超声引导经皮无水乙醇和高温蒸馏水注射疗法治疗肝癌

目的探讨PEIT和PHDI治疗HCC的临床应用价值。方法将40例HCC患者随机平均分为两组,两组在病情、病程、分类、年龄、性别、肿瘤大小和数量等方面无明显差异。两组患者分别接受PEIT及PHDI治疗,所有病例于治疗前后定期行彩超检查,同时检测肝功能、AFP、AFPmRNA、体液介质及CD4。结果PEIT组治疗后肿瘤直径缩小有效率高于PHDI组,差异有统计学意义（P〈0．05）;两组治疗前后体液介质、CD4、AFP、AFPmRNA差异均有统计学意义（P〈0．05）,PHDI组AFP降至正常者及AFPmRNA转阴率与PEIT组比较差异有统计学意义（P〈0．05）;PEIT和PHDI治疗后谷丙转氨酶升高分别为75％及5％,局部复发分别为16．67％及7．14％。结论PEIT和PHDI治疗HCC疗效稳定可靠。     

超声造影量化分析评价经非手术联合介入治疗后原发性肝癌的残存血供

目的探讨CEUS量化分析评价肝细胞癌（HCC）非手术联合介入治疗后残存血供的应用价值。方法对30例HCC患者共33个病灶进行TACE及超声引导下无水乙醇消融（PEI）治疗;在低机械指数状态下进行实时CEUS,评价疗效;采用时间-强度量化分析软件检测治疗后残留灶内血流灌注信息。结果 CEUS时间-强度量化分析表明3个病灶治疗彻底,病灶直径均〈3 cm;30个残留灶增强时间和增强强度无明显变化（P〉0.05）,而治疗前后曲线下面积差异有统计学意义（P〈0.05）。随访期间CEUS时间-强度量化分析参数差异无统计学意义（P〉0.05）。结论 CEUS量化分析不仅能够准确显示HCC经TACE/PEI治疗后的坏死范围,且有助于客观评价残留肿瘤的血供。     

超声引导下经皮肝穿刺瘤内无水酒精注射治疗小肝癌

目的探讨超声引导下经皮肝穿刺瘤内无水酒精注射治疗（PEIT）原发性小肝癌的疗效、治疗方法和注意事项。方法回顾分析自2000年以来在我院接受PEIT治疗的600例小肝癌患者的治疗情况,随访并统计分析治疗效果。结果经PEIT治疗后,600例患者的1年、2年、3年生存率分别为98.10%、82.04%和53.00%,与文献报道的手术切除治疗效果相当。结论PEIT治疗小肝癌操作简单,适应证广,疗效好,并发症少。     

三维超声观察5-Fu治疗前后兔乳腺VX2移植瘤的血流和体积改变

目的应用三维超声探讨5-Fu局部治疗前后兔乳腺VX2移植瘤的血流、体积变化。方法16只新西兰大白兔,每侧乳腺均种植一个VX2移植瘤共建立32个乳腺VX2移植瘤模型,分别于肿瘤移植后第2、3、4周经皮注射5-Fu至右侧移植瘤的瘤内及瘤周。应用三维超声监测肿瘤生长情况,于第1次治疗前及治疗后瞬间、第4周治疗结束后分析左右侧肿瘤血供的分级,利用VOCALⅡ功能量化分析肿瘤内部及周边的血供,并测量容积指数（VI）;同时测量肿瘤的体积,并进行自身左右侧对照。4周后处死瘤兔,用免疫组化法检测Bcl-2蛋白的表达,了解肿瘤凋亡情况,评价三维超声相关检测指标的价值。结果治疗前兔两侧乳腺VX2移植瘤的血供及VI值基本一致,治疗后瞬间及第4周治疗结束后右侧（治疗侧）血供及VI值明显减小（P〈0.05）;治疗前左右侧乳腺VX2移植瘤的体积差异无统计学意义,治疗后右侧肿瘤体积增长减慢（P〈0.05）;免疫组化显示：治疗侧乳腺肿瘤组织凋亡明显（P〈0.05）。结论三维超声能够更客观地反映5-Fu治疗前后兔乳腺移植瘤的血流和体积变化,5-Fu局部治疗兔乳腺VX2移植瘤有效。     

超声引导经皮无水乙醇注射治疗肝癌伴发门静脉癌栓

目的评价超声引导经皮无水乙醇注射（PEI）治疗肝细胞癌（HCC）伴发不同类型门静脉癌栓（PVTT）的临床应用价值。方法对90例HCC伴不同类型PVTT患者行超声引导PEI治疗,每周1-2次。治疗结束后随访12-60个月,统计患者1-5年生存率。结果 90例患者治疗后1-5年生存率分别为52.22%、23.33%、15.56%、12.22%、10.00%,中位生存时间为12个月。不同类型PVTT患者生存率不同,分型越低者生存时间越长。结论超声引导PEI治疗HCC伴发PVTT安全、有效,可明显延长分型较低癌栓患者的生存时间。     

高强度聚焦超声治疗晚期胰腺癌对机体免疫功能的影响

目的：探查高强度聚焦超声治疗胰腺癌对机体细胞免疫功能的影响。方法：应用HIFUNIT-9000型治疗仪对65例Ⅲ～Ⅳ期的胰腺癌病人进行治疗；VAS法评估治疗前后病人疼痛程度的改变；超声、CT观察治疗前后肿瘤大小及影像学特征的改变；流式细胞仪检测治疗前后病人外周血T淋巴细胞亚群的变化。17例未行HIFU治疗的中晚期胰腺癌病人作为对照。结果：65例病人治疗后，疼痛减轻52例（80．0％），治疗后评分疼痛下降程度明显大于对照组（P〈0．01）；56例（86．1％）治疗后肿瘤癌组织多普勒B超显示血供减少；CT证实HIFU组治疗前、后肿瘤增长幅度小于对照组（P〈0．05）；外周血γδT细胞及CD4^＋／CD8^＋比例均高于治疗前（P〈0．05）。结论：HIFU治疗晚期胰腺癌不仅安全有效，还可增强机体的抗肿瘤免疫功能。     

CT导引瘤内注射乙酸治疗原发性肝癌46例疗效分析

目的探讨CT导引瘤内注射乙酸治疗原发性肝癌的疗效。方法2001年2月-2006年10月在CT导引下直接瘤内注射乙酸治疗原发性肝癌患者46例（病灶61个）病灶,其中肿瘤直径≤3 cm者14个,3 cm〈直径≤5 cm者36个,直径〉5 cm者11个,多发肿瘤者10例（2-4个）。46例61个肿瘤CT导引PAI治疗145次。随访时间5-48个月,多次复查CT,动态观察肿瘤坏死情况,记录HCC患者的临床资料、存活时间、肝肾功能、AFP值等。结果46例61个肿瘤145次穿刺成功率100%;肿瘤坏死率为71%-100%;直径≤3 cm的小肝癌1、2、3、4年的生存率分别为100%（12/12）、92%（11/12）、83%（10/12）、67%（8/12）（P〈0.05）;3 cm〈直径≤5 cm者1、2、3、4年的生存率分别为89%（24/27）、78%（21/27）、67%（18/27）、44%（12/27）（P〈0.05）;直径〉5 cm者1、2年的生存率分别为29%（2/7）、14%（1/7）（P〈0.05）。主要并发症为局限性腹膜炎、化学性胸膜炎（少量胸腔积液）、气胸,无严重的不良反应和并发症。结论CT引导下经皮穿刺直接瘤体内注射乙酸治疗单结节、无转移的小肝癌是一种疗效可靠、经济实用的微创性治疗技术。     

肝动脉化疗栓塞术后补充经皮无水乙醇注射术治疗原发性肝细胞癌

目的本研究旨在评价肝动脉化疗栓塞术后经皮无水乙醇注射术补充治疗对原发性肝细胞癌（HCC）疾病进程和总生存期的影响。方法全部73例HCC，临床分期均为中国分期Ⅱ期，并接受至少2次肝动脉栓塞化疗。治疗组22例，于肝动脉栓塞化疗（TACE）后补充经皮无水乙醇消融术（PEI），对照组51例TACE后未予补充治疗，比较两组疾病进展时间与生存期差异，并作预后因素分析。结果治疗组与对照组中位疾病进展时间分别为10个月（95％可信区间7．9，12．1）和6个月（95％可信区间4．7，7．3）。治疗组3个月、6个月、1年无进展生存率为77．30％、63．61％、48．12％，对照组3个月、6个月、1年无疾病进展率为76．51％、42．17％、24．82％，两组有显著差别（10g—rank检验，P〈O．05）。两组中位生存期分别为17个月（95%可信区间11，23）、12个月（95％可信区间10，14），总生存期无显著差异（P〉0．05）。结论TACE术后补充PEI能明显延长HCC无进展生存期。     

经导管动脉栓塞和经皮乙醇注射联合治疗大肝细胞癌和肝硬化病人的长期效果

经导管动脉栓塞（TAE）和经皮乙醇注射（PEI）已广泛用于治疗肝细胞癌（HCC）病人。前者用作治疗进展期HCC，后者用作治疗小HCC。PEI治疗小HCC后病人的存活率很高，但大损害作PEI后肿瘤的局部复发率高。作者介绍了TAE和PEI联合治疗大HCC损害的经验。83例不能切除的大HCC损害病人，肿瘤最大直径＞3cm。55例为单个损害，28例为多个（2或3个）损害。全部病人均作TAE和PEI治疗。病人的3，5和7年存活率分别为68％，35％和14％。损害数（单个或多个），肝硬化分期（Child’s分期A，B或C），损害的最大直径（最大直径3～5cm和＞…     

经皮肝穿刺集束电极射频治疗大肠癌肝转移

目的：探讨经皮肝穿刺集束电极射频治疗大肠癌肝转移的价值及其适应证。方法：在B超引导下,使用RF2000射频仪对23例大肠癌肝转移患者（共39个转移结节）进行集束电极射频治疗,比较治疗前后肝功能、血清CEA、瘤体血供及大小的变化。结果：术后7d肝功能恢复至正常,78．3％患者血清CEA术后30d内降至正常范围（P＜0．05）。彩色B超及CT复查显示：瘤体直径＜5cm者,于术后1－6个月内其瘤体血供消失、体积缩小甚至消失。瘤体直径≥5cm者,于术后1－6个月内瘤体血供消失、体积缩小。结论：经皮肝穿刺集束电极射频治疗大肠癌肝转移疗效确切、简便安全。     

原发性肝癌经无水酒精瘤内注射治疗后血液AFPmRNA变化的研究

目的探讨在Ｂ型超声引导下,以无水酒精行肝癌局部注射对原发性肝癌的治疗作用。方法应用巢式逆转录多聚合酶链反应检测无水酒精局部注射治疗前后,肝癌患者周围静脉血液中ＡＦＰｍＲＮＡ变化。结果９例肝癌患者中术前有４例血液ＡＦＰｍＲＮＡ阳性（４／９）;无水酒精瘤内注射治疗３～５次后（２周）,血液ＡＦＰｍＲＮＡ阳性者减至１例（１／９）。结论无水酒精瘤内注射治疗原发性肝癌可以预防或阻止肝癌远处器官转移的发生。     

TACE联合PEI治疗原发性肝癌血液循环性肝癌细胞的变化及意义

目的：探讨联合经肝动脉化疗栓塞术(TACE)及B超引导下肿瘤局部无水酒精注射术(PEI),治疗原发性肝癌周围静脉血液循环性肝癌细胞的变化及其意义.方法:应用巢式RT-PCR检测12例原发性肝癌患者血液循环性肝癌细胞,并经TACE及PEI联合治疗,观察其血液循环性肝癌细胞的变化.结果:血液循环性肝癌细胞表达阳性的5例原发性肝癌患者(41.67%),经TACE及PEI联合治疗后,其血液循环性肝癌细胞均转为阴性(100%,P<0.01).结论:联合TACE及PEI治疗原发性肝癌可有效地杀灭血液中播散的循环性肝癌细胞,可预防肝癌的复发和转移.     

Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for treatment of advanced small hepatocellular carcinoma

BACKGROUND: We evaluated the long-term efficacy of the combination of transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol suspension and percutaneous ethanol injection (PEI) for treatment of advanced small hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Sixty-nine patients with HCC less than 3 cm in diameter and at most three lesions were enrolled in this study. HCC nodules were confirmed to be hypervascular by angiography. Thirty-two patients were treated with a combination of TACE and PEI (TACE/PEI group) and 37 patients with TACE alone (TACE group). RESULTS: The 5-year survival rates were 50% for the TACE/PEI group and 22% for the TACE group. The TACE/PEI group had a slightly but not significantly better survival than the TACE group. The 5-year survival rates of patients with solitary HCC were 61% for the TACE/PEI group and 24% for the TACE group. Although the two therapeutic groups both had high rates of recurrence, the rates in the TACE/PEI group were significantly lower than those in the TACE group (P <0.05). Severe complications such as intraperitoneal bleeding and segmental hepatic infarction were observed at low incidence, and recovered with supportive treatment. CONCLUSIONS: The combination of TACE and PEI appears to prolong survival, compared with TACE alone. This combination therapy can thus be a valuable form of treatment for unresectable advanced small HCC.     

Needle Tract Implantation of Hepatocellular Carcinoma and Pancreatic Carcinoma after Ultrasound-guided Percutaneous Puncture: Clinical and Pathologic Characteristics and the Treatment of Needle Tract Implantation

Tumor implantation along the needle tract following percutaneous procedures under ultrasonographic guidance for hepatocellular carcinoma (HCC) and pancreatic carcinoma (PC) has been well documented. The purpose of the present study was to investigate the correlation between the procedure, the pathologic differentiation of the primary tumor, and the treatment after implantation. Between July 1992 and March 2000, HCC patients (n = 372) who underwent biopsy, percutaneous ethanol injection (PEI) therapy and percutaneous microwave coagulation therapy (PMCT) and PC (n = 73) patients who underwent biopsy were retrospectively studied. Needle tract implantation was found in six of the HCC patients (1.6%) and one of the PC patients (1.4%). The interval to diagnosis ranged from 5 to 25 months (mean ± SD 11.2 ± 7.6 months) in the HCC patients. The needle tract implantation was evident for all procedure types in these patients (two after PEI alone, two after both biopsy and PEI, and one after PMCT) and for each degree of pathologic differentiation of the primary tumors (well differentiated in one, moderately differentiated in two, and poorly differentiated in one). Each implanted tumor was surgically resected, with no recurrence at the focal lesion. These results suggest that needle tract implantation develops regardless of the procedure or the pathologic differentiation of the primary tumor, and that surgical resection might be effective for controlling these implanted lesions.     

Radiofrequency ablation: a new approach in the treatment of hepatocellular carcinoma

HCC is a tumor with increasing incidence that usually develops on cirrhotic liver; therefore the prognosis depends on both tumor size and liver function. HCC generally shows a slow growth and (not very important) symptoms; so, the periodic surveillance of cirrhotic patients, by using US examination and alpha-fetoprotein level, allows an early diagnosis of the tumor. Several techniques have proved useful in the treatment of HCC but, in comparison with other currently available percutaneous therapies, RF ablation appears to have several advantages. Authors' results suggest that RF ablation is an effective and safe procedure for the therapy of local hepatic neoplasms. However, further studies will be required to demonstrate that RF ablation is more effective than percutaneous ethanol injection (PEI) in the treatment of HCC.     

A clinical study of liver resections in patients with small hepatocellular carcinoma less than three centimeter in diameter]

Liver resections for 52 cases with small hepatocellular carcinoma (HCC) less than 3cm in diameter were clinically studied. The 5-year-survival rate was 57.1%, which was better than that of percutaneous ethanol injection (PEI) therapy. Histological study revealed infiltration to the capsule in 48.1%, of which 20% had extra-capsular invasion. This finding seemed to be an important problem in PEI therapy. The group in which resected area was much larger than the extent of tumors had a tendency having good cumulative survival and non-recurrence rates. It is thought that the curative resection should be intended for small HCC if the patient has enough hepatic reserve to undertake a curative operation.     

Cutaneous Seeding of Hepatocellular Carcinoma Due to Percutaneous Ethanol Injection and Masquerading as a Pyogenic Granuloma

BACKGROUND: This investigation reports a 68-year-old man with a history of hepatocellular carcinoma (HCC) diagnosed 2 years previously who developed a single, easy-bleeding, pyogenic granuloma (PG)-like lesion on his right upper abdomen, located in the area of previous therapeutic percutaneous ethanol injection (PEI) for HCC treatment. The lesion developed 3 months after the injection. The tumor was found to be identical to his previous HCC. OBJECTIVE: To describe a case of cutaneous seeding of HCC during PEI presented as a PG-like lesion. To our knowledge, this is the first such case reported in the literature. METHODS: This is a case report and review the literature. RESULTS: Immunostainings for alpha-fetoprotein and hepatocyte monoclonal antibody confirmed the diagnosis. Besides, the patient had no other metastatic lesion. CONCLUSION: This tumor is believed to be caused by cutaneous seeding of HCC during PEI and is simulated clinically as a PG.