 :超选择性动脉内灌注尿激酶是治疗急性脑动脉闭塞性疾病的优先选择方法。     

CalliSpheres®微球支气管动脉化疗栓塞术治疗非小细胞肺癌性胸腔积液疗效观察

目的 评价CalliSpheres?载药微球支气管动脉化疗栓塞术联合肋间动脉灌注化疗治疗顽固性非小细胞肺癌(NSCLC)性胸腔积液疗效及安全性.方法 采用改良Seldinger技术经右侧股动脉插入动脉导管,用微导管超选插至患侧血供丰富的支气管动脉及肋间动脉,灌注化疗药物后使用CalliSpheres?载药微球栓塞肿瘤供血血管17例,并与19例传统治疗方法比较.结果 3个月后使用本法治疗的17例患者生活质量明显改善,治疗有效率明显高于使用传统化疗的患者,整体有效率达到了100％(疗效与传统方法比为100％ 比52.6％),中位疾病无进展期(mPFS)和总生存期(OS)高于使用传统化疗的患者(PFS为8.8个月比4.1个月,OS为13.4个月比7.0个月);该法不良反应轻微,所有患者均未出现严重并发症.结论 该治疗方法效果明显,不良反应小,为治疗顽固性NSCLC性胸腔积液提供了一条新思路.     

髂内动脉灌注药物和栓塞治疗妇科恶性肿瘤

笔者对14例晚期归科恶性肿瘤患者进行一侧经皮股动脉穿刺插管,双侧髂内动脉灌注药物或加用明胶海绵颗粒栓塞治疗,取得良好疗效,近期有效率92.85％,无一例并发症。本文介绍了动脉插管和造影的技术,灌注的药物和方法;对妇科恶性肿瘤的血供特点、动脉灌注化疗的理论根据进行了讨论。认为本法操作方便,病人的创伤小,并发症少,结合手术或放疗等措施可控制病情发展,减少病人痛苦,提高手术切除率和生存率。     

Superselective cerebral arterial infusion of BCNU in high-grade glioma: the radiologist's point of view

Thirty-two patients suffering from high-grade glioma were candidates for superselective cerebral arterial infusion of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) after surgery and radiation therapy. There were 74 catheterizations using an 8-French guiding catheter through which a 2.5-French balloon catheter was placed into the main arterial trunk feeding the tumor. Eleven procedures were abandoned because of arterial spasm with a transient neurological deficit or because of prolonged catheterization time. Sixty-three infusions of BCNU were done, each lasting three hours. Eighty-one percent of patients showed stabilization or improvement on computed tomographic (CT) scans five weeks after treatment. We thus demonstrate the safety of supraophthalmic catheterization, the feasibility of prolonged catheterization, and the relative effectiveness of low doses of BCNU infused over a long period of time in the treatment of cerebral gliomas.     

Superselective arterial BCNU infusion in the treatment of patients with malignant gliomas

Retinal and CNS toxicity have been reported with infraophthalmic infusion of BCNU in the treatment of patients with malignant gliomas. It is known, however, that the CNS toxicity can be reduced if the BCNU is dissolved in dextrose in water. This article describes the results from 15 patients who received 42 courses of BCNU administered by supraophthalmic internal carotid, middle cerebral, or posterior cerebral artery infusions. None of the patients developed leukoencephalopathy as demonstrated by CT scanning. The average reduction in tumor volume was 36%, and the median survival time from the date of diagnosis was 73 weeks. These values are comparable to those of a previous group of 20 patients treated with infraophthalmic infusions, with the exception that none of the patients in the present group developed retinal damage.     

动脉化疗治疗头颈部恶性肿瘤的临床研究

目的研究超选择性动脉介入灌注化疗和栓塞治疗头颈部恶性肿瘤的价值。方法31例头颈部恶性肿瘤患者根据肿瘤部位分别行超选择性舌动脉、颌内动脉、面动脉介入灌注化疗,其中明胶海绵颗粒栓塞11例。化疗药物采用顺铂(CDDP)、5-FU、甲氨碟呤(MTX)、表阿霉素(EPI)等2～3种联合应用。结果31例头颈部恶性肿瘤选择性动脉插管化疗和栓塞,半月后肿瘤体积缩小21例(占67.8%);肿瘤溃疡面缩小8例(占25.8%);未见明显变化2例。组织学疗效:19例介入治疗后接受手术,10例栓塞后的手术标本均为显效,栓塞标本近栓塞的血管处坏死程度重;9例未栓塞标本为有效。19例手术标本病理观察有效率94%。术中见肿瘤缩小,边界清楚,出血减少。19例术后目前仍生存15例(占78.9%),存活时间1～7.5年。结论术前超选择性动脉插管化疗栓塞对头颈部恶性肿瘤有较好的临床应用价值。     

脑动静脉畸形供血方式与栓塞的关系研究

目的探讨脑动静脉畸形供血方式与栓塞的关系。方法回顾性分析12 4例4 0 0次超选择性微导管造影所显示的脑动静脉畸形的供血方式及其栓塞后并发症的发生率。结果4 0 0次微导管超选择性造影显示终末型供血方式2 92次,占73% ,穿枝型供血方式2 8次,占7% ,动静脉直接交通型36次,占9%。畸形血管团内伴有动脉瘤2 4例,占6 %。畸形血管团内含有静脉瘤或引流静脉呈瘤样扩张者2 0例,占5 %。除穿枝型供血方式16例未行栓塞外,余者栓塞后无严重并发症发生。结论了解脑动静脉畸形供血方式便可知道能否安全的进行栓塞,而测定脑动静脉畸形的动静脉循环时间可指导栓塞用胶的配制浓度。     

抗内甲基转移酶单克隆抗体的制备及临床应用研究

目的：建立抗人甲基转移酶单克隆抗体细胞株并建立相应的蛋白测定方法,观察脑瘤组织中O^6-甲基鸟嘌呤－DNA甲基转移酶（MGMT）表达水平与亚硝脲药物疗效的关系,方法：采用细胞融合技术建立抗人甲基转移酶单克隆抗体细胞胞株,采用免疫组织化染色方法,检测60例脑瘤组织中MGMT表达水平,结果：得到了7株分泌抗人甲基转移酶单克隆抗体的杂交瘤细胞株,并建立了测定MGMT免疫组化方法,观察的60例脑瘤组织中有27例MGMT阴性,经亚硝脲药物治疗,其中24例好转,3例复发,另3例MGMT可疑阳性的患者,经亚硝脲药物治疗,其中2例好转,1例复发,25例MGMT阳性患者,经亚硝脲药物治疗,5例好转,12例复发,8例死亡,5例MGMT为强阳性患者,使用亚硝脲药物治疗无效,全部死亡,结论：建立了7株稳定分泌抗人甲基转移酶单克隆抗体的杂交瘤细胞株及MGMT蛋白测定方法,为临床开展亚硝脲预见性化疗提供了必要手段,初步结果显示,脑瘤组织中MGTM表达水平与亚硝脲药物疗效及预后有关,是肿瘤细胞对亚硝脲药物产生耐药性的基础。     

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

PURPOSE: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. MATERIALS AND METHODS: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2h; range 3-10h) after the onset of arterial embolism. Two 5mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. RESULTS: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6h, the mean total dose of rt-PA administered was 23.6mg (range 20-28mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. CONCLUSIONS: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of atrial fibrillation. Further studies should be undertaken to determine the risk of intracerebral haemorrhage caused by catheter-directed thrombolysis in individual stroke patients.     

经动脉介入栓塞治疗胰头癌临床观察(附13例报告)

目的 探讨介入动脉栓塞治疗中晚期胰头癌的疗效.方法对13例胰头癌患者进行胰十二指肠动脉造影后,超选入肿瘤供血动脉灌注健择1000 mg,然后用健择200 mg和10 ml碘化油混悬液进行栓塞,4周后行CT扫描评价疗效.结果所有患者临床症状明显减轻,肿块明显缩小.结论 动脉栓塞治疗胰头癌有较好的疗效,是目前临床治疗胰头癌的可行有效方法之一.     

Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors

BACKGROUND AND PURPOSE: High-dose intraarterial chemotherapy with repeated one-shot infusion may be useful for treating head and neck tumors. We evaluated the efficacy of superselective continuous arterial infusion chemotherapy administered via a coaxial catheter system and compared the results with those of subselective catheterization for treatment of oral cavity tumors. METHODS: Forty-nine consecutive patients with tumors of the oral cavity (clinical stage I, 12 cases; stage II, 19 cases; stage III, six cases; stage IV, 12 cases) were treated by arterial infusion chemotherapy. After a guiding catheter was advanced into the superficial temporal artery, superselective catheterization was performed using a coaxial system microcatheter. Superselective catheterization was accomplished in 34 cases, and was unsuccessful in 15, owing to difficulties in performing catheterization or to multiple feeding arteries. In the latter cases, the tip of the catheter was placed near the origin of the feeding arteries (subselective catheterization). RESULTS: Thirty (88%) of 34 patients had a complete response to superselective arterial infusion chemotherapy and two (6%) had a partial response. Twelve (80%) of 15 patients had a complete response to subselective arterial infusion chemotherapy and three (20%) had a partial response. Local recurrence was more frequent after subselective treatment (13%) than after superselective (6%) treatment. CONCLUSION: Superselective continuous arterial infusion chemotherapy may be suitable for local control of oral cavity tumors, with a low rate of recurrence.     

经支气管动脉化学栓塞术治疗中心型肺癌的疗效分析

目的：探讨经支气管动脉化学栓塞治疗中心型肺癌的近期疗效。方法：对25例病理确诊的原发性中心型肺癌进行选择性支气管动脉插管造影，并将3F同轴微导管置于肿瘤的供血动脉内注入适当剂量的碘化油＋顺铂乳剂。结果：经支气管动脉化学栓塞治疗后，临床症状改善率为100％，且无严重并发症发生，1年生存率为72％（18／25）。结论：经支气管动脉化学栓塞术治疗中心型肺癌具有较好的临床疗效。     

胆管癌性阻塞内支架术后再狭窄的介入治疗

目的　探讨胆管癌性阻塞内支架术后再狭窄的介入治疗方法及其疗效。方法　 12例胆管癌性阻塞性黄疸内支架术后胆管再狭窄患者 ,采用经皮经肝穿刺胆道引流术 (PTCD)加金属内支架置入术或结合局部持续性灌注化疗术及化疗性栓塞术 ,共使用 12枚金属内支架。结果　 12例采用经皮经肝穿刺置入金属胆道内支架均获得成功 ,均一次性置入支架。术后总胆红素、丙氨酸转氨酶、谷酰转肽酶、碱性磷酸酶均有明显下降。术后 12例患者黄疸消退满意。 3例黄疸消退 ,置入内支架术后 4周在DSA下行局部持续性灌注化疗术及化疗性栓塞术。结论　经皮胆管内金属支架再置入术是姑息性治疗胆管癌性阻塞性黄疸内支架术后胆管再狭窄的安全、有效方法 ,结合局部持续性动脉灌注化疗及化疗性栓塞术 ,能提高患者的生命质量及延长生存期