介入球囊间断阻肯动脉血流合并华蟾素灌注治疗晚期肝癌

目的：探讨采用介入球囊间断肝动脉血流合并华蟾素灌注治疗晚期肝癌的疗效。方法：经左锁骨下动脉置入球囊导管于肝动脉血流，合工中药华蟾素混合碘油栓塞，华蟾素肝动脉灌注，治疗１０例晚期肝癌。结果：ＰＲ８例，ＮＣ２例，大部分临床症状得到改善，无明显的副作用。结论：本方法可使肝癌多次缺血并得到药物灌注的双重作用，从而提高了晚期肝癌的临床疗效，延长生存期，尤适合于肿瘤较大，并有一定程度肝功能损害的肝癌患者，此方     

华蟾素持续动脉灌注联合栓塞治疗原发性肝癌32例

[目的]观察华蟾素持续动脉灌注联合栓塞治疗原发性肝癌的临床疗效。[方法]64例原发性肝癌患者随机分成治疗组（32例）和对照组（32例）,治疗组采用经右股动脉穿刺并于大腿内侧皮下留置化疗泵内灌注华蟾素注射液并进行栓塞治疗;对照组仅采用常规右股动脉穿刺插管肝动脉化疗栓塞术。[结果]治疗组和对照组有效率分别为62.5%和61.3%（P〉0.05）。治疗后治疗组AFP下降率优于对照组（P〈0.05）。[结论]原发性肝癌患者使用华蟾素注射液持续动脉灌注联合栓塞治疗可以有效抑制肿瘤生展,延长生存期,且具有改善肝功能的作用。     

晚期肝癌肝动脉灌注化疗(附43例)

目的:观察晚期肝癌的灌注化疗与传统的全身化疗的疗效比较。方法:对43例晚期肝癌用区域化疗或超选择动脉灌注化疗与21例传统的全身化疗进行疗效比较。结果:动脉化疗疗效高、毒副反应少。结论:对失去手术治疗机会的晚期肝癌患者,肝动脉灌注化疗效果好。     

双途径介入化疗与单纯肝动脉栓塞化疗治疗晚期肝癌的临床观察

目的研究肝动脉化疗栓塞基础上经皮经肝门静脉灌注化疗治疗晚期肝癌的疗效.方法对49例不能手术切除的晚期原发性肝癌随机分组,行单纯肝动脉化疗栓塞治疗与在肝动脉化疗栓塞基础上加用经肝门静脉灌注化疗,对比分析.结果肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌患者的半年、一年、二年、三年生存率分别为100%、76.5%、35.29%、23.53%,AFP及全身转移的发生率明显降低,与对照组有显著差异.结论肝动脉化疗栓塞基础上经肝门静脉灌注化疗治疗晚期肝癌疗效优于单纯性经肝动脉化疗栓塞.     

肝动脉灌注羟基喜树碱等合并栓塞治疗原发性肝癌41例报告

目的:观察以羟基喜树碱(HPT)为主的化疗药经肝动脉灌注合并栓塞治疗中晚期原发性肝癌的疗效.方法:从1993年9月～1998年2月,采用HPT、吡柔比星、顺铂或5-氟脲嘧啶与碘化油联合经肝动脉灌注栓塞,治疗不能手术的中晚期肝癌41例.结果:41例患者共接受102次介入治疗.部分缓解21例,稳定16例,进展4例,总有效率51.2%.30例患者血清AFP≥200ug/L,经治疗后22例AFP明显下降或恢复正常.生存率6个月为87.2%,1年58.1%,2年19.0%.不良反应主要为骨髓抑制(Ⅰ度～Ⅲ度)和消化道反应(Ⅰ度～Ⅱ度).结论:肝动脉灌注以HPT为主的药物合并栓塞治疗中、晚期肝癌,疗效好,毒副反应小.     

肝脾动脉双栓塞治疗原发性肝癌合并脾机能亢进21例

目的探讨肝脾动脉栓塞治疗原发性肝癌合并脾机能亢进的疗效及价值.方法采用Seldinger技术,将导管插至脾动脉,先行部分脾栓塞术,后插入肝动脉行灌注化疗栓塞术.结果21例病人均不同程度的改善了临床症状,肝癌治疗的有效率达80.9%,脾亢治疗的有效率达100.0%.结论肝脾动脉双栓塞治疗原发性肝癌合并脾机能亢进疗效确切,创伤小,具有较高的治疗价值.     

国人精确放疗联合经肝动脉化疗栓塞术治疗原发性肝癌疗效的Meta分析

目的:比较精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌与单纯经肝动脉灌注化疗栓塞治疗的疗效。方法:通过计算机和手工检索全面收集国内关于精确放疗联合经肝动脉灌注化疗栓塞与单纯经肝动脉灌注化疗栓塞治疗原发性肝癌的临床对照研究文献,并按Cochrane协作网推荐的方法进行Meta分析。采用RevMan 5.0软件,应用固定效应模式分析,对符合纳入标准的12个研究进行Meta分析。结果:与单纯经肝动脉灌注化疗栓塞相比,精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌,肿瘤有效率与控制率均有明显提高,远期生存率亦有明显提高,两者间差异有显著性。结论:精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌疗效好,安全性高,值得推广。     

反复暂时性肝动脉门静脉阻断并介入治疗晚期肝癌

反复暂时性肝动脉阻断（ＲｅｐｅａｔｅｄＴｅｍｐｏｒａｒｙＢｌｏｃｋａｄｅｏｆｔｈｅＨｅｐａｔｉｃＡｒｔｅｒｙ简称ＲＴＢＨＡ），对晚期肝癌是较为理想的一种新的治疗方法。作者在ＲＴＢＨＡ的基础上采用双重阻断血流的方法配合双灌注介入化疗，治疗了１２例晚期不...     

原发性肝癌肝动脉化疗栓塞合并LAK/IL-2灌注治疗的临床Ⅲ期观察

评价肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗原发性肝癌的初步疗效。方法不能切除的肝癌患者经肝动脉化疗栓塞后灌注自体ＬＡＫ细胞及ＩＬ┐２，并与单独行肝动脉化疗栓塞的不能切除肝癌患者比较其肿瘤大小，生活质量的变化及毒副反应。结果经肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗的２２例肝癌有效率（ＣＲ＋ＰＲ）为１３．６％，包括１例完全缓解和２例部分缓解，而单独化疗栓塞对照组１７例中仅１例显示部分缓解（有效率５．９％）。化疗栓塞＋ＬＡＫ／ＩＬ┐２治疗组与单独化疗栓塞对照组中ＭＲ、ＳＤ、ＰＤ分别为５、１２、１例和１、１１、４例。治疗组中大多数病人生活质量改善或稳定，而对照组中生活质量则无提高。两组病人的毒副反应均较轻而短暂。结论经肝动脉化疗栓塞合并ＬＡＫ／ＩＬ┐２灌注治疗原发性肝癌疗效较优于单独肝动脉化疗栓塞治疗，原发性肝癌更有效的综合治疗方案有待进一步探索     

合并门脉高压症的重度肝硬化肝癌的治疗

目的　探讨合并门脉高压症的重度肝硬化肝癌的治疗方法。方法　对 48例合并门脉高压症重度肝硬化肝癌在肿瘤TNM临床分期 (CTNM)诊断的基础上 ,分别采用联合切除手术治疗、姑息切除术后插管化疗、肝动脉介入治疗及全身化疗等不同治疗方法。结果　经上述多途径分类治疗后 ,48例均获得较为满意的临床疗效。尤其是 6例不能手术切除的巨大重度肝硬化肝癌患者在经肝动脉介入治疗后 ,获得再手术机会成为一个有希望的治疗模式。结论　外科手术治疗的疗效仍居各种疗法之冠 ,对于失去手术机会的中、晚期重度肝硬化肝癌 ,肝动脉介入治疗是首选方法。     

Radiotherapy and intra-arterial chemotherapy of locally advanced hepatocellular carcinoma. Analysis of prognostic factors]

Prognostic factors in the treatment of local advanced hepatocellular carcinoma with radiotherapy, transcatheter arterial embolization and arterial infusion. PURPOSE: The treatment effects of radiotherapy and combination modality therapy for the local advanced hepatocellular carcinoma (HCC) were retrospectively reviewed. MATERIAL AND METHODS: Three hundred and fifty-six patients of HCC (187 recurrent cases after surgical resection) were treated by 1) radiotherapy only; 2) Bi-therapeutic method: hepatic artery ligation (HAL) and/or hepatic artery embolization (HAE) plus radiotherapy; and 3) tri-therapeutic method (bi-therapeutic method plus hepatic artery infusion) from 1975 to 1996. Kaplan-Meier method has been used to evaluate the survival rates. RESULTS: There were no significant differences among these three treatment groups in the symptom relief rate, but the mean relief time period was much shorter in radiotherapy alone group (2.5 vs 44 months, P < 0.05). A lower tumor response rate was found in the radiotherapy alone group (P < 0.05), although that was similar for both primary or recurrent tumors (P > 0.05). There were evident differences in five-year survivals among these three treatment groups: 0% for radiotherapy alone, 22.8% for bi-therapeutic method and 38.8% for tri-therapeutic method (P < 0.01). The prognosis was influenced by Okuda classification. CONCLUSION: Non-resectable local advanced HCC can be treated by the combination modality therapy, including radiotherapy, with a quite high cure rate. Radiotherapy alone can relief the symptoms.     

Modified pharmacokinetic modulation chemotherapy (PMC) with medication of UFT and intraarterial infusion of 5-FU for advanced unresectable HCC

Advanced unresectable hepatocellular carcinoma (HCC) was treated with modified pharmacokinetic modulation chemotherapy (PMC). METHOD: Modified PMC consists of medication with UFT and intraarterial infusion of 5-FU. The dose of UFT is 300 or 400 mg/day. The infusion to hepatic artery of 5-FU is performed with 500 mg/body in an outpatient clinic once a week from reservoir port for 5 hours. RESULTS: The number of recurrent cases after hepatectomy was 5, and that of initial cases with unresectable HCC was 3. Three cases had tumor thrombus in the main portal branch. One patient had tumor thrombus in the inferior vena cava, which reached to the right atrium. The mean number of infusions in all cases was 21. One case showed PR, and 3 cases NC. Three of 6 mortality cases died from liver failure without tumor progression. One year survival rates of the patients with tumor thrombus in the portal trunk or IVC were 75.0%. The mean survival period of these cases was 12.5 +/- 4.2 months. CONCLUSION: Modified PMC had no severe side effect and was effective for advanced unresectable HCC.     

肝动脉解剖变异在肝癌介入治疗中的临床价值

 目的 探讨肝动脉解剖变异在肝癌介入治疗中的临床价值。方法 本文收集2003年1月～2004年6月在同济医院放射科做肝动脉化疗栓塞术（TACE）和肝动脉栓塞（TAE）的中晚期肝癌150例，将每例病人的肝动脉造影所见与临床资料及随访结果一起进行分析。结果 150例中，有肝动脉变异者23例，占全部病例的15．3％。结论 表明肝动脉变异发生率较高。同时发现有些病例虽然肝动脉及其分支无变异，但肝动脉走行位置变异，对选择性肝动脉插管有较大影响。作者对肝动脉变异的类型、肝动脉走行位置异常、以及它们在肝癌介入治疗中的意义进行了讨论。     

Chemoembolization therapy with lipiodol, cisplatin and etoposide for hepatocellular carcinoma

Chemoembolization using CDDP, VP-16 and lipiodol was carried out for 7 patients with hepatocellular carcinoma (HCC). CDDP/lipiodol, CDDP/VP-16, CDDP/lipiodol (lipiodol 2-10 ml, CDDP 1-2 mg/kg, VP-16 100 mg/body) and gelatine sponge were administered in that order through the catheter located in the proper, or right or left hepatic artery. Three patients underwent hepatic resection 38-50 days after this treatment. Complete necrosis of the tumor was recognized in the one case, although the portion of necrosis did not exceed 70% in large sized HCC as the diameter of more than 10 cm. In 4 unresectable cases the decreases in tumor size were observed by ultrasonography and computed tomography. The response was: 3 partial responses and 1 no change. One out of 4 cases could undergo hepatic resection 17 months after this treatment. Two patients are alive 20 months after this treatment, although one patient died of HCC after 25 months. Serious side effect was not observed.     

以外科手术为主综合治疗小肝癌134例临床报告

背景与目的：手术切除是治疗小肝癌的首选方法,但术后5年复发率高达35．4％－45．3％,是影响手术疗效的关键因素。本研究拟探讨以外科为主的综合治疗来降低小肝癌术后复发率。方法：以外科为主综合治疗小肝癌（直径≤5cm）患者134例,男119例,女15例,年龄18－70岁,中位年龄45岁;手术切除（切除组）121例,其中,不规则性肝叶切除16例,局部切除83例,肝叶或肝段切除12例,左半肝切除2例,联合胆吓切除8例;切除后切缘注射无水酒精或用渗入无水酒精的明胶海绵包埋于瘤床共22例。手术不能切除13例,行肝固有动脉结扎合并肝动脉及门静脉双插管化疗或瘤体内注射无水酒精或冷冻、射频治疗、微波固化、栓塞化疗等。结果：小肝癌手术切除率90．3％,无手术死亡。切除组术后1、3、5、10年生存率分别为89．3％、74．4％、64．6％和43．8％;术后1、3、5年复发率分别为11．9％、23．8％和32．1％。全组1、3、5、10年生存率分别为88．8％、72．2％、63．4％和41．7％;1、3、5年复发率分别为15．9％、29．1％和36．6％。结论：手术切除是治疗小肝癌的有效方法,以个体化为原则外科为主的综合治疗可降低术后复发率,提高小肝癌治疗效果。     

~（131）I美妥昔单抗治疗79例原发性肝癌的近期疗效及毒副作用观察

目的：总结131I美妥昔单抗（商品名：利卡汀）治疗中晚期原发性肝癌（HCC）的近期疗效及毒副作用。方法：已确诊的HCC患者79例,采用经肝动脉途径灌注利卡汀治疗。治疗后每月随访患者一般情况、影像学改变、甲胎蛋白（AFP）、肝功能、外周血白细胞、血小板变化等。对治疗前不同肝功能分级患者复发情况进行比较,评价近期疗效及毒副作用。结果：利卡汀治疗后71例随访的患者中1个月无复发率为100%,3个月无复发率为76.1%,6个月无复发率为28.2%。所有患者中死亡14例,占19.2%,中位生存时间8个月。均未发生与治疗药物相关的严重并发症。结论：131I美妥昔单抗用于不可手术切除肝癌患者,尤其是肝功能情况较好患者的疗效明显;是原发性肝癌治疗中的一种新型、有效的治疗方法。     

多层螺旋CT血管成像在肝癌化疗栓塞中的临床指导作用

背景与目的：多层螺旋CT血管成像具有扫描速度快、覆盖范围大、肝脏血管图像清晰．多角度三维显示等特点,对肝脏病变的诊断和治疗已显示出重要价值。目前对于多层螺旋CT肝脏血管三维成像的研究主要集中在肝脏肿瘤、肝移植术前评价及肝脏血管系统解剖,对于指导肝癌动脉化疗栓塞的研究仍然有限。本研究通过对比分析肝癌患者肝脏多层螺旋CT血管成像（muhislice CT angiography,MSCTA）与数字减影血管造影（digital subtraction angiography,DSA）图像．探讨MSCTA在肝癌肝动脉化疗栓塞治疗中的临床指导作用。方法：本组50例肝癌患者行多层螺旋CT肝脏双期增强扫描。采用最大密度投影（maximal intensitypmjection,MIP）和容积再现（volume rendering technique,VRT）重建技术行肝动脉、门静脉血管成像,再经股动脉插管分别行腹腔动脉、肠系膜上动脉、肾动脉、膈动脉DSA造影及TACE治疗,对比分析肝癌MSCTA与DSA图像。结果：肝动脉解剖分型和肿瘤供血动脉来源的DSA与MSCT的MIP、VRT血管成像显示符合率达到100％,χ^2检验,两者间差异无统计学意义（P=1．00）,而对肝动门脉瘘及门脉癌栓的显示MSCTA比DSA更有优势。结论：MSCTA检查无创、简单易行,其图像的三维重建立体感强,可准确提供肝动脉、门静脉及肿瘤供血来源等信息,对指导肝癌经肝动脉化疗栓塞有很好的临床指导作用。     

Combined pancreatoduodenectomy and orthotopic liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus： A case report

Hepatocellular cancer (HCC) is the most common primary malignant hepatic tumor that accounts for over 80% of primary liver tumors. The outlook for HCC is dismal if it is left untreated and the treatment for patients with HCC evolved into a complex task. The treatments for HCC are mainly surgical therapies including hepatic resection (HR) and liver transplantation. Although HR is a well accepted therapy for HCC, it is not suitable for patients with advanced cirrhosis. Orthotopic liver transplantation (OLT) is considered more appropriate in cases with HCC related to cirrhosis, because it may eliminate both the tumor and the underlying liver disease. In this study, we reported a patient with HCC and portal vein tumor thrombus underwent combined pancreatoduodenectomy with OLT and survived 23 months in our center.     

Correlation of the Appearances of DSA with VEGF Expression and Its Clinical Significance in Patients with Primary Hepatocellular Carcinoma

目的探讨原发性肝癌患者的数字减影血管造影(DSA)表现和血管内皮细胞生长因子(VEGF)水平之间的关系。方法对24例原发性肝癌患者30次进行DSA的同时选用酶联免疫吸附定量法检测血清的VEGF水平。结果24例HCC血管造影中,18例有肝动脉肿瘤染色,瘤区肝动脉染色15例为多血供,3例为少血供;4例仅表现为门静脉供血; 1例为肠系膜上动脉供血,且合并大量门静脉瘘;另1例肿瘤无血供,HCC组血清VEGF表达水平(194．5±14．2)ng/L与对照组(132．4±47．9)比较,有显著性差异(P<0．01)。结论肝癌病灶血供丰富或伴有动静脉瘘形成者,血循环中VEGF浓度明显增高,且和肝内播散、肝癌复发及转移呈正相关。     

肠细膜上动脉供血型肝癌的血管造影分析及介入治疗

目的 研究肠细膜上动脉供血型(即变异肝动脉起源于肠细膜上动脉)肝癌的血管造影表现及插管技术。 方法 回顾分析41例肠细膜上动脉供血型肝癌的DSA及介入治疗资料,统计血管解剖变异的发生率,对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。 结果 350例肝癌中,肠细膜上动脉供血型41例(11.9％),其中副肝右动脉15例(36.5％),替代肝右动脉16例(39.0％),肝总动脉8例(19.5％),腹腔动脉干起源于肠细膜上动脉2例(5％)。31例肠细膜上动脉发出替代或副肝右动脉者,29例(94.0％)腹腔动脉造影表现为肝右动脉细小或缺如,肝右叶出现无血管区。RH导管超选择性插管成功25例(61％),未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。 结论 肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血,熟悉其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。