导管肝动脉化疗灌注术及栓塞术治疗原发性肝癌的临床分析

目的:对比分析经肝动脉化疗灌注(transcatheter hepatic arterial infusion,TAI)及经肝动脉化疗栓塞(transcatheter hepatiarterial chemoembolization,TACE)治疗原发性肝癌的临床应用效果。方法:回顾性分析我院收治的原发性肝癌患者60例,按照治疗方式的不同分为灌注组和栓塞组,每组各30例。灌注组患者接受经肝动脉介入化疗药物灌注术,栓塞组患者接受经肝动脉化疗栓塞术,对比分析两组患者的近期疗效,2年内生存率以及不良反应发生情况。结果:栓塞组的治疗近期有效率为60.0%,明显高于灌注组的30.0%,差异有统计学意义(P0.05);栓塞组2年的生存率为73.3%,明显高于灌注组的46.7%,两组相比差异有统计学意义(P0.05);两组患者不良反应发生率之间相比无统计学差异(P0.05)。结论:经肝动脉化疗栓塞术治疗原发性肝癌的近期疗效显著,延长患者生存期,因此,推荐临床更多采用经肝动脉化疗栓塞术治疗失去手术适应症的原发性肝癌。     

化疗栓塞术联合射频消融治疗肝癌的疗效观察

目的探讨化疗栓塞术联合射频消融术治疗肝癌的临床疗效。方法选取2014年5月至2016年4月我院收治的70例原发性肝癌患者为研究对象,随机分为对照组和观察组,各35例。对照组接受肝动脉灌注化疗栓塞术治疗,观察组患者行肝动脉灌注化疗栓塞术联合射频消融术治疗。比较两组患者的总有效率、肿瘤血供消失率、肿瘤完全坏死率和不良反应发生情况。结果观察组临床总有效率(77.14%)显著高于对照组(51.43%),组间差异显著(P<0.05)。治疗12个月后,观察组肿瘤血供消失率(80.00%)、肿瘤完全坏死率(74.29%)显著高于对照组(54.29%,31.43%),组间差异显著(P<0.05)。观察组不良反应发生率(20.00%)略高于对照组(17.14%),组间差异不显著(P>0.05)。结论原发性肝癌采用肝动脉灌注化疗栓塞术联合射频消融术治疗效果好,不良反应发生率低,值得临床应用。     

中晚期肝癌肝动脉化疗栓塞508例疗效分析

目的 探讨中晚期肝癌肝动脉化疗栓塞的疗效及影响疗效的因素。方兴未艾508例不能切除的原发性肝癌行选择性肝动脉插管灌注化疗和栓塞治疗共2025次，其中行选择性肝动脉管灌注化疗栓塞治疗448例，单纯灌注化疗60例。结果 选择性肝动脉插管灌注化疗栓塞1、2、3年生存率分别为81.3%、38.6%、21.6%；单纯灌注化疗1、2、3年生存率分别为54.3%、21.3%、9.6%。肿瘤分类、栓塞剂及用量、门静脉是否有癌栓、倒支循环的形成、碘油沉积情况及栓塞术和方法选择是否是影响疗效的主要因素。结论 选择性肝动脉插管灌注化疗栓塞中可作为中晚期肝癌的常见治疗，远期疗效明显优于单纯灌注化疗。     

肝动脉化疗栓塞治疗鼻咽癌肝转移疗效观察

目的探讨肝动脉化疗栓塞在鼻咽癌肝转移治疗中的应用及其价值.方法对35例鼻咽癌肝转移患者进行了肝动脉化疗栓塞治疗,其中32例可评价病例均进行了肝动脉化疗/栓塞,按肿瘤位置及供血情况相应分配化疗药物用量.肝转移瘤经化疗栓塞治疗的疗效及生存期情况采用SPSS软件进行统计分析.结果肝转移瘤经化疗栓塞后总的临床有效率(完全缓解5例 部分缓解10例)为46.9%(15/32).单纯行肝动脉灌注化疗与同时行灌注化疗并联合栓塞治疗患者的临床疗效无统计学差异.全部患者的平均生存期为12.66个月,其1、2、3年累积生存率分别为43.8%、15.6%及6.3%.无严重的并发症.结论肝动脉化疗栓塞可以作为治疗鼻咽癌肝转移瘤的一种姑息手段.     

双灌注介入疗法治疗中晚期肝癌36例疗效观察

目的探讨双灌注介入疗法治疗中晚期肝癌的价值。方法对72例确诊肝癌病例随机分为对照组和观察组,分别行单纯肝动脉灌注化疗栓塞术（TACE）和双灌注介入疗法,并按《实体瘤疗效评价标准》统计其疗效差别,进行回顾性分析,总结双灌注介入疗法的应用价值。结果单纯行肝动脉灌注化疗栓塞术组总有效率为61.1%,行双灌注介入疗法组总有效率为77.8%。两组间比较差异有统计学意义（P〈0.05）。结论双灌注介入疗法比单纯行肝动脉灌注化疗栓塞术效果更加稳定确切,在不增加治疗副作用的前提下,达到了类似肝动脉-门静脉双途径介入治疗的目的,且减少了肝动脉-门静脉双途径介入治疗术后的不良反应和并发症,提高了患者的生活质量,延长了患者的生存期。     

经皮肝穿门静脉联合经肝动脉热灌注治疗肝转移癌48例

目的:探讨经皮肝穿门静脉入路联合经肝动脉灌注加热的化疗药物和碘油治疗肝转移癌的疗效。方法:肝转移癌患者96例,随机分为联合组48例和对照组48例,分别采用经门静脉入路联合经肝动脉热灌注和常规经肝动脉化疗栓塞治疗。结果:术后复查CT、MRI,联合组有效率明显高于对照组,两组差异有统计学意义(P<0.05);术后随访6、12、18、24个月,联合组生存期明显优于对照组,两组差异有统计学意义(P<0.05)。结论:经皮肝穿门静脉入路联合经肝动脉热灌注治疗肝转移癌疗效比常规经肝动脉化疗栓塞方法更有效,且不良反应发生率与对照组无明显差异。     

乳腺癌术后肝转移83例综合治疗

目的比较手术治疗和非手术治疗,全身化疗和肝动脉插管栓塞化疗处理乳腺癌术后肝转移的疗效。方法回顾性分析83例确诊乳腺癌术后肝转移患者的临床资料,对比不同治疗方法的疗效。结果全组患者治疗的总有效率37.3%(31/83),手术治疗组完全缓解率高于其他治疗组,但由于样本量较少,差异无统计学意义(P>0.05),肝动脉栓塞化疗组有效率高于全身化疗组(P<0.05)。结论对于有手术指征的乳腺癌术后肝转移患者首选手术治疗,肝动脉插管栓塞化疗可以作为乳腺癌术后肝转移的有效安全治疗措施。     

三种不同化放疗方法对宫颈癌患者术前辅助治疗效果对比研究

目的观察子宫动脉灌注栓塞化疗、全身静脉化疗和体外放疗在宫颈癌Ⅰb2期到Ⅱb期患者术前辅助治疗中的疗效。方法选择2017年1月至2020年1月在眉山市人民医院妇科收治的原发性宫颈癌患者220例,在行手术治疗前,依据治疗方式分为子宫动脉灌注栓塞化疗组72例,全身静脉化疗组75例和体外放疗组73例,术后1个月观察3组患者的近期临床症状缓解、肿块消退情况及胃肠道不良反应发生情况。结果治疗1个月后,(1)三组患者临床症状均有不同程度缓解,子宫动脉灌注栓塞化疗组总缓解率83.33%(60/72)优于全身静脉化疗组68.00%(51/75)和体外放疗组64.38%(47/73),P值均<0.05;(2)子宫动脉灌注栓塞化疗组患者的肿块消退情况明显优于全身静脉化疗组和体外放疗组,子宫动脉灌注栓塞化疗组的总有效率为87.50%(63/72),明显高于全身静脉化疗组的72.00%(54/75)和体外放疗组的68.49%(50/73),P值均<0.05;(3)子宫动脉灌注栓塞化疗组的无反应比例43.06%(31/72)明显高于体外放疗组20.55%(15/73),P值均<0.05。结论子宫动脉灌注栓塞化疗联合手术治疗能有效控制Ⅰb2期到Ⅱb期宫颈癌患者病情的发展,能提高近期临床症状缓解率,疗效优于全身静脉化疗及体外放疗,且胃肠道不良反应发生率低。     

临床初探滋养细胞肿瘤介入治疗的近期临床效果

目的对比全身静脉化疗,评价超选择性子宫动脉栓塞及置管持续灌注化疗治疗妊娠滋养细胞肿瘤的方法及疗效。方法45例妊娠滋养细胞肿瘤患者,随机分为子宫动脉介入化疗栓塞组25例及全身静脉化疗组20例,观察两组疗效及不良反应（骨髓抑制和胃肠道反应）,评价其两组临床疗效。结果介入治疗组副反应低于全身化疗组（P〈0．05）,病灶缩小率及血β-hCG下降程度高于全身化疗组（P〈0．05）,疗程短于全身化疗组（P〈0．05）。结论超选择性子宫动脉栓塞及置管持续灌注化疗治疗妊娠滋养细胞肿瘤疗效明确,疗程短,毒副反应轻。     

肝动脉化疗栓塞联合复方苦参注射液治疗原发性肝癌疗效分析

目的 评价肝动脉化疗栓塞联合复方苦参注射液治疗原发性肝癌的疗效.方法 对48例原发性肝癌患者随机分为联合治疗组和单纯化疗组,两组患者均进行连续3个周期的肝动脉化疗栓塞,联合组患者同时静脉滴注复方苦参注射液3个周期.结果 观察肝癌治疗有效率、治疗前后肝功能及血常规变化差异均有统计学意义.结论 肝动脉化疗栓塞联合复方苦参注射液可以提高肝癌治疗有效率,明显降低单纯化疗的不良反应,改善患者生活质量,具有肝功能保护作用,是治疗肝癌的有效治疗方法.     

Nature of Doppler perfusion index changes in patients with colorectal cancer liver metastases.

OBJECTIVE: Occult hepatic metastases from colorectal cancer result in an increase of the ratio of arterial hepatic blood flow to total hepatic blood flow, described as the Doppler perfusion index. Whether this alteration is due to an increase in arterial blood flow or a decrease in portal venous inflow has not yet been unequivocally determined. The purpose of this study was to analyze changes in hepatic perfusion in patients with liver metastases from colorectal cancer by standardization of hemodynamic parameters to body surface area. METHODS: Hemodynamic parameters (crosssectional area, blood flow, and congestive index) were measured for the common hepatic artery and portal vein with duplex color Doppler sonography in 20 patients with liver metastases and 20 healthy control subjects and evaluated relative to body surface area. RESULTS: No statistically significant differences in age, body surface area, cross-sectional area of the common hepatic artery, and congestion index of the common hepatic artery and portal vein were observed between control subjects and patients with liver metastases. Patients with liver metastases had significantly greater arterial hepatic blood flow and Doppler perfusion index and significantly smaller portal cross-sectional area portal blood flow as well as total liver blood flow (P <.001). CONCLUSIONS: This study supports the theory that the primary mechanism of alteration in liver perfusion is the reduction of portal inflow with subsequently increased arterial hepatic blood flow.     

经肝动脉药盒持续灌注氟脲苷与地塞米松治疗化疗抵抗的结直肠癌肝转移的疗效与安全性分析

目的探讨经肝动脉药盒灌注氟脲苷与地塞米松治疗化疗抵抗的结直肠癌肝转移的疗效及安全性。方法对23例经过至少二线化疗失败的结直肠癌肝转移患者采用介入放射方法植入肝动脉药盒,术后第2天开始经药盒灌注氟脲苷与地塞米松,对其治疗疗效、毒副反应及生存状态进行回顾性分析。结果 23例患者的肝内疾病控制率为69.6%,其中部分缓解10例(43.5%),稳定6例(26.1%);4例患者转化为可手术切除,转化率为17.4%。中位肝内无进展生存时间为(9.0±1.8)月,中位总生存时间为(14.0±1.8)月。结论经肝动脉药盒灌注氟脲苷与地塞米松可作为化疗抵抗的结直肠癌肝转移的补救治疗,并可能使部分患者转化为可手术切除,从而获得长期生存的机会。     

三氧化二砷经导管肝动脉化疗栓塞介入治疗中晚期原发性肝癌临床疗效及安全性观察

目的研究中晚期原发性肝癌治疗中三氧化二砷经导管肝动脉化疗栓塞介入疗法的应用效果。方法采用回顾性分析方法,研究对象为2017年1月至2018年6月武警山东省总队医院收治的82例中晚期原发性肝癌患者,根据治疗方式不同将其分为研究组(n=41)与对照组(n=41),对照组选用常规肝动脉栓塞疗法,研究组选用三氧化二砷经导管肝动脉化疗栓塞介入疗法。比较2组治疗后总有效率、生存率及不良反应[心电图T波及ST-T改变、胆红素异常、白蛋白降低、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)升高、AST升高]发生率。结果研究组治疗后总有效率为75.61%,明显高于对照组的53.66%,差异有统计学意义(P<0.05)。治疗后,研究组患者1年生存率为82.93%,明显高于对照组的60.98%,差异有统计学意义(P<0.05);2组患者2年生存率比较(46.34%vs.34.15%),差异无统计学意义(P>0.05)。研究组患者治疗后心电图T波及ST-T改变、胆红素异常、白蛋白降低、ALT升高、AST升高发生率分别为2.44%、4.88%、4.88%、7.32%、7.32%,明显低于对照组(17.07%、24.39%、21.95%、24.39%、26.83%),差异有统计学意义(P<0.05)。结论中晚期原发性肝癌治疗中三氧化二砷经导管肝动脉化疗栓塞介入疗法的应用效果显著,可延长患者生存周期,且不良反应少,安全性高。     

西妥昔单抗联合mFOLFOX6一线治疗k-ras野生型结直肠癌肝转移临床疗效观察

目的评价西妥昔单抗联合mFOLFOX6一线治疗k-ras野生型结直肠癌肝转移患者的临床疗效及安全性。方法本院自2008年1月至2011年12月收治的失去手术机会的晚期结直肠癌肝转移患者39例,其中一线接受西妥昔单抗联合mFOLFOX6方案治疗19例（联合组）,单用mFOLFOX6方案化疗20例（化疗组）,具体方案为：西妥昔单抗首次400mg／m2,静脉滴注120rnin,后续每周250mg／m2,静脉滴注60min,每周给药1次或500mg／m2,首次静脉滴注120min,之后每次滴注60min,每2周给药1次;mFOLFOX6方案：奥沙利铂85mg／m2,第1天,LV400mg／m2,第1天,5-FU400mg／m2,静推,第1天,2400mg／m2,持续静注46h,2周为一周期;化疗组仅接受上述mFOLFOX6方案化疗。结果全组39例患者均可评价疗效,联合组获得CR2例（10．5％）,PR11例（57．9％）,SD4例（21．1％）,PD2例（10．5％）,RR为68．4％,DCR为89．5％。化疗组获得CR为0例,PR6例（30．0％）,SD8例（40．0％）,PD6例（30．0％）,RR为30．0％,DCR为70．0％。两组缓解率RR比较有统计学差异（P=0．016）,中位PFS分别为10．4个月、6．3个月,联合组优于化疗组;获得R0肝转移灶切除者两组分别为36．8％VS．10．0％（P=0．047）,手术者PFS分别为12．6个月、15．6个月,均优于未获得手术机会的患者;主要不良反应为皮疹、腹泻、恶心呕吐、神经毒性及血液学毒性,均可耐受。结论西妥昔单抗联合mFOLFOX6一线治疗k-ras野生型晚期结直肠癌肝转移患者,获得较好的临床缓解率及更高的肝切除率,获得R0肝转移灶切除的患者可以获得更高的疾病无进展时间,两组不良反应均可耐受,值得在临床推广应用。     

超选择性TACE和静脉化疗治疗宫颈癌的临床应用

目的:探讨超选择性髂内动脉插管化疗加栓塞(TACE)及静脉化疗治疗宫颈癌的临床价值。材料和方法:25例宫颈癌采用Seldinger’s技术选择性髂内动脉插管,联合抗癌药物灌注、栓塞加放射治疗。25例静脉化疗加放射治疗。据妇科和超声检查及临床症状改善情况以评价近期疗效并随访。结果:近期疗效为动脉组完全缓解(CR)3例(12.0%)、部分缓解(PR)17例(68.0%)、稳定(NC)5例(20.0%),总有效率(CR+PR)为80.0%。静脉组CR 0例(0.0%)、PR 9例(36.0%)、NC 16例(64.0%),总有效率36.0%。随访5年生存率动脉组为1年84.0%(21/25)、3年52.0%(13/25)、5年44.0%(11/25)。静脉组为1年60.0%(15/25)、3年24.0%(6/25)、5年20.0%(5/25)。结论:髂内TACE治疗晚期宫颈癌的疗效确切,毒副作用较轻,值得临床推广。     

动脉内重组人血管内皮抑制素联合化疗栓塞术治疗原发性肝癌的疗效及CT灌注参数变化

目的 探讨动脉内重组人血管内皮抑制素（恩度）联合化疗栓塞术（TACE）治疗原发性肝癌（PHC）前后CT灌注参数变化.方法 选取PHC患者40例,随机分为观察组及对照组各20例,对照组给予单纯TACE,观察组给予动脉内恩度联合TACE术,观察术前及术后1个月的CT灌注参数变化.结果 2组间客观缓解率（RR）及不良反应发生率无显著差异（P＞0.05）,但观察组临床受益率（CBR）显著高于对照组（P＜0.05）;术后,观察组患者血流量（BF）、肝动脉灌注值（ALP）、肝脏灌注指数（HPI）参数较术前显著下降（P＜0.05或P＜0.01）,且显著优于对照组（P＜0.05）.结论 动脉内恩度联合TACE术治疗PHC患者能显著提高CBR,不良反应未见显著增加,且CT灌注参数变化显著优于单纯TACE术.     

Arterial therapies of colorectal cancer metastases to the liver

Intra-arterial therapies directed to the liver take advantage that liver tumors are fed by the hepatic artery while the liver vascularization is 30% arterial. Most common techniques of intra-arterial therapies for colorectal cancer liver metastases (CRLM) include intra-arterial hepatic chemotherapy (IAHC), transarterial chemoembolization (TACE), and radioembolization. Such treatments are used as salvage therapies because they provide response when systemic therapies are inefficient. They are also used as a first line therapy to produce maximal response in order to convert the patient from non-surgical to surgical. IAHC with FUDR or oxaliplatinum allow 90% response rate and conversion to surgery of 40% to 50% of initially inoperable patients. TACE is used in CRLM with promising response rate, namely due to the use of drug eluting beads that can be loaded with irinotecan which can elute the drug they contain after embolization in liver tumor. Radioembolization is a unique way of delivering a high tumoricidal dose of radiation (>100 Gy) to liver tumor without harming the healthy liver, and provided interesting results in salvage therapy, enough to be evaluated today in a randomized control trial in first line therapy where FOLFOX is proposed with and without additional radioembolization.     

Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

The Hepatic CHEMOSAT^® Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile. Funding: Delcath Systems Inc., New York, NY, USA.     

Doppler sonographic evaluation of hemodynamic changes in colorectal liver metastases relative to liver size.

OBJECTIVE: The mechanisms of hemodynamic alterations in colorectal liver metastases are not clearly understood yet. Considering that an increase in liver size in patients with metastases could also result in an alteration in total liver flow, we aimed to analyze hemodynamic changes relative to the liver volume and to search for the possibility of any intrinsic factors affecting blood flow in patients with metastases. METHODS: Twenty-eight patients with colorectal liver metastases and 20 control subjects with no liver disease were evaluated sonographically. All patients were examined prospectively by Doppler sonography and helical computed tomography. Hepatic hemodynamic parameters, including blood flow in the hepatic artery and portal vein, total blood flow to the liver, and Doppler perfusion index, were calculated, and values relative to liver volume were obtained. Hepatic perfusion changes in liver metastases were then compared with those in a control group. RESULTS: The liver volume of the patients with liver metastases was greater than that of the control group (P=.003). Hepatic arterial blood flow rates were higher, whereas portal flow rates were lower, in patients with liver metastases compared with control subjects (P<.05). Total liver blood flow was not significantly different between the two groups. However, total blood flow relative to liver volume was significantly lower in the metastatic group (P<.001). Doppler perfusion index values in the patients with metastasis were significantly higher than in the control group (P=.000). CONCLUSIONS: Our findings may support the hypothesis that a humoral mediator-induced portal venous flow reduction causes perfusion changes in liver metastases from colorectal disease. However, an additional intrinsic hepatic hemodynamic event should also be present. Doppler perfusion index measurements can provide additional information in the evaluation of patients with colorectal liver metastases.