集束射频治疗肝癌36例疗效分析

了解集束射频治疗（RF）肝癌的近期疗效。检查36例原发性肝癌（PHC）患者接受RF治疗前后肿瘤大小、AFP值、肿瘤血供以及超声情况。超声检查提示，36例PHC中有26例治疗一周后肿块缩小30%以上。一个月缩小40%以上。所有病例肿块内的血供消失。治疗一个月后AFP值下降400mg/L以下者A组占66.5%，B组占59.8%。RF治疗中晚期PHC的近期疗效较其他治疗好。     

CT引导经皮肝穿射频治疗肝癌

研究集束电极射频 (radiofrequency ,RF)治疗肝癌的方法及疗效。在CT引导下将中空金属钛多极穿刺针经皮直接穿刺置入瘤体 ,分点一次或多次对瘤体进行射频治疗 ,术中直视肿瘤射频治疗后的图像及CT值 ,术后观察患者的瘤体血供情况、肿瘤大小及AFP值的变化。瘤体直径 <5cm的肝癌 ,术后 1- 5个月大部分瘤体血供消失 ,瘤体缩小 ,瘤体直径 >5cm的肝癌 ,配合介入栓塞治疗 ,多数瘤体缩小。CT引导多弹头射频治疗肝癌定位准确 ,近期疗效安全有效     

120例原发性肝癌的肝动脉化疗栓塞术疗效观察

目的 观察中晚期原发性肝癌经导管肝动脉化疗栓塞术(TACE)治疗的疗效。方法自1990-2003年共有120例中晚期肝癌患者，接受TACE介入治疗，评估和随访治疗前后的疗效。结果经过治疗，79．2％(95／120)的患者临床症状缓解；88．3％(55／120)肿块缩小；78．2％(79／101)AFP明显下降；生存期延长，1、2、3年生存率分别为80．8％(87／120)、48．3％(58／120)和1130％(36／120)。结论TACE治疗是中晚期肝癌的有效手段，使不能手术切除的肝癌成为适应手术治疗，延长了患者的生命，提高了生活质量。     

肝动脉栓塞化疗联合无水乙醇局部注射治疗中晚期肝癌

目的探讨肝动脉栓塞化疗（TACE）联合超声引导下无水乙醇注射（PEI）治疗中晚期原发性肝癌的临床价值。方法47例中晚期肝癌患者,随机分为两组。TACE组22例,单纯行TACE治疗,TACE联合PEI组25例,行TACE联合PEI治疗。结果TACE联合PEI组血清AFP转阴率、肿瘤缩小率及0．5、1、1．5、2a生存率分别为80．00％、80．00％、100．00％、88．00％、76．00％、56．00％,明显高于TACE组的47．05％、50．00％、81．82％、63．64％、54．55％、27．27％（P均〈0．05）。结论TACE联合PEI治疗中晚期肝癌疗效明显并延长患者生存期。     

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。     

肝动脉栓塞化疗治疗原发性肝癌

目的采用肝动脉栓塞化疗治疗原发性肝癌的疗效.方法住院原发性肝癌28例,男25例,女3例,年龄34岁～72岁,平均56岁,全部患者行AFP,CT,B超检查.肿瘤直径<5cm5例,6cm～10cm16例,11cm～15cm5例,>15cm2例.其中单发结节8例,多发结节16例,弥漫型4例,所有患者在治疗前分别测血分析、AFP、肝功能(TBIL,DBIL,ALT,γ-GT),并做CT和B超.治疗后1wk,2wk,3wk,4wk复查血分析、肝功能和B超,每3mo复查CT栓塞化疗时先行肝动脉造影了解肿瘤的大小、位置、类型及血供情况,根据肿块的大小取40%国产碘油(肿瘤直径1cm用碘化油1mL)+等量的76%泛影葡胺+丝裂霉素12mg充分乳化,在透视下缓慢注1/3量末梢栓塞,接着注入阿霉素30mg,顺铂30mg,后将剩余的2/3量乳化剂电视透视下缓慢推注,当乳化剂在肿瘤内填充满意后停止推注,最后用造影剂行中央性栓塞,等患者一般情况良好,可行再次栓塞.结果栓塞后1wk内,大多数患者有纳差、肝区痛、发热,约1wk内消失.术后肝脏CT随访显示瘤体缩小20例,占71.43%,其中缩小50%以上占8例,均为单结节型,AFP在治疗后有不同程度下降,其中9例转为正常,肝功能随访6mo以上20例,较治疗前总蛋白、清蛋白稍有改善,而ALP较治疗前有明显改善(P<0.01)结论肝动脉栓塞化疗是当前无法切除中晚期肝癌的首选疗法、可明显延长患者3a生存率.     

高强度聚焦超声治疗原发性肝癌的初步临床观察

探讨应用高强度聚焦超声（HIFU）治疗肝癌的临床疗效。将本组23例肝癌患者应用JC型高强度聚焦超声肿瘤治疗系统进行治疗。23例患者经HIFU治疗后，应用功能影像学及肿瘤标志物评价，肿瘤靶区血供消失。检查AFP下降或转为正常。应用高强度聚焦超声治疗肝癌是一种有效，安全，无创的非侵入性治疗方法。     

原发性肝癌

微导管在原发性肝癌介入治疗中的应用价值——黎军强等（广西贵港市人民医院放射科537100）；《放射学实践》，2006，21（6）：611-613[目的：探讨微导管在原发性肝癌化疗性栓塞中的应用价值。方法：应用微导管对29例原发性肝癌患者行供血动脉超选择化疗栓塞术。结果：本组29例共行化疗性栓塞41次，术后血清AFP下降大干50％者24例（82．8％），肿瘤缩小〉50％者6例（20．7％），肿瘤缩小在25％-50％者16例（55．2％），其余患者肿瘤体积无明显变化。术后肝功能损害轻微，无严重并发症。结论：微导管超选择插管治疗肝癌操作简单、方便，超选择成功率高，疗效好，术后并发症少，具有十分重要的临床应用价值。]     

放射性125I密封籽源瘤内植入治疗老年原发性肝癌近期临床疗效观察

目的 评价放射性粒子治疗老年原发性肝癌的近期临床疗效与安全性.方法 回顾性分析接受放射性粒子植入的老年原发性肝癌患者93例,观察治疗前后肿瘤的影像学变化情况,甲胎蛋白(AFP)水平及不良反应情况.结果 治疗后肿瘤的体积较治疗前缩小,6m后总体有效率为83.0％ (88/106).AFP水平降低,治疗后2m、4m、6mAFP与治疗前相比,差异有统计学意义.有1例出现穿刺后腹腔内出血,保守治疗后好转,出现1级急性放射性损伤共3例.结论 放射性粒子植入治疗老年原发性肝癌近期临床疗效好,并发症少,是治疗原发性肝癌的有效手段之一.     

原发性肝癌肿瘤标记物研究进展

原发性肝癌（PHC）的发病率和病死率均居于我国恶性肿瘤的前三位。上海复旦大学肝癌研究所对高危人群每6个月监测AFP和腹部超声，发现肝癌筛查能降低肝癌病死率的37％。但国内外研究表明，近1／3的PHC患者甲胎蛋白（AFP）阴性。因此，寻找肝癌特异性早期诊断方法，是目前临床亟待解决的难题。现就目前临床上应用的和新发现的PHC肿瘤标记物综述如下。     

Glycylproline dipeptidyl aminopeptidase isoenzyme in diagnosis of primary hepatocellular carcinoma

AIM: To investigate the role of glycylproline dipeptidyl aminopeptidase (GPDA) isoenzyme in the diagnosis of primary hepatocellular carcinoma (PHC), especially in patients with negative alpha-fetoprotein (AFP). METHODS: A stage gradient polyacrylamide gel discontinuous electrophoresis system was developed to separate serum GPDA isoenzymes, which were determined in 102 patients with PHC, 45 cases with liver cirrhosis, 24 cases with chronic hepatitis, 35 cases with benign liver space-occupying lesions, 20 cases with metastatic liver cancer and 50 cases with extra-hepatic cancer, as well as 80 healthy subjects. The relationships between GPDA isoenzymes and AFP, the sizes of tumors, as well as alanine aminotransferase (ALT) were also analyzed. RESULTS: Serum GPDA was separated into two isoenzymes, GPDA-S and GPDA-F. The former was positive in all subjects, while the latter was found mainly in majority of PHC (85.3 %) and a few cases with liver cirrhosis (11.1 %), chronic hepatitis (33.3 %), metastatic liver cancer (15.0 %) and non-hepatic cancer (16.0 %). GPDA-F was negative in all healthy subjects and patients with benign liver space-occupying lesions, including abscess, cysts and angioma. There was no correlation between GPDA-F and AFP concentration or tumor size. GPDA-F was consistently positive and not correlated with ALT in PHC, but GPDA-F often converted to negative as decline of ALT in benign liver diseases. The electrophoretic migration of GPDA-F became sluggish after the treatment of neuraminidase. CONCLUSION: GPDA-F is a new useful serum marker for PHC. Measurement of serum GPDA-F is helpful in diagnosis of PHC, especially in patients with negative AFP. GPDA-F is one kind of glycoproteins rich in sialic acid.     

Analysis of clinical effect of high-intensity focused ultrasound on liver cancer

AIM:To evaluate the clinical effect of high-intensity focusedultrasound(HIFU)in the treatment of patients with livercancer.METHODS:HIFU treatment was performed in 100 patientswith liver cancer under general anesthesia and by atargeted ultrasound.Evaluation of efficacy was made onthe basis of clinical symptoms,liver function tests,AFP,MRI or CT before and after the treatment.RESULTS:After HIFU treatment,clinical symptoms wererelieved in 86.6%(71/82)of patients.The ascitesdisappeared in 6 patients.ALT(95±44)U/L and AST(114±58)U/L before HIFU treatment were reduced tonormal in 83.3%(30/36)and 72.9%(35/48)patients,respectively,after the treatment.AFP was lowered by morethan 50% in 65.3%(32/49)patients.After HIFU treatment,MRI or CT findings indicated coagulation necrosis and bloodsupply reduction or disappearance of tumor in the target region.CONCLUSION:HIFU can efficiently treat the patients withliver cancer.It will offer a significant noninvasive therapyfor local treatment of liver tumor.     

Analysis of clinical effect of high-intensity focused ultrasound on liver cancer

AIM: To evaluate the clinical effect of high-intensity focused ultrasound (HIFU) in the treatment of patients with liver cancer. METHODS: HIFU treatment was performed in 100 patients with liver cancer under general anesthesia and by a targeted ultrasound. Evaluation of efficacy was made on the basis of clinical symptoms, liver function tests, AFP, MRI or CT before and after the treatment. RESULTS: After HIFU treatment, clinical symptoms were relieved in 86.6%(71/82) of patients. The ascites disappeared in 6 patients. ALT (95+/-44) U/L and AST (114+/-58) U/L before HIFU treatment were reduced to normal in 83.3%(30/36) and 72.9%(35/48) patients, respectively, after the treatment. AFP was lowered by more than 50% in 65.3%(32/49) patients. After HIFU treatment, MRI or CT findings indicated coagulation necrosis and blood supply reduction or disappearance of tumor in the target region. CONCLUSION: HIFU can efficiently treat the patients with liver cancer. It will offer a significant noninvasive therapy for local treatment of liver tumor.     

高强度聚焦超声治疗肝细胞癌的疗效及其影响因素

目的:观察原发性肝癌(HCC)经高强度聚焦超声(HIFU)治疗后临床效果并探讨其影响因素.方法:通过对2001-04/2002-12经HIFU治疗的104例原发性肝癌患者肿瘤大小,数目,是否转移,HIFU前后AFP,HIFU前肝功能,ChildPugh分级和TNM分期及彩色多普勒超声检查等指标观察HIFU治疗效果.结果:104例原发性肝细胞癌治疗后HCC患者临床症状缓解率为83.2%(80/104),肝功能好转者占82.7%(86/104),AFP降低超过原数值50%者占62.5%(65/104),彩色多普勒超声检查癌灶灰阶明显增加或减弱,癌灶内血液供应减少或消失.HIFU治疗后生存期3-6mo占59.5%,12mo占38.7%,24mo占25.6%.HIFU治疗效果与治疗前AFP,TNM分期,治疗前是否联合TACE治疗,治疗前是否有转移等因素有关.结论:HIFU治疗HCC是有效和可行的,其疗效与治疗前AFP,TNM分期,治疗前是否联合TACE治疗,治疗前是否有转移等因素有关.     

甲胎蛋白在原发性肝癌首诊中的价值

目的探讨甲胎蛋白（AFP）在原发性肝癌首诊中的诊断价值。方法回顾性分析177例临床资料相对完善的最终确诊为原发性肝癌（PHC）患者首诊时的AFP及影像学结果,以2011年收治的98例慢性乙型肝炎、82例乙型肝炎肝硬化患者为对照组。计数资料采用χ2检验。结果177例PHC患者首诊时AFP≥400 ng／ml 93例,20 ng／ml ＜AFP＜400 ng／ml 38例,正常46例,分别占5254%、21.47%、25.99%,异常率占74.01%,显著高于慢性乙型肝炎组（χ2=106.07,P＜0.001）和乙型肝炎肝硬化组（χ2=67.82,P＜0.001）;177例患者中63例病程中AFP＜400 ng／ml,占35.59%;肿瘤直径≤3 cm患者的AFP水平低于直径＞5 cm患者（χ2=862,P＜0.005）;首诊时AFP确诊率低于B超 （χ2=30.39,P＜0.000）和CT （χ2=84.83,P＜0.000）。结论PHC患者首诊时AFP异常率较高,且AFP水平越高,其诊断价值越大,AFP水平与肿瘤大小有一定关系;也要警惕AFP阴性的PHC;动态监测AFP并结合影像学检查有利于早期诊断,以减少漏诊误诊。     

磷脂酰肌醇蛋白聚糖-3和甲胎蛋白联合检测对原发性肝癌的诊断价值

目的通过联合检测磷脂酰肌醇蛋白聚糖-3（GPC3）、甲胎蛋白（AFP）在原发性肝癌患者血清及组织中的表达情况,探讨对原发性肝癌的诊断价值。方法分别采用ELISA和免疫组织化学法检测57例肝癌、74例肝炎后肝硬化患者和47例正常血清和肝组织GPC3、AFP表达水平,根据不同临床病理指标进行分组比较。结果 （1）肝癌患者、肝炎后肝硬化及正常对照者血清中GPC3水平分别为（212.6±137.5）、（60.9±27.8）、（39.5±18.7）ng/ml;肝癌患者血清GPC3浓度显著高于正常及肝炎后肝硬化患者（t=4.503,P〈0.05;t=6.045,P〈0.05）;血清GPC3、AFP联合检测原发性肝癌的敏感性和特异性为84.2%和95.7%,均显著高于任一单项检测（t=4.132,P〈0.05;t=6.514,P〈0.05）;（2）GPC3在肝癌组织表达高于癌旁和正常肝组织（t=3.724,P〈0.05;t=15.799,P〈0.05）;GPC3与肿瘤大小、肿瘤数目、HBsAg及AFP水平无明显相关,而与病理分级和临床分期有关;（3）AFP阳性肝癌血清GPC3阳性率为91.4%,而在AFP阴性肝癌中GPC3阳性率为59.1%。结论 GPC3联合AFP检测有助于提高原发性肝癌的确诊率,检测GPC3有助于提高AFP阴性患者肝癌的确诊率。     

Mass screening of primary hepatocellular carcinoma by alpha-fetoprotein in a rural area of Taiwan--a dried blood spot method

A prospective survey of primary hepatocellular carcinoma (PHC) was conducted in a rural area of Taiwan using a two-site enzyme immunoassay for alpha-fetoprotein (AFP) in dried blood samples collected on filter paper. Of 1894 men over 40 years of age who were tested, 20 (1%) had AFP levels of greater than 20 ng/ml of blood on screening. Nineteen of these men received ultrasound examinations, and small PHCs were detected in 4 (21%). The remaining 15 cases had other types of hepatobiliary tract diseases, and 6 (40%) were also serum HBsAg positive. They should all be closely followed up by AFP determination and ultrasound examination of the liver. In contrast to the low resection rate of PHC in symptomatic patients who were admitted through the outpatient clinic during the period of this survey, the four cases with small PHC discovered by AFP screening had their tumors successfully removed (5/57 vs. 4/4, p less than 0.005). Our preliminary results showed that this method is a simple, sensitive and convenient assay for AFP and may be used as a first-line screening test in mass population surveillance programs for PHC, particularly in areas where PHC is highly prevalent.     

Mass screening of primary hepatocellular carcinoma by alpha-fetoprotein in a rural area of Taiwan – a dried blood spot method

ABSTRACT— A prospective survey of primary hepatocellular carcinoma (PHC) was conducted in a rural area of Taiwan using a two-site enzyme immunoassay for alphafetoprotein (AFP) in dried blood samples collected on filter paper. Of 1894 men over 40 years of age who were tested, 20 (1%) had AFP levels of greater than 20 ng/ml of blood on screening. Nineteen of these men received ultrasound examinations, and small PHCs were detected in 4 (21%). The remaining 15 cases had other types of hepatobiliary tract diseases, and 6 (40%) were also serum HBsAg positive. They should all be closely followed up by AFP determination and ultrasound examination of the liver. In contrast to the low resection rate of PHC in symptomatic patients who were admitted through the outpatient clinic during the period of this survey, the four cases with small PHC discovered by AFP screening had their tumors successfully removed (5/57 vs. 4/4, p<0.005). Our preliminary results showed that this method is a simple, sensitive and convenient assay for AFP and may be used as a first-line screening test in mass population surveillance programs for PHC, particularly in areas where PHC is highly prevalent.     

超声导引下经皮微波消融治疗邻近危险区域肝癌临床观察

目的探讨经皮微波消融（PMCT）治疗邻近胃肠、胆囊、膈肌、心脏、肾脏等危险区域（即肿瘤距上述脏器最短距离≤0.5 cm）肝癌的有效性和安全性,寻找合适的治疗条件,从而实现对肝脏肿瘤完全凝固坏死而邻近重要器官无明显热损伤。方法选择邻近胃肠（4例）、胆囊（10例）、膈肌（24例）、心脏（4例）、肾脏（3例）等危险区域肝癌患者45例均行PMCT治疗。术前术后均行B超,增强CT扫描,检测甲胎蛋白（AFP）,判断疗效。同时常规查肝肾功能。观察不良反应及并发症的发生率,血清AFP变化,肿瘤缓解率。结果⑴PMCT后8周增强CT提示肿瘤完全坏死38例,坏死率84.44%;4周复查AFP,35例AFP术前阳性患者中23例转为阴性（65.71%）,与文献报道非危险区域肝癌微波消融治疗的疗效无差异。⑵1例邻近膈顶肝癌患者PMCT治疗后出现血胸,经止血对症治疗7 d后出血吸收出院;1例出现针尖断开滞留于消融中心区域,无症状,随访一年针尖位置无变化。其余患者均未出现与操作相关并发症。结论采取适当措施下对于邻近危险区域肝癌进行PMCT治疗,其疗效与非危险区域PMCT疗效接近,同时可以避免出现与操作相关的并发症。