肝动脉化疗栓塞治疗原发性肝癌中碘油沉积良好患者疗效观察

目的：评价肝动脉化疗栓塞治疗原发性肝癌中碘油沉积良好患者疗效。:方法：采用Kaplan-Meier统计学方法对144例碘油沉积良好的原发性肝癌患者进行回顾性分析,计算其生存率。结果：144例患者总体1、2、3、4、5年生存率分别为85．0％、 63．7％、51．7％、33．9％、16．9％。与本科报道的肝癌总体生存率比较,1、2、3、4年生存率有显著性差异（P＜0．001）,5年生存率无明显差异（P＝0．88）。结论：肝TACE治疗中肝瘤内碘油沉积良好能提高肝癌患者近期的治疗效果和1、2、3、4年生存率,但5年以后的远期疗效欠佳。肝TACE治疗的同时需对患者进行综合治疗才能进一步提高疗效。     

原发性肝癌肝动脉化疗碘油栓塞后的MRI诊断价值

目的 研究MRI检查技术，尤其是FSET2WI和多时相快速动态增强扫描评价原发性肝癌动脉化疗碘油栓塞后（TACE）的影像学表现，探讨其临床应用价值。方法收集2000年9月至2004年7月肝癌病例30例（共37个病灶），于TACE后2～6个月行GE1．5TMRI检查，并于MRI检查后2～6d行DSA检查。研究肝癌TACE后肿瘤的坏死或存活的MRI信号特点，以及MRI和DSA在显示肿瘤存活结果的符合情况。结果37个肝癌TACE术后病灶中，MRI明确判断21个病灶有肿瘤残存，16个病灶凝固坏死明显。MRI判断病灶残存的敏感性为91．3％，特异性100％，准确性94．6％。与DSA相比无明显统计学差异（P〉0．05）。结论FSET2WI和多时相快速动态增强扫描序列相结合，同时观察病灶周围的完整与否，可以准确地判断肝癌TACE后肿瘤的坏死或残存。作为一种无创伤性检查。可以作为评价肝癌TACE术后疗效的首选检查。     

经肝动脉碘油化疗栓塞术治疗原发性肝癌疗效分析——附38例报告

经肝动脉碘油化疗栓塞术（Lp－TAE）是目前治疗中晚期肝癌的重要方法,已经收到较好的治疗效果。1992年8月至1997年12月对我院失去手术机会的原发性肝癌38例经Lp-TAE治疗90次,现就其疗效分析报导。1临床资料和治疗方法1．1一股资料本组对例,男28例,女10例,年龄最小35岁,最大67岁,平均56.5岁。川T＞对出呼”119例,IIB6Ag阳性2例,川0＞8以我院周工正常值5－25U）21例,肝硬化伴腹水、黄殖、脾大、A／G倒置者u例。按ChilCe分级肝功能A级15例,B级14例,C级9例。38例肝癌均经B超、CT、肝动脉造影确诊,肝占位病变5．Icmx4．gc…     

彩色多普勒超声在肝细胞癌经动脉化疗栓塞术后的应用

对于失去手术机会的肝细胞肝癌,介入治疗是目前比较公认的首选治疗方法,但因其复发、转移率高,故术后寻找一种简便、有效的监测方法客观评价其疗效显得尤其重要。本文综述了彩色多普勒超声在肝细胞肝癌经动脉化疗栓塞术后评价的应用,及与其他影像学方法比较和其优势所在。     

原发性肝癌动脉化疗栓塞术少见严重并发症分析

目的：对原发性肝癌（primary hepatic carcinoma ,PHC）动脉化疗栓塞术（transcatheter arterial chemoemboli-zation ,TACE）术后发生的少见严重并发症发生原因做相关分析。方法分析2010年1月～2013年10月间351例PHC患者行TACE治疗患者资料,对发生少见严重并发症的患者影像及临床相关资料做相应分析,以期得出不同严重并发症的发生原因及预防措施。结果少见严重并发症包括肝破裂出血3例,1例经保守治疗后好转,2例死亡;肝脓肿2例,1例经抗感染及脓肿穿刺引流治愈,1例发生感染性休克而死亡;1例食管胃底静脉曲张破裂大出血,经内科止血处理好转;1例并发急性胆囊炎经对症处理后好转;余3例分别死于碘油脑栓塞（cerebral lipiodol embolism ,CLE）、肺栓塞和股动脉延迟出血。结论原发性肝癌T ACE治疗严重并发症临床少见,一旦发生可能危及患者生命,因此严格遵循PHC诊疗规范,把握适应证,合理控制化疗药物剂量技术及栓塞程度。     

平阳霉素碘油乳剂栓塞治疗原发性肝癌的临床研究

评价平阳霉素碘油乳剂肝动脉栓塞对原发性肝癌肿瘤血管的祛血管作用及其强度和相应临床疗效。方法：对１１例原发性肝癌肝动脉注入ＰＬＥ,同期１８例原发性肝癌以丝裂霉素碘油乳剂作对照,观察并比较两组栓塞后肿瘤血管及肿瘤体积变化。结论ＰＬＥ对原发性肝癌肿瘤血管有祛血管作用,其强度大于ＭＬＥ。祛血管同时伴随肿瘤体积缩小。     

超声评价原发性肝癌肝动脉化疗栓塞后疗效的价值及前景

肝动脉化疗栓塞术(transcatheter arterial chemoemboliza-tion,TACE)作为治疗不能手术切除的肝细胞肝癌(hepatocel-lular carcinoma,HCC)首选方法在临床广泛应用,目前多用碘化油作为栓塞剂,但是,TACE后切除的HCC病灶,病理切片显示仅有22%~50%的肿瘤组织完全坏死,肿瘤易复发[1],因此,治疗后对病灶及血供情况随访观察、判定疗效对制订进一步的治疗方案非常必要。数字减影血管造影(digital subtrac-tion angiograpy,DSA)是评价TACE疗效最有价值的检测手段之一[2],但是由于其为有创性检查,不能作为常规随访手段。CT、MRI及超声检查…     

肝动脉化疗栓塞序贯冷循环射频消融治疗原发性肝癌的体会

目的 评价肝动脉化疗栓塞术（TACE）联合冷循环射频消融术（RFA）治疗原发性肝癌的临床价值。方法 65例原发性肝癌分为单纯TACE治疗组31例,TACE联合冷循环射频消融术治疗组（TACE＋RFA组）34例。治疗后通过DSA、CT、超声检查及血清甲胎蛋白（AFP）测定评价。结果 单纯TACE组的肿瘤完全坏死率、复发率、1年生存率分别为16．1％、48．4％、48．4％,TACE＋RFA联合组分别为47．1％、17．7％、79．4％,两组比较有极显著统计学差异（P〈0．01）;单纯TACE组的肿瘤缩小率、AFP下降率分别为22．6％、19．4％,TACE＋RFA联合组分别为32．4％、44．1％,两组比较差异有显著性（P〈0．05）。结论 TACE＋RFA较单纯TACE治疗中晚期肝癌效果好,是治疗中晚期肝癌的一种有效方法,值得提倡。     

Computed tomography after Lipiodol chemoembolization in hepatocellular carcinoma

In order to ascertain the patterns of Lipiodol uptake and the diagnostic value of Lipiodol-CT in hepatocellular carcinoma (HCC), we present a retrospective analysis of CT and histological findings after Lipiodol chemoembolization. After chemoembolization 22 consecutive patients with H HCC wer studied with CT and pathological cor relat ion was available in all cases. Two patterns of Lipiodol uptake were defined: nodular (with complete or incomplete Lipiodol retention) and diffuse pattern. Lipiodol-CT demonstrated all principal tumors and 7 satellite CT lesions in 16 cases of nodular pattern, while 13 satellite lesions were not detected. Significant tumor necrosis (mean necrotic rate >90 %) was detected in 13cases of nodular pattern with complete Lipiodol retention. No significant necrosis was present in nodular pattern with incomplete retention, nor in diffuse pattern. Lipiodol-CT remain, an important diagnostic cool in presurgical evaluation of HCC, although some satellite lesions remain undetected. Nodular pattern correlates well with significant necrosis, but diffuse pattern does not.     

Determination of the optimum dose level of lipiodol in transcatheter arterial embolization of primary hepatocellular carcinoma based on retrospective multivariate analysis

Purpose Multivariate analysis was used to study the effectiveness and optimum dose level of Lipiodol (LP) in transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC).Methods A total of 219 cases of nodular type HCC, with a tumor diameter less than 7 cm, were studied. TAE was performed using both Gelfoam sponge (GS) and LP in 158 cases; in the remaining 61 cases only GS was used.Results Statistical stepwise variable selection revealed that only LP had a negative T-value, suggesting that LP is a useful factor for prognosis. The most favorable effect on patient prognosis was obtained with an LP dose level (expressed in mm) of 1–1.5 times the absolute value of the tumor diameter (expressed in cm).Conclusion A significant difference (p < 0.01, logrank test) in survival was found between the GS with LP group and the GS only group, using Cox's proportional hazard model.     

术前经动脉化疗栓塞对肝癌细胞增殖的影响

目的　评价术前经导管动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)对肝细胞癌细胞增殖的影响。方法　经手术病理证实的肝细胞癌 136例 ,其中行 1～ 5次TACE后Ⅱ期手术切除 79例 (TACE组 ) ,按治疗方式不同分 4组 ,A组 11例 ,仅灌注化疗药物 ,治疗 1～ 4次 ;B组 33例 ,化疗药加碘化油栓塞 ,治疗 1～ 5次 ;C组 2 3例 ,化疗药加碘化油加明胶海绵颗粒栓塞 ,治疗 1～ 3次 ;D组 12例 ,化疗药加碘化油、无水乙醇、明胶海绵颗粒栓塞 ,治疗 1～ 3次。单纯手术 5 7例 (非TACE组 ) ,用免疫组化检测各标本Ki 6 7和增殖细胞核抗原 (PCNA)蛋白表达。结果　TACE组的C组和D组较非TACE组Ki 6 7和PCNA蛋白表达显著降低 (P <0 .0 5 )。A组和B组较非TACE组Ki 6 7和PC NA蛋白表达显著增高 (P <0 .0 5 )。结论　多材料联合栓塞TACE后肝癌细胞的增殖活性受抑制 ,而单材料栓塞、单纯化疗后肝癌细胞的增殖活性得到增强。     

肝细胞癌化疗栓塞后胰岛素样生长因子-2与转移关系的研究

目的前瞻性评估肝细胞癌(HCC)经导管化疗栓塞(TACE)前后血清胰岛素样生长因子(IGF-2)表达变化与转移的关系。方法采用ELISA法对62例HCC患者分别于TACE术前、术后4周测血清IGF-2值,术后6个月评估远处转移发生情况。结果62例HCC患者术前血清IGF-2值为(6.74±0.04)pg/ml,术后血清IGF-2值较术前增高(P<0.05)。在碘油分布不均匀及门静脉癌栓组中,血清IGF-2值增高。血清IGF-2升高者中,半年内有20例发生远处转移,而血清IGF-2值下降组仅2例。结论HCC患者TACE后血清IGF-2增加,与转移发生有关;IGF-2可以作为提示转移发生的监测指标。     

Postoperative recurrence of hepatocellular carcinoma: Results of transcatheter arterial chemoembolization

A retrospective analysis was made of the effect of transcatheter arterial chemoembolization (TACE) in 87 patients with recurrent hepatocellular carcinoma (HCC). In contrast to the predominantly single nodular HCC (60.2%) on preoperative angiography, recurrent HCC showed a multinodular pattern in 54.2%. Preoperative TACE had significantly prolonged the interval between surgery and recurrence. One- and 2-year survival rates after TACE of the 87 recurrent HCCs were 74.7% and 55.%, respectively, which were not significantlydifferent from those of a control group of 206 patients with HCC in Child's class A, who were treated with TACE only. We believe that TACE is an effective measure in the management of preoperative and recurrent HCC.     

肝动脉导管栓塞化疗治疗肝癌的护理

目的:探讨肝动脉栓塞化疗治疗肝癌的术前、术后的护理措施。方法:对36例行TACE的患者在术前充分准备、术后精心护理。结果:肝动脉栓塞化疗治疗有效率82 % ,术后出现不良反应的患者,经对症治疗、护理均痊愈。结论:肝动脉栓塞化疗治疗肝癌是手术不能切除或术后复发HCC的首选方法,细致、周到的护理是治疗成功的重要保证     

Therapeutic effectiveness of segmental arterioportal chemoembolization via hepatic artery for localized hepatocellular carcinoma

Segmental arterioportal chemoembolization via hepatic artery with overflow to the segmental portal vein was performed in 41 patients with hepatocellular carcinoma. Emulsion of doxorubicin (mean 37 mg) and two-to-three volume of iodized oil (mean 11 ml) was infused from a segmental artery of the liver until the segmental portal branches around the tumor were visualized fluoroscopically. By the iodized oil accumulation, the tumors were divided into five types: single nodular (SN); single nodular with proliferation (SN-P); multinodular fused (MN-F); multinodular (MN); and massive. Massive and MN types showed high incidence of local recurrence. However, SN-P and MN-F types showed a good tumor response and no local recurrence. In 32 unresected cases the overall response rate was 53%, the 1-year actuarial survival was 90% and 3-year survival was 43%. Six of nine operative specimens revealed complete necrosis of the tumor microscopically and three showed 90–95% necrosis. Thick fibrous capsules were found in all nine resected cases around the necrosis both of the tumor and of the non-cancerous parenchyma. This therapy was regarded as having a great capacity to kill the infiltrative portion of localized tumor and the thick capsule may be a peculiarity of this therapy which played a major role in guarding against regrowth of the tumor. Correspondence to: H. Oi