肝癌的冷冻治疗

冷冻疗法已成为治疗不能手术切除肝癌的重要手段.冷冻方法可选择手术中冷冻,切除或不切除肿瘤、腹腔镜下冷冻,或在超声、cT或MRI监测下,经皮冷冻.作为一局部治疗,冷冻具有超越其他治疗方法的若干优点:仅消融肝内肿瘤组织,而少伤及正常组织;由于大血管流动血流的温热作用,冷冻可安全地治疗临近大血管的肝肿瘤:冷冻比之手术更适宜治疗肝多发性肿瘤.冷冻联合肝动脉化学栓塞(TACE)、酒精注射或125碘粒子植入,有相辅相成的作用.对于冷冻在肝癌治疗中应用,可归结如下:(1)小于5 cm,尤其小于3 cm的肝癌,数目不超过3个,可以手术中冷冻或经皮冷冻.(2)大于5 cm的肝癌,先作TACE,再给予经皮冷冻.(3)大于5 cm,边缘不整,预计冷冻不完全的肝癌,可予手术中或经皮冷冻,同时在冷冻区周边部注射酒精或植入125碘粒子.     

肝癌的冷冻治疗

冷冻疗法己成为治疗不能手术切除肝癌的重要手段。冷冻方法可选择手术中冷冻，切除或不切除肿瘤、腹腔镜下冷冻，或在超声、CT下，经皮冷冻。作为一局部治疗，冷冻具有超越其他治疗方法的若干优点：仅消融肝内肿瘤组织，而少伤及正常组织；由于大血管流动血流的温热作用，冷冻可安全地治疗临近大血管的肝肿瘤；冷冻比手术更适宜治疗肝多发性肿瘤。冷冻联合肝动脉化疗栓塞（TACE）、酒精注射或^125碘粒子植入，有相辅相成的作用。对于冷冻在肝癌治疗中应用，可归结如下：①〈5cm，尤其〈3cm的肝癌，数目不超过3个，可以手术中冷冻或经皮冷冻。②〉5cm的肝癌，先作TACE，再给予经皮冷冻。③〉5cm，边缘不整，预计冷冻不完全的肝癌，可予手术中或经皮冷冻，同时在冷冻区周边部注射酒精或植入^125碘粒子。     

人工气胸后氩氦刀冷冻治疗近膈顶部肝癌4例

有报道显示早期肝癌经局部消融治疗可获得与外科手术相媲美的长期生存[1].氩氦刀冷冻消融是近年发展迅速的一种局部治疗方法,利用局部超低温冷冻的方法损毁肿瘤组织,且创伤小、耐受好[2].发生于近膈顶部肝癌被肺组织包绕,行肝肿瘤消融手术必须经皮经肺穿刺进入肝脏瘤体,易产生大量气胸、血胸[3].我院采用人工气胸后氩氦刀冷冻治疗近膈顶部肝癌,手术风险降低、并发症少、预后好,且目前鲜见相关报道.目前我们完成对4例肝癌的治疗,临床疗效满意.     

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点:一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.     

经皮导管冷冻消融技术在心律失常治疗中的应用

冷冻消融由于其特有的机制，能在标测时产生可逆的心肌损伤，消融时牢固地黏附在靶点，减少了手术疼痛、血栓形成等并发症的发生。经皮导管冷冻消融已广泛的应用于心律失常的治疗中。     

氩氦刀冷冻消融术治疗180例肝癌临床分析

目的探讨氩氦刀冷冻消融术治疗肝癌方法的安全性和近期疗效。方法选择180例肝癌患者在超声引导下行经皮穿刺氩氦刀冷冻治疗。术后定期复查肿瘤标志物及CT或MRI随访。结果小肝癌（≤5cm）患者135例,85%达到完全消融。大肝癌（〉5cm）患者45例,治疗后AFP降至正常范围或CT、MRI提示肿瘤完全坏死21例,占46.8%。转移性肝癌44例,治疗后肿瘤标志物降至正常或CT、MRI提示完全坏死30例,占68.2%。结论超声引导下肝癌的经皮穿刺氩氦刀冷冻消融术是一种安全、有效的治疗方法。     

综合靶向消融治疗中晚期肝癌的临床研究

目的 探讨用氩氦刀冷冻 微波消融 化学消融等综合靶向消融治疗中晚期肝癌的疗效.方法 78例中晚期肝癌患者采用综合靶向消融治疗,先行肝动脉栓塞化疗,一周后行局部氩氦刀冷冻术、微波消融或化学消融术;56例单纯行动脉栓塞化疗.结果 治疗组1年生存率56.4%,对照组1年生存率36.9%;治疗组AFP平均值低于对照组,有显著性差异.结论 综合靶向消融治疗能提高中晚期肝癌患者的生存率,较单纯介入疗法治疗更为有效.     

氩氦刀联合肝动脉栓塞化疗与单纯氩氦刀治疗原发性肝癌比较研究

目的比较氩氦刀冷冻消融治疗联合肝动脉灌注化疗栓塞（TACE）与单纯氩氦刀治疗原发性肝癌的优劣。方法 86例原发性肝癌患者随机分为2组,A组43例行单纯氩氦刀冷冻消融治疗,B组43例行氩氦刀冷冻消融治疗联合TACE。分别在治疗前、治疗后8、15、30和50 d监测并记录各组甲胎蛋白（AFP）的动态变化。结果与A组比较,B组的AFP下降明显（P〈0.05）。结论氩氦刀冷冻消融联合TACE治疗原发性肝癌是一种微创、安全、有效的新方法,对于不适宜手术切除治疗的肝癌患者是一种有效的治疗方法。     

经皮氩氦刀冷冻消融治疗老年肝癌20例

磁共振导引下氩氦刀靶向冷冻消融术是近年开展的冷冻治疗新技术,利用局部超低温冷冻的方法损毁肿瘤组织,避免了因开刀手术导致过量肝组织被切除使肝脏功能受到影响,因而使一些无法耐受肝脏手术的老年肿瘤病人可以接受该治疗[1].本文通过对经皮穿刺氩氦刀冷冻消融治疗老年肝癌进行临床总结,探讨此疗法治疗肝癌的适应证、疗效及安全性和临床意义.     

经皮导管冷冻消融技术及其在心律失常治疗中的应用

冷冻消融和射频消融治疗机制完全不同,前者组织损伤小,内皮破坏程度低,细胞外基质亦受到了保护,因此血栓形成发生率低。通过冷冻标测可准确确定消融靶点,通过冷冻粘结的特点可增加消融导管的稳定性,此外,冷冻治疗可完整的保护结缔组织间质,其毗邻冷冻损伤的组织能马上恢复正常的电活动。经皮导管冷冻消融技术已广泛地应用于房室结折返性心动过速、心房扑动、心房颤动等心律失常疾病的治疗。     

利用生物纳米技术检测外周血肺癌细胞的实验研究

目的建立磁性纳米颗粒从肿瘤患者外周血中富集与纯化肿瘤细胞的方法,应用荧光纳米晶生物探针检测方法,实现对肺癌早期微转移的诊断。方法体外培养人肝癌细胞和肺癌细胞,采集健康人外周血单个核细胞（PBMC）,将PBMC与肝癌细胞和肺癌细胞按比例混合,通过磁粒抗体复合物富集癌细胞,用荧光纳米晶探针进行肺癌特异性鉴定。结果光镜下可见较多的人肝癌细胞和人肺癌细胞与磁性纳米颗粒紧密结合,而PBMC与磁性纳米颗粒不结合。荧光显微镜下可见荧光纳米晶表面蛋白A探针特异性地与肺癌细胞结合产生荧光信号,但与肝癌细胞不结合,无荧光信号出现。结论本方法可成功地从外周血中富集到肺癌细胞,经荧光纳米晶探针成功地鉴定为肺癌细胞,达到诊断肺癌早期微转移的目的。     

体外负载冻融抗原的脐血树突状细胞诱导的抗肝癌效应

目的评价体外应用肝癌细胞冻融抗原负载的脐血树突状细胞（DC）所诱导的抗肝癌效应。方法采集健康足月剖宫产孕妇胎盘端脐血,分离脐血单个核细胞（CBMNC）及T淋巴细胞,用GM-CSF、IL-4及TNF-α联合诱导CBMNC分化为DC,观察形态学变化并以流式细胞术鉴定,选培养的第3天以肝癌细胞冻融抗原负载的CBMNC-DC,以负载抗原的DC刺激自体淋巴细胞活化为自体细胞毒性T淋巴细胞（CTL）,并用CTL对肝癌细胞进行杀伤,MTT法测定活化的自体淋巴细胞的相对数量和CTL对肝癌细胞的杀伤率。结果体外负载肿瘤冻融抗原的脐血DC可诱导显著的自体效应淋巴细胞增殖及抗肝癌效应。结论体外负载抗原的脐血DC可诱导显著的抗肝癌效应,是具有临床应用前景的肝癌疫苗。     

Cryotherapy in the management of premalignant and malignant conditions of the esophagus

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen(liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett's esophagus(BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.     

Cytotoxic cell function in bronchogenic carcinoma

Biologic response modifiers (BRM) such as interleukin-2 (Il-2) and gamma-interferon (gamma IFN) can augment preexisting or initiate new cytotoxic capacity of human lymphocytes against tumor cells. Although in vivo therapy with BRM or adoptive immunotherapy with BRM-treated cells seems logical in the treatment of bronchogenic carcinoma, recent studies have shown that lymphocytes from the lung and tumor tissues of patients with bronchogenic carcinoma have defective cytotoxic function. We sought to determine if defects in lung cytotoxic cell function are primary or secondary to local tumor effects, and if peripheral blood lymphocyte populations from patients can serve as a source for BRM-stimulated cytotoxic cells. We evaluated the natural killer (NK) cell and lymphokine (Il-2) activated killer cell activity (LAK) activity of mononuclear cell populations from 11 patients with newly diagnosed bronchogenic carcinoma and three control groups. Cultured human squamous cell and adenocarcinoma cell lines proved useful in evaluating LAK activity in these studies. Levels of NK and LAK activity in patients compared favorably with both those of non-smokers in two different age ranges and with smokers. Peripheral blood cytotoxic cell function remains intact and responsive to augmentation by BRM in patients with recently diagnosed bronchogenic carcinoma. Reported defects in patient lung cell cytotoxic function appear to be local tumor-related defects not present in peripheral blood lymphocytes.     

人造血管肺动脉重建术治疗中央型肺癌

目的探讨人造血管在肺动脉重建术对中心型肺癌的治疗效果。方法用人造血管肺动脉成形术或同时行支气管成形术治疗中心型肺癌29例,其中鳞癌20例,腺癌9例;左上叶袖状切除16例,右上叶6例,右中上叶7例。结果本组无手术死亡,术后1例发生支气管胸膜瘘,余28例无并发症,术后1年及3年生存率分别为69％和36％,术后定期彩超检查均未发现重建血管内有血栓形成及血流受阻情况。结论人造血管肺动脉重建术的应用最大限度地切除了肿瘤组织,并最大限度地保留了肺功能,重建肺动脉能长期、有效的维持肺循环功能。     

Hepatic arterial embolization for malignant hypercalcemia in hepatocellular carcinoma

Summary A patient who presented with hypercalcemia was found to have an hepatocellular carcinoma. Medical treatment failed to normalize blood calcium levels. Liver resection was not feasible due to major extrahepatic involvement. Selective arterial embolization of the tumor was performed, resulting in correction of the hypercalcemia. This observation suggests that some life-threatening complications of unresectable hepatocellular carcinoma can be treated by arterial embolization of the tumor.     

高频彩超在甲状腺癌诊断中的价值

目的探讨高频彩色多普勒超声对甲状腺癌的诊断价值。方法应用高频彩超诊断经病理学证实的30例甲状腺癌,观察肿块的大小、回声及形态、数目及彩色血流情况,测量收缩期最高流速（Vmax）、舒张期最低流速（Vmin）、阻力指数（RI）及颈部淋巴结有无肿大。结果30例甲状腺癌中,乳头状癌19例,滤泡状腺癌6例,髓样癌3例,未分化癌2例。肿瘤侧的Vmax、Vmin、RI均明显高于无瘤侧各指标,差异有统计学意义（P〈0．05）。结论高频彩超可以确定甲状腺癌肿块的数目、部位、大小以及有无淋巴结肿大,为甲状腺癌的诊断提供参考依据。     

Cryotherapy for inoperable rectal cancer

Summary Cryotherapy was used for palliation of symptoms in seven patients with inoperable rectal cancer and in one with perineal recurrence of cancer after abdominoperineal resection. Bleeding was controlled, obstruction was relieved and colostomy was not required. These benefits were related to reduction of tumor bulk. It appears that cryotherapy can compete successfully with irradiation and electrocoagulation in the management of selected cases of inoperable rectal cancer. Ease of administration, relief of symptoms, lessened risk, and avoidance of colostomy are advantages which indicate the general suitability of cryotherapy for the patient with inoperable cancer who cannot tolerate major operations. Read at the meeting of the American Proctologic Society, New Orleans, Louisiana, April 17 to 19, 1967.     

结肠癌患者外周血VEGF-C和CK20 mRNA的表达与淋巴转移的关系

目的探讨结肠癌患者外周血VEGF-C mRNA和CK20 mRNA的表达与淋巴转移的关系。方法应用RT-PCR检测80例结肠癌患者、30例结肠良性肿瘤患者、30例健康人外周血VEGF-C mRNA和CK20 mRNA的表达。结果 VEGF-C mRNA在结肠癌患者外周血的阳性表达率为52.5%,在结肠良性肿瘤、健康人的表达率分别为10.0%、0,其中有淋巴结转移的结肠癌患者的阳性表达明显高于无淋巴结转移的阳性表达(P<0.05)。CK20 mRNA在结肠癌患者外周血的阳性表达率为60.0%,在结肠良性肿瘤、健康人的表达率均为0,其中有淋巴结转移的结肠癌患者的阳性表达明显高于无淋巴结转移的阳性表达(P<0.05)。结论结肠癌患者外周血VEGF-C mRNA和CK20 mRNA的表达与淋巴转移相关。     

同种异基因皮肤移植对昆明小鼠荷H22型肝癌细胞生长的影响

目的观察同种异基因皮肤移植对昆明小鼠肝细胞癌生长及相关免疫指标的影响。方法采用荷H22型肝癌昆明小鼠为动物模型并分为3组,在皮下接种小鼠H22肝癌细胞悬液后,接受C57／BL6小鼠皮肤移植物的昆明小鼠为实验组,而接受同种同基因移植和不移植组均作为对照组,比较肿瘤的生长情况;同时检测小鼠外周血淋巴细胞亚群和肿瘤组织内细胞的凋亡细胞,比较各组间差异。结果接受同种异基因皮肤移植的昆明小鼠,肿瘤的生长速度慢于其他2组;接受同种异基因皮肤移植的小鼠瘤组织内凋亡细胞数量高于对照组。结论同种异基因皮肤移植对小鼠H22肝癌细胞的生长具有抑制作用,这种作用可能通过诱导肝癌细胞凋亡而发挥作用。