聚合白蛋白和~(32)P胶体治疗肝癌的临床观察和护理

30例肝癌患者接受B超引导下瘤内注射MAA和~(32)P胶体治疗,观察治疗前后患者的临床表现、肿块大小、血清AFP水平以及肝肾功能、血常规和免疫指标的变化,总结护理经验。治疗后患者临床症状减轻,血清AFP水平明显下降;肿块均见缩小。1、2、3年生存率分别为90％、76.67％、43.33％,平均生存期19.5个月。局部无并发症,治疗前后ECG、肝肾功能、血常规和免疫功能均无变化。认为MAA和~(32)P胶体瘤体内照射治疗肝癌是一种简单、安全和有效的新方法,副作用小,适应症广,细心护理有助于减少并发症的发生。     

聚合白蛋白和~(32)P胶体治疗肝癌的临床观察和护理

30例肝癌患者接受B超引导下瘤内注射MAA和~(32)P胶体治疗,观察治疗前后患者的临床表现、肿块大小、血清AFP水平以及肝肾功能、血常规和免疫指标的变化,总结护理经验。治疗后患者临床症状减轻,血清AFP水平明显下降;肿块均见缩小。1、2、3年生存率分别为90％、76.67％、43.33％,平均生存期19.5个月。局部无并发症,治疗前后ECG、肝肾功能、血常规和免疫功能均无变化。认为MAA和~(32)P胶体瘤体内照射治疗肝癌是一种简单、安全和有效的新方法,副作用小,适应症广,细心护理有助于减少并发症的发生。     

聚合白蛋白和~(32)P胶体治疗肝癌的临床观察和护理

30例肝癌患者接受B超引导下瘤内注射MAA和~(32)P胶体治疗,观察治疗前后患者的临床表现、肿块大小、血清AFP水平以及肝肾功能、血常规和免疫指标的变化,总结护理经验。治疗后患者临床症状减轻,血清AFP水平明显下降;肿块均见缩小。1、2、3年生存率分别为90％、76.67％、43.33％,平均生存期19.5个月。局部无并发症,治疗前后ECG、肝肾功能、血常规和免疫功能均无变化。认为MAA和~(32)P胶体瘤体内照射治疗肝癌是一种简单、安全和有效的新方法,副作用小,适应症广,细心护理有助于减少并发症的发生。     

聚合白蛋白和32P胶体局部放射治疗肝癌30例分析

目的 探讨局部注射32P胶体和聚合白蛋白(MAA)治疗中晚期肝癌的可行性。方法 超声引导下瘤内注射MAA和32P胶体治疗中晚期肝癌30例，并观察其疗效和毒副作用。结果 治疗后所有患者临床症状均减轻，AFP水平明显下降；平均肿块缩小率为53．25％，组织学检查显示治疗区内肿瘤组织完全或部分坏死、纤维化。6个月、1年、2年和3年生存率分别为100％、90％、76．67％和43．33％，平均生存期19．5个月。治疗前后肝肾功能、血常规和免疫功能均无明显变化，局部无并发症发生。结论 对于晚期肝癌患者，局部注射放射性核素32P胶体和聚合白蛋白是一种简单、安全和有效的新方法，副作用低、适应证广。     

聚合白蛋白和胶体^32P瘤内注射治疗肝癌的动物实验与临床应用

目的研究单纯注射胶体32P和先注入聚合白蛋白(MAA),再注射胶体32P两种不同给药方法的32P体内分布情况,探讨瘤内注射MAA和胶体32P治疗肝癌的疗效与副作用.方法在Balb/c小鼠右侧胸前皮下接种H22肝癌细胞,10d后长出直径约1cm的肿瘤,将其随机分为2组,第1组只注射胶体32P1.85MBq;第2组先注入1×105颗粒MAA,再注入胶体32P1.85MBq,注射后30min、24h、48h、8d和16d分别测定肿瘤组织、外周血液和心、肝、脾、肾、骨髓的放射性;第16天和1个月时对肿瘤组织作病理切片,观察治疗效果.临床上B超引导下将MAA和胶体32P依次瘤内注射治疗肝癌30例,观察治疗前后临床症状、肿块大小、AFP水平、心肝肾功能、外周血象和免疫指标.结果胶体32P内照射可使肿瘤组织坏死、纤维化.预先注射MAA,MAA可以有效阻止32P的全身扩散,使胶体32P长时间滞留在肿瘤内.临床应用发现该方法可使肿块缩小,平均缩小率53.25%,血清AFP水平下降,临床症状改善,1、2、3年生存率分别为90%、76.67%、43.33%,无心、肝、肾损害和骨髓抑制等副作用.结论瘤内注射MAA和胶体32P是一种简单、安全、有效的治疗肝癌的新方法.     

聚合白蛋白和胶体~(32)P瘤内注射治疗肝癌的动物实验与临床应用

目的 研究单纯注射胶体32P和先注入聚合白蛋白（MAA）,再注射胶体32P两种不同给药方法的32P体内分布情况,探讨瘤内注射MAA和胶体32P治疗肝癌的疗效与副作用。 方法 在Bal b/c 小鼠右侧胸前皮下接种H22肝癌细胞,10d后长出直径约1cm的肿瘤,将其随机分为2组,第1组只注射胶体32P 1.85MBq;第2组先注入1×105颗粒MAA,再注入胶体32P 1.85MBq,注射后30min、24h、48h、8d和16d分别测定肿瘤组织、外周血液和心、肝、脾、肾、骨髓的放射性;第16天和1个月时对肿瘤组织作病理切片,观察治疗效果。临床上B超引导下将MAA和胶体32P依次瘤内注射治疗肝癌30例,观察治疗前后临床症状、肿块大小、AFP水平、心肝肾功能、外周血象和免疫指标。 结果 胶体32P内照射可使肿瘤组织坏死、纤维化。预先注射MAA,MAA可以有效阻止32P的全身扩散,使胶体32P长时间滞留在肿瘤内。临床应用发现该方法可使肿块缩小,平均缩小率53.25%,血清AFP水平下降,临床症状改善,1、2、3年生存率分别为90%、76.67%、43.33%,无心、肝、肾损害和骨髓抑制等副作用。 结论 瘤内注射MAA和胶体32P是一种简单、安全、有效的治疗肝癌的新方法。     

超声引导经皮穿刺电化学治疗肝癌26例疗效观察

目的　探讨电化学治疗肝癌的疗效和副作用。方法　 2 6例肝癌患者接受B超引导下电化学治疗 ,观察治疗前后患者的临床表现、肿物大小、甲胎球蛋白 (AFP)水平、组织病理学、免疫指标以及肝肾功能和血常规的变化。结果　治疗后临床症状减轻 ,AFP水平下降 ,细胞免疫功能增强。组织学示治疗区肿瘤组织完全或部分坏死、纤维化。完全缓解 (CR) 2例 ,部分缓解 (PR) 13例 ,好转 (MR) 2例 ,稳定 (SD) 7例 ,进展 (PD) 2例 ,总有效率为 5 7 7%。5例治疗后行二期手术。 6个月、1、2年生存率分别为 92 36 %、88 5 %、4 6 15 %。中位生存期 14个月。无局部并发症 ,治疗前后肝肾功能和血常规无变化。结论　电化学治疗肝癌是一种简单、安全和有效的新方法 ,副作用少 ,适应证广     

聚合白蛋白和胶体~(32)P肝癌内注射时~(32)P在瘤外组织的动态分布

目的　研究瘤内单纯注射32 P胶体和先注射聚合白蛋白 (MAA) ,再注射32 P胶体两种不同给药方法的32 P在瘤外各组织器官的动态分布 ,探讨不同剂量MAA的阻滞效果及MAA颗粒数量和32 P胶体应用剂量的相关关系。方法　在Balb/c小鼠右侧胸前皮下接种H2 2 肝癌细胞 ,10天后接种部位长出直径约 1cm的肿瘤。随机将其分为 4组 :第 1组只注射32 P胶体 1 85MBq ;第 2组先注射 1× 10 4颗粒MAA ,再注射32 P胶体 1 85MBq ;第 3组先注射 1× 10 5颗粒MAA ,再注射32 P胶体 1 85MBq ;第 4组先注射 1× 10 5颗粒MAA ,再注射32 P胶体 18 5MBq。注射后 2 4小时、第 8天和第 16天时处死小鼠 ,测定心、肝、肾、肺和骨骼的放射性。结果　瘤内注射32 P胶体时 ,32 P可向全身其他器官扩散 ;当向肿瘤内注射的32 P胶体剂量相同时 ,预先注入 1× 10 4颗粒MAA和 1× 10 5颗粒的两组小鼠 ,其体内32 P的分布均比未注射MAA的一组小鼠要少 ,其中 1× 10 5颗粒MAA组的小鼠 ,32 P体内分布又比 1× 10 4颗粒MAA组少 ;当预先注入的MAA颗粒数量相同时 ,注射的32 P胶体剂量增加 ,体内分布亦随之增加。结论　与单纯瘤内注射32 P胶体相比 ,先在瘤内注入MAA ,再注入32 P胶体 ,MAA可以有效阻止32 P胶体的全身扩散 ,使32 P胶体能够较长时间的滞留在肿瘤     

超声引导下射频消融治疗原发性肝癌176例临床分析

目的探讨超声引导下经皮冷循环射频消融（RFA）治疗原发性肝癌的疗效及安全性。方法对176例原发性肝癌患者的202个肿瘤结节行RFA治疗,观察术后疗效及并发症发生情况。结果术后瘤体完全消融率为93％,术前血清AFP水平升高者术后12个月显著降低（P〈0．05）,1、3、5a生存率分别为84．7％、56．9％和43．1％;138例患者出现转氨酶升高、发热等并发症,对症处理后好转。结论RFA治疗原发性肝癌可显著延长患者无瘤存活时间,且具有创伤小、并发症少等优点,但应注意选择适应证。     

聚合蛋白和胶体^32P肝癌内注射时^32P在瘤外组织的动态分布

]目的研究瘤内单纯注射32p胶体和先注射聚合白蛋白(MAA),再注射32p胶体两种不同给药方法的32p在瘤外各组织器官的动态分布,探讨不同剂量MAA的阻滞效果及MAA颗粒数量和32p胶体应用剂量的相关关系.方法在Balb/c小鼠右侧胸前皮下接种H22肝癌细胞,10天后接种部位长出直径约1cm的肿瘤.随机将其分为4组第1组只注射32p胶体1.85MBq;第2组先注射1×104颗粒MAA,再注射32p胶体1.85MBq;第3组先注射1×105颗粒MAA,再注射32p胶体1.85MBq;第4组先注射1×105颗粒MAA,再注射32p胶体18.5MBq.注射后24小时、第8天和第16天时处死小鼠,测定心、肝、肾、肺和骨骼的放射性.结果瘤内注射32p胶体时,32P可向全身其他器官扩散;当向肿瘤内注射的32p胶体剂量相同时,预先注入1×104颗粒MAA和1×105颗粒的两组小鼠,其体内32p的分布均比未注射MAA的一组小鼠要少,其中1×105颗粒MAA组的小鼠,32p体内分布又比1×104颗粒MAA组少;当预先注入的MAA颗粒数量相同时,注射的32p胶体剂量增加,体内分布亦随之增加.结论与单纯瘤内注射32p胶体相比,先在瘤内注入MAA,再注入32p胶体,MAA可以有效阻止32p胶体的全身扩散,使32p胶体能够较长时间的滞留在肿瘤内,从而减少了全身分布.     

Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma

This randomized, controlled trial assessed the efficacy of transarterial Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-Sous-Bois, France) chemoembolization in patients with unresectable hepatocellular carcinoma. From March 1996 to October 1997, 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and randomly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery (chemoembolization group, 40 patients) or symptomatic treatment (control group, 40 patients). One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis. Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease. Survival was the main end point. The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 (range, 1-15) courses per patient. Chemoembolization resulted in a marked tumor response, and the actuarial survival was significantly better in the chemoembolization group (1 year, 57%; 2 years, 31%; 3 years, 26%) than in the control group (1 year, 32%; 2 years, 11%; 3 years, 3%; P =.002). When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model, the survival benefit of chemoembolization remained significant (relative risk of death, 0.49; 95% CI, 0.29-0.81; P =.006). Although death from liver failure was more frequent in patients who received chemoembolization, the liver functions of the survivors were not significantly different. In conclusion, in Asian patients with unresectable hepatocellular carcinoma, transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment.     

经颈静脉肝内门腔静脉分流术治疗肝癌合并门静脉高压的临床研究

目的 探讨经颈静脉肝内门腔静脉分流术(TIPS)治疗肝癌合并门静脉高压的有效性、安全性和临床价值.方法 收集肝癌合并门静脉高压患者95例,其中63例行TIPS治疗(TIPS组),观察术后情况并随访生存期资料,其余32例(对照组)行内科支持治疗,随访生存期资料.评估TIPS组术后情况、术后肝性脑病、再出血、死亡原因等.行Kaplan-Meier生存分析比较两组中位生存时间,分析Child-Pugh分级及终末期肝病评估模式(MELD)评分与术后生存时间的关系.结果 TIPS组术后门静脉压力梯度平均降低13.6 cmH2O(1 cmH2O-0.098 kPa),术后6个月肝性脑病和再出血的累积发生率分别为20.6%和26.3%,截至随访结束死亡56例,其中最终死于门静脉高压破裂出血者12例.TIPS组中位生存期较对照组延长.TIPS组中MELD评分≤13分者中位生存时间大于评分>13分者(x2=4.71,P=0.03),Child-Pugh分级A到C级中位生存时间依次缩短(x2=15.6,P=0.00).结论 TIPS是治疗肝癌合并门静脉高压及其并发症安全有效的方法 ,应根据术前肝功能状况选择手术患者.     

Accompanying liver cirrhosis as a risk factor for recurrence after resection of solitary hepatocellular carcinoma

BACKGROUND/AIMS: A high recurrence rate after hepatic resection adversely influences the postoperative prognosis of patients with hepatocellular carcinoma. In the present study, long-term results and prognostic factors were evaluated in patients who underwent hepatic resection for solitary hepatocellular carcinoma. METHODOLOGY: The records of 105 patients who underwent hepatic resection for hepatocellular carcinoma between June 1978 and April 2000 were retrospectively reviewed. In 61 patients with solitary hepatocellular carcinoma who survived the curative operation, the prognostic significance of 11 clinicopathological parameters was investigated by univariate and multivariate analyses. RESULTS: After curative resection, the cumulative survival rate at 5 years in these 61 patients with solitary hepatocellular carcinoma was significantly better than in 25 patients with multiple hepatocellular carcinomas (44% vs. 25%, p = 0.01). However, even in the solitary group, the cumulative recurrence-free survival rate at 5 years was only 32%; and in 27 (75%) of 36 patients, in whom recurrence was confirmed within 5 years, hepatocellular carcinoma recurred within 2 years. Multivariate analysis disclosed that only accompanying liver cirrhosis was a variable having prognostic significance for overall and recurrence-free survival. A study of other clinicopathological factors, including tumor size, failed to demonstrate any prognostic value. CONCLUSIONS: The present result suggests that hepatic resection can be indicated in patients with solitary hepatocellular carcinoma, irrespective of its size. Though the postoperative recurrence associated with the underlying cirrhosis is still frequent, long-term survival can be expected if the recurrent tumors are successfully treated by a strategy using multiple modalities.     

Long-term prognosis after arterio-portal embolization for hepatocellular carcinoma

BACKGROUND/AIMS: Resection is the treatment of choice for hepatocellular carcinoma. However, relatively few patients with hepatocellular carcinoma are surgical candidates. The efficacy of a radiologic hepatectomy, achieved by combined embolization of the arterial and portal tumor blood supply, was determined and compared to surgical hepatectomy in a retrospective analysis. METHODOLOGY: The records of 32 patients treated for hepatocellular carcinoma between 1989 and 1992 were reviewed. The outcome in 15 patients treated with combined selective segmental portal vein embolization and hepatic artery embolization without hepatectomy (Embolization group) was compared with the outcome in 17 patients who under went curative hepatic resection (Resection group). The recurrence-free and cumulative survival rates were compared in the two groups. RESULTS: Except for a greater number of men in the Resection Group (p=0.03), the demographics and clinical characteristics of the two groups were similar at baseline. There was no patient who died within 30 days of treatment. The recurrence-free survival rates after embolization and resection were 20.8 and 23.4% at 5 years, respectively. The corresponding cumulative survival rates were 23.2 and 51.3%. CONCLUSIONS: Combined embolization without hepatectomy may be a viable alternative to curative hepatectomy for selected patients with hepatocellular carcinoma.     

Prophylactic chemolipiodolization for postoperative hepatoma patients

BACKGROUND/AIMS: The efficacy of prophylactic chemolipiodolization following hepatic resection in patients with hepatocellular carcinoma was studied. METHODOLOGY: Forty-four of 67 consecutive patients with hepatocellular carcinoma who underwent hepatectomy between 1980 and 1997 were divided into two groups: group A (n = 21), in which prophylactic chemolipiodolization was performed during postoperative follow-up (2.4 times on average using a 39 mg mean dose of epirubicin or doxorubicin); and group B (n = 23), without prophylactic chemolipiodolization. The clinicopathological background and patient survival were compared retrospectively. RESULTS: There were no differences in the clinicopathological background between the two groups. Multiple intrahepatic recurrence was frequently observed in group B (P < 0.02). The recurrence-free survival rates in group A (54.4% and 31.1% at 3 and 5 years, respectively) were significantly higher than those in group B (15.7% and 7.9%, respectively). The survival rates of group A (95.2% and 80.4% at 3 and 5 years, respectively) were significantly higher than those in group B (40.1% and 22.9%, respectively). CONCLUSIONS: Our data suggest that postoperative prophylactic chemolipiodolization can be an effective treatment in reducing intrahepatic recurrence and may prolong survival for hepatocellular carcinoma patients following hepatic resection.     

Hepatic resection for hepatocellular carcinoma in diameter of > or = 10 cm

BACKGROUND/AIMS: Definitive efficacy of hepatic resection for hepatocellular carcinoma larger than or equal to 10 cm in diameter remains to be resolved. METHODOLOGY: The surgical outcomes in 33 consecutive patients with hepatocellular carcinoma in diameter of > or = 10 cm who underwent hepatic resection were retrospectively clarified. Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model. RESULTS: The overall incidence of postoperative complications was 39%, and 5 patients among them had hospital deaths (15%) including 2 (6%) operative deaths. The 3-year, 5-year, and 9-year overall survival rates after hepatic resection were 32%, 27%, and 17%, respectively. Univariate analysis revealed that liver cirrhosis and stage IV-A (pTNM staging) were significant factors of poor overall survival. By Cox's proportional hazards model, liver cirrhosis was an independently unfavorable prognostic factor of long-term survival. Hospital mortality rate in patients with cirrhosis was 31%. The 5-year overall survival rate in patients with cirrhosis (7%) was significantly shorter than that in patients without cirrhosis (43%) (P = 0.006). In addition, the 5-year overall survival rate in patients with stage IV-A (11%) was significantly shorter than that in patients with stage II and III (48%) (P = 0.024). The incidence of stage IV-A in patients with cirrhosis (77%) was significantly higher than those without cirrhosis (35%) (P = 0.032). CONCLUSIONS: Hepatic resection for hepatocellular carcinoma in diameter of > or = 10 cm was effective for patients without liver cirrhosis and with stage II or III. Appropriate selection of the candidates for partial hepatectomy based on the above prognostic factors may play an important role in the improvement of high mortality rate and poor long-term survival for such patients. Prospective randomized trials are needed to define the role of hepatic resection for cirrhotic patients with large HCC.     

Diagnosis and treatment of cholangiocellular carcinoma of the liver

Of the 239 patients with primary liver cancer treated in our department over the last 13 years, 27 had cholangiocellular carcinoma, and 4 cystic adenocarcinoma of the liver. In this paper, the diagnosis and treatment of cholangiocellular carcinoma was reviewed and discussed. Twenty-four (88.9%) of the 27 patients with cholangiocellular carcinoma underwent surgery and 16 (66.7%) had hepatic resection. There were no operative deaths. None with hilar type cancer survived more than 2 years but in the case of the peripheral type the one-year cumulative survival rate after hepatectomy was 63.6%, the 3- and 5-year rates were both 33.9%. Two cases survived more than 5 years. One was a 69-year-old female who died of tumor recurrence 5 years and 6 months after hepatectomy; the other a 61-year-old female who is still alive and well, without recurrence, 10 years and 5 months after right trisegmentectomy. Although the cholangiocellular carcinoma in our series were in the advanced stages, good results were obtained by hepatic resection with multimodal treatment.     

Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein.

BACKGROUND/AIMS: Hepatocellular carcinoma with tumor thrombus in the main portal vein is generally associated with a poor prognosis. If the liver function tolerated the hepatic resection, we aggressively selected surgical treatment. METHODOLOGY: We performed surgical treatment in 18 of 72 patients with hepatocellular carcinoma with tumor thrombus in the main portal vein. We analyzed the prognostic factors and survival rate of the surgical treatment group. RESULTS: The overall cumulative survival rates following the operation at 1 and 2 years were 48% and 34%, respectively. No patients died within 30 days of the operation. An univariate survival analysis revealed that intrahepatic metastases (P = 0.013), tumor differentiation (P = 0.011) and operative curability (P = 0.0058) had significant effects on survival. For the 6 patients with a complete resection, the cumulative survival rates at 1 and 2 years were 75% and 75%, respectively. In the 3 of 5 patients who died within 90 postoperative days, incomplete removal of the tumor thrombus in the portal vein or hepatic vein caused early recurrence and death. CONCLUSIONS: If the liver function tolerates the hepatic resection, hepatectomy of the main tumor combined with removal of tumor thrombus in the main portal vein is an effective treatment. This is especially true in patients where a long life is made possible by a complete resection of the main tumor, intrahepatic metastases and tumor thrombus. An important feature of this operation is to attempt complete removal of the tumor thrombus so as to prevent early recurrence and death.     

老年人肝癌切除术围手术期肝功能损伤的临床研究

目的 研究老年人原发性肝癌肝切除术围手术期肝功能损伤的原因及防治措施,以提高其临床疗效.方法 回顾性分析原发性肝癌肝切除病例62例,老年组32例,非老年组30例,采用单因素分析和多元逐步回归模型分析围手术期老年组与非老年组、肝门阻断组和非阻断组、出血量多组(≥500 ml)和出血量少组(＜500 ml)肝功能损害的影响因素.结果 老年肝癌切除术后肝功能损伤的发生率为32.6%,肝功能衰竭的病死率为1.6%.单因素分析显示肝门阻断、术中出血、术中输血量及肿瘤大小与术后肝功损伤有关.多元逐步回归模型显示肝门阻断的标准化回归系数0.314,(t=2.272,P＜0.05),肝门阻断是决定术后肝功能损伤的独立因素.结论 老年肝癌肝切除术后肝功能损伤的主要原因是肝门阻断和术中大出血,提高手术技能、缩短肝门阻断时间和减少术中出血是预防老年人肝癌术后肝功能损伤的主要措施.