微导管在肝脏良性实体肿瘤介入治疗中的临床应用

目的 探讨SP微导管在肝脏良性实体肿瘤介入治疗中的临床应用.方法 42例肝脏良性实体肿瘤行超选择性肝动脉插管并经微导管内注射平阳霉素碘油乳剂(PLE),瘤体大的可用明胶海绵颗粒追加栓塞.随访6-24个月,观察肝脏良性实体肿瘤栓塞前、后肿瘤大小、异常血管湖变化、临床症状和并发症发生情况.结果 42例肝脏良性肿瘤患者栓塞术后瘤体缩小约45%-70%,部分可缩小约90%,异常血管湖消失,总有效率100%,无与手术有关的严重并发症发生.结论 PLE经SP微导管注入行超选择性肝动脉栓塞治疗肝脏良性实体肿瘤是非常安全和有效的方法.     

肝动脉注射碘化油对肝癌的CT诊断和疗效分析

目的:探讨肝动脉注射碘化油对原发性肝癌的CT诊断及治疗效果.方法:分析32例原发性肝癌患者的CT扫描片,将注入碘化油前后的CT片加以比较,同时将第一次治疗后的CT片与治疗后8～10个月的CT片进行对比分析.结果:32例注入碘化油后CT扫描所检出的病灶数比注射前多出15处;8～10个月后,病灶明显缩小,部分较小病灶已不再显影.结论:注射碘化油后,可明显提高原发性肝癌的CT诊断准确性,对原发性肝癌有较好的治疗效果.     

平阳霉素碘油乳剂治疗肝海绵状血管瘤的临床疗效与价值

目的探讨和评价平阳霉素乳剂（PLE）在治疗肝海绵状血管瘤（CHL）中的临床疗效与价值。方法24例CHL经导管行肝动脉PLE治疗，并用明胶海绵颗粒栓塞供血动脉，观察治疗前后肿瘤大小变化，碘油沉积情况，临床症状及并发症。结果经PLE栓塞治疗后，所有肿瘤直径有不同程度缩小，碘油沉积情况良好，术后无严重并发症。结论PLE是经导管肝动脉栓塞治疗CHL的安全有效的方法。     

Prognosis of cerebral lipiodol embolism caused by transarterial chemoembolization

Objectives: Transarterial chemoembolization (TACE) plays an essential role in the management of unresectable hepatocellular cell carcinoma and other hepatic neoplasms. Cerebral lipiodol embolism (CLE) is a rare complication of TACE and its prognostic factors have not been well studied. The aim of this paper was to elucidate the prognostic factors of CLE based on clinical data obtained from our patients and cases published since 2004.

Methods: We present two patients with CLE, analyze the clinical data, and review all CLE cases published since 2004. A poor outcome was defined as stupor, coma, quadriplegia, or death within 45 days. Patients who had other neurological conditions within 45 days were considered as having a good outcome.

Results: The rate of poor outcome was 25.7% (9/35). Compared with the patients with good outcome, those with poor outcome were older (mean age 68.3 ± 7.3 vs. 58.3 ± 10.6 years, p = 0.03), more often female (76.9% vs. male 33.3%, p = 0.02), and more likely chemoembolized via both the right hepatic and right inferior phrenic arteries (44.4 vs. 8.7%, p = 0.02).

Discussion: The prognosis of CLE was related to age, gender, and the arteries selected for injection.     

经肝动脉化疗栓塞联合肿瘤间质治疗肝癌后免疫功能改变

目的 探讨单纯经肝动脉化疗栓塞(TACE)及联合肿瘤问质治疗后肝癌患者免疫功能的变化及意义.方法 对照组(A组)20例肝癌患者行单纯TACE治疗,实验组(B组)20例肝癌患者行经肝动脉化疗栓塞联合经皮肝瘤内药物注射碘油化疗药物肿瘤间质治疗.术前及术后1周抽取两组患者外周血,应用流式细胞仪检测外周血T淋巴细胞亚群(CD3~+T、CD4~+T、CD8~+T、CD4~+T/CD8~+T),单向扩散法检测免疫球蛋白水平变化.结果 A、B组手术后1周CD3、CD4及CD4/CD8升高,两组手术前后比较有显著性差异(P<0.05);A、B两组术后比较,除CD8外亦有显著性差异(P<0.05).A、B组术后免疫球蛋白和补体有所升高.A组手术前后无显著性差异(P>0.05);B组手术前后除C3外具有显著性差异(P<0.05),A、B两组术后比较无显著性差异(P>0.05).结论 单纯TACE治疗肝癌增强患者细胞免疫功能,对体液免疫影响较小:联合瘤内碘油化疗药物乳剂注射肿瘤间质治疗的方法可以更大程度地改善患者细胞免疫和体液免疫功能.

Abstract：

Objective To study the changes of immune function in patients with liver cancer after transcatheter arterial chemoembolizaton (TACE) combined with interstitial therapy. Methods Forty patients with liver cancer were randomly divided into groups A and B to received TACE and TACE combined with percutaneous lipiodol and anti-cancer agent injection into the tumor. The T lymphocyte cell subsets in the peripheral blood before and one week after the operation were measured by flow cytometry, and the immunoglobulin contents determined by single radial immunodiffusion. Results CD3, CD4, and CD4/8 levels increased significantly after the operation in both groups A and B (P<0.05). The postoperative CD3 and CD4 levels, but not that of CD8, differed significantly between the two groups (P<0.05). The operations also resulted in an increase in the contents of the immunoglobulins and complements in the two groups, but the changes were not significant in group A (P>0.05); in group B, significant increases occurred in the immunoglobulin and complement levels (P<0.05) with the exception of C3. Conclusion The combination of TACE and interstitial therapy with percutaneous intratumor injections of lipiodol and anti-cancer agents may better improve the cell-mediated immunity and humoral immune function of liver cancer patients.     

三丙烯微球联合碘油在脾动脉部分栓塞术中的应用*

目的 探讨三丙烯微球联合碘油在脾动脉部分栓塞术中（PSE）的应用价值。方法 按前瞻性随机对照研究原则将180例患者分为三丙烯微球栓塞组（1组）、三丙烯微球联合碘油栓塞组（2组）及明胶海绵栓塞组（3组）。给予相应的PSE治疗,统计各组患者疗效（3及6个月白细胞、血红蛋白及血小板检测值和达到正常值例数）及并发症（发热、腹膜炎及持续时间、腹痛的程度及持续时间）情况;统计各组患者6个月栓塞血管再通数。结果 1组与2组疗效及6个月栓塞血管再通例数比较,差异无统计学意义（P?>0.05）,1组与2组均高于3组（P?<0.05）;2组术后腹膜炎天数及腹痛持续时间均短于1组和3组（P?<0.05）。结论 三丙烯微球联合碘油栓塞在PSE中应用是安全有效的,能减轻并发症的强度。     

Lipiodol hysterosalpingogram: A modified HSG technique to minimize risks associated with lipiodol use

Assessment of tubal patency and therapeutic tubal flushing using Lipiodol, an oil‐soluble contrast media (OSCM), has been shown to enhance fertility, resulting in increased interest in the use of Lipiodol. A modified hysterosalpingogram (HSG) technique, including a supplementary ultrasound with the contrast in situ, is recommended when using Lipiodol, taking into account both safety issues and technical challenges specific to Lipiodol.     

Postoperative adjuvant transarterial chemoembolization for participants with hepatocellular carcinoma: A meta‐analysis

Aim: The efficacy of transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC) is positive, but for postoperative HCC, many studies have reported controversial results. The present study aimed to evaluate the efficacy of postoperative adjuvant TACE for participants with HCC. Methods: Electronic and manual searches were conducted to identify randomized controlled trials (RCT) evaluating postoperative adjuvant TACE for participants with HCC. Results: Six RCT totaling 659 participants, of whom almost all were of stage IIIA HCC, were included. For the 1‐year tumor recurrence rate, hepatectomy plus TACE showed statistically significant less incidence of recurrence, with a pooled risk ratio (RR) of 0.68 (95% confidence interval [CI] = 0.55–0.84, P = 0.0003). For 1‐year mortality, the trials were favorable for TACE with a pooled risk ratio of 0.48 (95% CI = 0.35–0.65, P < 0.00001). For 3‐year mortality, the trials also revealed statistically significant less incidence, with a pooled risk ratio of 0.76 (95% CI = 0.64–0.90, P = 0.002). However, for 5‐year mortality, TACE did not demonstrate statistically significant less incidence (RR = 0.94, 95% CI = 0.81–1.08, P = 0.36). Transient fever and nausea/vomiting were reported as side‐effects of TACE but were well tolerated by most participants. Conclusion: Postoperative adjuvant TACE seems promising for participants with HCC with risk factors (multiple nodules of >5 cm or vascular invasion) but requires further trial.     

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.