支气管动脉化疗栓塞联合125I放射性粒子植入术治疗老年非小细胞肺癌的效果分析

目的：分析支气管动脉化疗栓塞联合125I放射性粒子植入术治疗老年非小细胞肺癌的效果。方法选取2011年1月~2013年1月本院收治的90例无法进行根治性切除术的老年非小细胞肺癌患者,将其随机分为观察组、对照组,每组45例。观察组进行支气管动脉栓塞化疗联合125I放射性粒子植入治疗3~6个疗程,对照组行吉西他滨联合顺铂化疗(GP方案)4~6个疗程,比较两组患者的疗效、不良反应发生率、生存时间。结果观察组的有效率为73.33%,对照组为44.44%,两组比较,差异有统计学意义(P<0.05)。随访17个月后,观察组死亡4例,对照组死亡1例,观察组、对照组的中位生存时间分别为(399.2±19.5)、(331.5±16.4)d,组间比较,差异有统计学意义(P<0.05)。结论支气管动脉化疗栓塞联合125I放射性粒子植入术治疗无法进行根治性切除术的老年非小细胞肺癌的短期效果优于GP方案化疗。     

原发性肝癌TACE治疗后的影像学评价

原发性肝癌是严重威胁人类健康及寿命的恶性肿瘤之一,经动脉导管化疗栓塞术(TACE)是治疗原发性肝癌应用较为广泛的非外科手术治疗方法,准确地判断肝癌TACE治疗术后的疗效直接关系到临床治疗方案的选择及预后。目前,临床上对肝癌TACE术后的影像学检查方法众多,本文主要针对超声、CT、MR、DSA及PET/CT等影像学检查方法在肝癌TACE治疗后疗效评估中应用的现状进行综述。     

Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography

Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.     

超声引导下微波消融术联合TACE治疗特殊部位中晚期原发性肝癌的疗效及安全性分析

目的：探讨超声引导下微波消融术联合经肝动脉化疗栓塞（TACE）治疗特殊部位中晚期原发性肝癌的疗效,并分析其及安全性。方法：选择2015年1月至2018年1月我院收治的特殊部位中晚期原发性肝癌的患者120例,按照随机数字表法分为对照组和观察组,各60例。对照组给予单纯TACE术治疗,观察组给予超声引导下微波消融术联合TACE术治疗,比较两组治疗效果,肝功能指标[血清总胆红素（TBIL）、结合胆红素（DBIL）、谷丙转氨酶（ALT）和白蛋白（Alb）],术后并发症,住院时间和住院费用,术后6个月、1年、2年生存率。结果：观察组治疗有效率86.67%高于对照组的68.33%（P<0.05）。治疗后,观察组TBIL、DBIL、ALT水平低于对照组（P<0.05）,Alb水平高于对照组（P<0.05）。观察组术后恶心呕吐、发热、肝区疼痛发生率与对照组无显著差异（P>0.05）。观察组住院时间长于对照组（P<0.05）,住院费用高于对照组（P<0.05）。观察组术后6个月、术后1年和术后2年生存率分别为95%、90.00%、80.00%,均高于对照组的80.0%、75.00%、61.67%（P<0.05）。结论：超声引导下微波消融术联合TACE术治疗特殊部位中晚期原发性肝癌疗效较好,能够明显改善患者肝功能,提高术后短期生存率。     

Late hepatic artery pseudoaneurysm： A rare complication after resection of hilar cholangiocarcinoma

We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type 11 hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography （MDCTA） showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization （TAE） of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and welltolerated with normal liver function tests and without signs of liver infarction.     

TACE联合氩氦刀冷冻治疗原发性肝癌临床分析

目的探讨肝动脉化疗栓塞术（TACE）联合氩氦刀冷冻治疗原发性肝癌的近期疗效。方法将77例中晚期肝癌随机分为二组：A组37倒,行TACE联合氩氦刀冷冻治疗;B组40例,单纯行TACE术。比较两组患者血清AFP水平以及半年和1年生存率。结果A组AFP下降比B组明显（P〈0．05）,A组患者1年生存率高于B组（P〈0．05）。结论TACE联合氩氦刀冷冻治疗原发性肝癌疗效优于单纯性行TACE治疗,是治疗中晚期肝癌的一种有效方法。