肝癌肝动脉栓塞化疗术并发碘油肺栓塞的临床观察

探讨肝癌肝动脉栓塞化疗术并发碘油肺栓塞的发病机制、临床表现、治疗方法及预防措施。分析肝癌行TACE术后发生碘油肺栓塞7例患者的术前肝脏CT、术中DSA检查、术中所用的碘油量及化疗药物剂量、术中术后的临床表现、辅助检查及临床治疗情况。患者出现不同程度的咳嗽、咯血、呼吸困难和低氧血症,胸片可见片状密度增高影。给予吸氧、扩张支气管、必要时呼吸机辅助呼吸及其他支持治疗后好转。随访观察20d～2个月,复查胸片正常。7例病例病灶直径约>10cm,存在肝动脉-肝静脉瘘的5例,碘油用量>20mL的5例。初步研究结果提示,碘油肺栓塞常发生在巨块型肝癌,且多存在肝动脉-肝静脉瘘,碘油用量多>20mL,术中正确处理可减少此类并发症的发生。     

原发性肝癌导向治疗44例报告

应用~(125)I-lipiodol抗癌乳剂经肝动脉灌注治疗不可切除的中晚期肝癌44例,取得显著的疗效,所有病例均有不同程度的症状改善,其中30例AFP阳性患者、25例术后一月完全转阴,5例AFP值下降至200ng/ml以下;术前AFP值增高(100～400ng/ml)4例患者,术后均转为阴性,20例肝区疼痛消失;18例肿瘤缩小。本法的主要特点,即将肿瘤区域的局部放疗、化疗和栓塞疗法三者结合在一起,不同环节的联合作用,起到综合抗癌的效果,为肝癌的导向治疗开辟了新的方法。     

经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效观察

目的探讨经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效和安全性。方法 7例外生型肝癌接受经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,治疗后评价肿瘤反应及毒副反应。结果所有7例患者共顺利完成10次经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,初次术后3个月后评价疗效,其中CR 2例,PR 4例,SD 1例,有效率为85.7%,无严重毒副反应发生。结论应用经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌患者耐受性良好,且有较好的近期疗效,可以作为经动脉灌注化疗栓塞术治疗的补充。     

Adjuvant lipiodol I-131 after curative resection/ablation of hepatocellular carcinoma

Aim. A total of 329 patients with hepatocellular carcinoma have been treated at our unit since 1990. Following the randomized controlled trial in Hong Kong by Lau et al. in 1999, patients have been offered adjuvant lipiodol I-131. The aim of this study was to determine the effectiveness of adjuvant lipiodol I-131, following potentially curative surgery with resection and/or ablation, on overall and disease-free survival rates. Material and methods. The prospectively updated hepatocellular carcinoma database was analysed retrospectively. A total of 34 patients were identified to have received adjuvant lipiodol I-131 post-curative treatment with surgical resection and/or ablation. Patient demographics, clinical, surgical, pathology, and survival data were collected and analysed. Results. Three patients received ablation alone, 24 resection, and 7 resection and ablation. Of the 34 patients treated, there were 2 possible cases of treatment-related fatality (pneumonitis and liver failure). Potential prognostic factors studied for effect on survival included age, gender, serum AFP concentration, Child-Pugh score, cirrhosis, tumor size, portal vein tumor thrombus, tumor rupture, and vascular and margin involvement. The median follow-up duration was 23.3 months. The overall median survival was 40.1 months, while the overall survival rates at 1, 2, 3, and 4 years were 87.1%, 71.7%, 60.7%, and 49.6%, respectively. Median duration to recurrence was 22.3 months. Conclusion. Administration of adjuvant lipiodol I-131 is associated with good overall survival.     

平阳霉素碘油乳剂治疗肝海绵状血管瘤疗效影响因素分析

目的分析平阳霉素碘油乳剂动脉内栓塞治疗（PLE—IASE）肝海绵状血管瘤（SCHL）的影响因素。方法89例诊断明确的SCHL患者,瘤体直径为（8．3±3．8）cm。临床症状上仅有焦虑症状者53例,右上腹疼痛35例,Kasabach—Merrit综合征1例。PLE—IASE治疗前根据肝动脉造影表现进行动脉造影分型,分型确定后配制PLE经供血动脉注射。其中平阳霉素（PYM）用量为（9．8±4．4）mg,碘油（lipiodol,LP）用量为（5．9±2．9）ml。治疗结束后根据复查点片确定其碘油沉积状态。随访6～72个月,观察患者并发症发生情况,计算症状缓解率和瘤体缩小率。以瘤体缩小率为应变量,术前肿瘤直径、动脉造影分型、PYM用量、LP用量及碘油沉积状态为自变量,进行线性回归分析。结果89例患者动脉造影分型富血型51例,乏血型26例,动静脉分流（AVS）型12例。治疗后碘油沉积状态良好64例,不良25例。随访结束时53例焦虑患者症状缓解,35例右上腹疼痛者33例缓解,2例术后仍有间歇性疼痛。1例Kasabach-Merrit综合征术后血小板恢复正常。随访症状缓解率98．7％。随访期间未发生严重并发症。线性回归分析显示动脉造影分型、PYM用量及碘油沉积状态对瘤体缩小率有显著影响,而术前肿瘤直径及LP用量对瘤体缩小率无显著影响。结论PLE—IASE为一种安全有效的介入治疗方法,动脉造影分型、PYM用量及碘油沉积状态对瘤体缩小率有显著影响,而术前肿瘤直径及LP用量对瘤体缩小率无显著影响。     

Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients

BACKGROUND & AIMS: To elucidate the survival of the patients with unresectable hepatocellular carcinoma (HCC) who underwent transcatheter arterial lipiodol chemoembolization (TACE) and to analyze the factors affecting the survivals. METHODS: During the last 8 years, a nationwide prospective cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment. Exclusion criteria were extrahepatic metastases and/or any previous treatment prior to the present TACE. The primary end point was survival. The survival rates were calculated by the Kaplan-Meier method. The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model. The mean follow-up period was 1.77 years. RESULTS: For overall survival rates by TACE, median and 1-, 3-, 5-, and 7-year survivals were 34 months, 82%, 47%, 26%, and 16%, respectively. Both the degree of liver damage and the tumor-node-metastasis (TNM) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals (P = .0001). The multivariate analyses showed significant difference in degree of liver damage (P = .0001), alpha-fetoprotein value (P = .0001), maximum tumor size (P = .0001), number of lesions (P = .0001), and portal vein invasion (P = .0001). The last 3 factors could be replaced by TNM stage. The TACE-related mortality rate after the initial therapy was .5%. CONCLUSIONS: TACE showed safe therapeutic modality with a 5-year survival of 26% for unresectable HCC patients. The degrees of liver damage, TNM stage, and alpha-fetoprotein values were independent risk factors for patient survival.     

Cerebral lipiodol embolism after transarterial chemoembolization for hepatic carcinoma: a case report

We report a case of cerebral lipiodol embolism (CLE) after transarterial chemoembolization (TACE) for unresectable hepatic carcinoma (HCC). A 54-year-old man with unresectable HCC underwent TACE via the right hepatic artery and right inferior phrenic artery using a mixture of 40 mg pirarubicin and 30 mL lipiodol. His level of consciousness deteriorated after TACE, and non-contrast computed tomography revealed a CLE. The cerebral conditions improved after supportive therapy. The complication might have been due to hepatic arterio-pulmonary vein shunt caused by direct invasion of the tumor. Even though CLE is an uncommon complication of TACE, we should be aware of these rare complications in patients with high risk factors.     

Estimation of usefulness of N-butyl-2-cyanoacrylate-lipiodol mixture in transcatheter arterial embolization for urgent control of life-threatening massive bleeding from gastric or duodenal ulcer

We estimated the usefulness of a mixture of N-butyl-2-cyanoacrylate (NBCA) with lipiodol for transcatheter arterial embolization (TAE) used to control massive bleeding from gastric or duodenal ulcer. Thirty patients who had gastric or duodenal ulcers and massive bleeding that was uncontrollable by endoscopic procedures were included in this study. All patients were subjected to TAE (without NBCA in 23 and with NBCA in seven patients). Coils and/or gelfoam were also used. The achievement of haemostasis, occurrence of rebleeding and the time taken for TAE were compared between patients who received TAE without and with NBCA. Eighteen of 23 patients (78.3%) who received TAE without NBCA and six of seven patients (85.7%) who underwent TAE with NBCA achieved complete haemostasis without rebleeding. The time for TAE was significantly shorter in patients who received NBCA compared with those who did not (P= 0.0095). TAE using NBCA or a combination of NBCA and coils achieved a rapid, complete embolization regardless of vascular distribution or arterial diameter. Thus NBCA is considered to be useful as a secondary embolization material in TAE that is urgently conducted to control massive bleeding from gastric or duodenal ulcers.     

带药微球与碘化油、明胶海绵联合应用栓塞治疗肝癌的可行性研究

本文通过对２４例肝脏恶性肿瘤患者，应用带药微球并联合应用碘化油和／或明胶海绵栓塞治疗，探讨多种栓塞剂联合应用治疗肝癌的可行性。结果表明：单独应用微球栓塞，血管再通率较高，而将微球同碘油联合应用，可发挥碘油携带微球，微球携带药物的“双重携带”作用，得到最佳栓塞效果。本组患者１年生存率为６６％。     

介入性灌注热碘油栓塞兔VX_2肝癌的疗效研究

目的评价热碘油对兔VX2肝癌的疗效及安全性。方法将30只载瘤兔,随机分为两组,每组15只。A组为常温30℃碘油灌注,B组为60℃热碘油灌注。经导管由肝动脉分别灌注常温碘油和热碘油,10 d后观察两组肿瘤体积及血清AST水平,观察载瘤兔的存活期。结果 B组肿瘤生长率(0.90±0.18)与A组(1.28±0.27)相比有统计学差异(P<0.05);A组存活期(42.0±2.0)d与B组(32.5±3.0)d相比有统计学差异(P<0.05)。A组血清AST水平与B组相比无统计学差异(P>0.05)。结论 60℃热碘油栓塞兔VX2肝癌可明显降低肿瘤生长率并延长存活期。