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1.
目的观察肝动脉栓塞化疗联合氩氦刀冷冻消融治疗不能手术的中晚期肝癌的有效性和安全性。方法对35例原发性肝癌患者首先进行动脉栓塞化疗治疗,2~3周后进行氩氦刀冷冻消融治疗,氩氦刀冷冻消融治疗后1~2周再次进行动脉栓塞化疗,治疗结束后评价近期疗效,并随访生存情况。结果35例患者均可评价疗效,其中完全缓解7例,部分缓解21例,稳定4例,进展3例,临床有效率为80.00%(28/35),疾病控制率为91.43%(32/35)。患者中位无进展生存(PFS)为8.9个月,中位总生存(OS)为16.3个月。结论肝动脉栓塞化疗联合氩氦刀冷冻消融治疗不能手术的原发性肝癌创伤小、恢复快、并发症少、疗效可靠。  相似文献   

2.
氩氦冷冻消融治疗原发性肝癌临床研究   总被引:1,自引:0,他引:1  
[目的]回顾性分析氩氦冷冻消融治疗肝细胞癌(HCC)的临床疗效。[方法]227例HCC患者,按巴塞罗那分期标准:早期26例、中期73例和进展期128例,行经皮穿刺氩氦刀冷冻消融治疗。[结果]氩氦冷冻消融治疗HCC后随访12—63个月,早期、中期及进展期HCC患者中位生存期分别为36、23和12个月。早期生存期为37.8±13.8个月,1、2、3、5年生存率分别为92.3%、84.6%、65.4%、11.5%;中期生存期为24.5±9.7个月,1、2、3年生存率分别为84.9%、56.2%、21.9%;进展期生存期为16.9±8.4个月,1、2、3年生存率分别为68.8%、22.7%、6.3%。AFP阳性HCC患者治疗后28.1%的患者转为阴性;55.6%的患者术后4周AFP明显降低:上消化道出血是HCC患者的主要死亡原因。[结论]氩氦冷冻消融并发症少、消融彻底;不同分期HCC的生存时间、生存中位数有显著差异,以早期最长;以延长进展期HCC生存期最明显,是一种较理想的消融治疗肝癌手段。  相似文献   

3.
 目的探讨氩氦刀冷冻消融治疗肝硬化性、原发性肝癌并发症的防治。方法60例不宜手术切除的中晚 期原发性肝癌患者,在超声引导下行氩氦刀冷冻消融治疗,观察术后并发症的发生并总结预防及治疗经验 。结果肝硬化原发性肝癌氩氦刀冷冻消融治疗可出现多系统、多器官的并发症,经积极干预,并发症明显 减少,部分可恢复。本组研究中胸腔积液比例明显高于文献,未出现致命性并发症。结论氩氦刀冷冻消融 治疗肝硬化基础上的原发性肝癌是一种创伤小、疗效显著且安全的方法,其并发症是可防可控的。  相似文献   

4.
目的:观察氩氦刀联合肝动脉化疗栓塞术治疗原发性肝癌的疗效。方法:40例原发性肝癌病人,根据病人情况选择TACE术和氩氦刀冷冻消融术治疗的先后顺序。1月后复查血清AFP、肝脏CT增强扫描及肝动脉造影(DSA)检查。随诊12个月。结果:治疗前AFP〉400ng/ml,治疗后下降〉50%者83.9%(26/31);肝脏CT增强扫描及DSA造影提示:肿瘤完全坏死50.0%(20/40);不完全坏死27.5%(11/40);部分坏死22.5%(8/40)。6个月、12个月生存率分别为91.0%和76%。治疗中、 治疗后未发生严重并发症。结论:氩氦刀联合肝动脉化疗栓塞术治疗原发性肝癌疗效确切,不良作用少。  相似文献   

5.
目的探讨B超引导氩氦刀冷冻治疗肿瘤的价值.方法无法手术切除的原发性肝癌、腹后腔血管内皮肉瘤、左肺鳞状细胞癌及右甲状腺髓样癌患者各一例在B超引导下进行氩氦刀冷冻治疗.结果4例患者三个月后B超及CT复查瘤体均缩小1/3,临床症状明显好转.结论B超引导氩氦刀冷冻治疗,定位准确,安全可靠,效果明显,具有重要的价值及临床意义.  相似文献   

6.
B超引导氩氦民冷冻治疗肿瘤的价值   总被引:1,自引:0,他引:1  
目的探讨B超引导氩氦刀冷冻治疗肿瘤的价值.方法无法手术切除的原发性肝癌、腹后腔血管内皮肉瘤、左肺鳞状细胞癌及右甲状腺髓样癌患者各一例在B超引导下进行氩氦刀冷冻治疗.结果4例患者三个月后B超及CT复查瘤体均缩小1/3,临床症状明显好转.结论B超引导氩氦刀冷冻治疗,定位准确,安全可靠,效果明显,具有重要的价值及临床意义.  相似文献   

7.
氩氦刀联合肝动脉化疗栓塞术治疗原发性肝癌的临床研究   总被引:1,自引:0,他引:1  
目的:观察氩氦刀联合肝动脉化疗栓塞术治疗原发性肝癌的疗效.方法:40例原发性肝癌病人,根据病人情况选择TACE术和氩氦刀冷冻消融术治疗的先后顺序.1月后复查血清AFP、肝脏CT增强扫描及肝动脉造影(DSA)检查.随诊12个月.结果:治疗前AFP>400ng/ml,治疗后下降>50%者83.9% (26/31);肝脏CT增强扫描及DSA造影提示:肿瘤完全坏死50.0% (20/40);不完全坏死27.5% (11/40);部分坏死22.5% (8/40).6个月、12个月生存率分别为91.0%和76%.治疗中、治疗后未发生严重并发症.结论:氩氦刀联合肝动脉化疗栓塞术治疗原发性肝癌疗效确切,不良作用少.  相似文献   

8.
氩氦刀冷冻消融治疗原发性肝癌的临床研究   总被引:8,自引:0,他引:8  
[目的]探讨氩氦刀冷冻消融综合治疗中晚期肝癌的疗效。[方法]96例中晚期原发性肝癌分3组观察。第一组用氩氦刀冷冻消融联合TACE治疗37例;第二组单纯用氩氦刀冷冻消融32例:第三组单纯用TACE27例。氩氦刀冷冻消融采用B超/或CT引导经皮穿刺肝肿瘤,共计对97个病灶使用203把氩氦刀二次循环冷冻。[结果]氩氦刀冷冻术后有94.2%(65/69)的患者精神状态得到改善,腹部疼痛症状减轻,恢复快。氩氦刀超低温冷冻联合TACE的近期疗效和12、24个月的生存率明显优于另外两组,中位生存期延长(P<0.05)。[结论]氩氦刀联合TACE是治疗肝癌有效的方法之一,可望提高肝癌患者生存期和改善生命质量,为丧失手术机会的晚期肝肿瘤患者开辟了一条新的治疗途径。  相似文献   

9.
氩氦刀靶向冷冻治疗肝癌的初步研究   总被引:1,自引:1,他引:1  
目的 初步建立氩氦刀靶向冷冻治疗肝癌的技术和探讨其原理、安全性及近期疗效。方法 8例无法手术的原发和继发性肝癌,其中3例术前行肝动脉栓塞化疗,采用氩氦超导手术系统(简称氩氦刀),分别在CT、DSA定位或术中直视下对肿瘤病灶行冷冻治疗。结果 8例患者冷冻治疗后无手术死亡、出血、胆瘘、皮肽冻伤、感染、穿刺道种植转移等严重并发症。术后CT影像能观察到病灶冷冻治疗的有效范围,3例术前接受肝动脉栓塞化疗者术后1-6个月瘤体有进一步不同程度的缩小。3例原发性肝癌术前AFP值增高的患者术后均有下降。治疗后随访2-11个月,仅1例死于全身转移,其余均存活。结论 CT、DSA引导和术中直视氩氦刀冷冻治疗肝癌技术可靠,创伤小,安全性高,是治疗无手术机会肝癌的一种有效的新手段,其远期疗效和在肝癌综合治疗中的价值尚有待于进一步的前瞻性临床试验研究说明。  相似文献   

10.
[目的]探讨肝动脉栓塞化疗联合美国氩氦刀冷冻消融对中晚期原发性肝癌的治疗效果。[方法]62例巨块型肝癌患者,随机分为对照组和治疗组。对照组:肝动脉栓塞化疗(TACE)30例:治疗组:TACE+氩氦刀32例。观察两组治疗后完全坏死率、初次复发率、1年生存率、AFP转阴率及不良反应。[结果]对照组、治疗组完全坏死率分别为26.7%、65.6%,初次复发率为46.7%、12.5%,1年生存率为56.7%、84.4%,AFP转阴率为28.57%、59.1%,两组间完全坏死率、初次复发率、1年生存率、AFP转阴率的差异均有统计学意义。[结论]肝动脉栓塞化疗联合美国氩氦刀冷冻消融治疗中晚期原发性肝癌效果明显优于单纯肝动脉栓塞化疗治疗效果。  相似文献   

11.
8cm以上肝癌术后残癌的肝动脉栓塞化疗预后因素分析   总被引:1,自引:0,他引:1  
目的:了解肝动脉栓塞化疗对直径大于8cm肝癌术后残癌的疗效和影响预后的因素。方法:肝癌切除术后2个月内经超声和动脉造影证实有残癌的肝癌患者,行肝动脉栓塞化疗;采用COX模型研究影响疗效的因素。结果:治疗后1,2,3,4年生存率为74.9%,44.2%,36.8%,18.4%。肝癌切除术后残癌的TNM分期是影响疗效的独立因素(P=0.003)。而原发癌的肿瘤分期,手术方式(局部切除或肝叶切除),肝动脉栓塞化疗的次数,不是影响预后的独立因素。结论:肝癌术后行肝动脉栓塞化疗是可行的,术后残癌的分期是影响肝动脉栓塞化疗效果的主要因素,大体积肿瘤术后尽早行肝动脉栓塞化疗是必要的。  相似文献   

12.
目的:探讨肝细胞肝癌(hepatocellular carcinoma,HCC)术后出现CNLC III/IV期复发危险因素,并构建线上预测模型。方法:回顾性分析我院2011年1月至2017年12月接受肝癌切除术的289例HCC患者临床及病理资料,基于Logistic回归分析明确HCC患者术后出现CNLC III/IV期复发高危因素,并以多因素回归分析结果为基础构建线上预测模型,通过一致性指数(C指数)、校正曲线及临床决策曲线验证该模型预测能力及临床效能。结果:截止至随访日期,共有158例(54.7%)的HCC患者出现术后复发,其中56例(19.4%)为CNLC III/IV期复发。经过多因素Logistic回归分析得术前NLR≥1.56(OR:2.745,95%CI:1.041~7.240,P=0.041)、肿瘤直径≥5.75 cm(OR:3.664,95%CI:1.612~8.328,P=0.002)、肿瘤低分化(OR:4.197,95%CI:2.027~8.688,P<0.001)、微卫星灶(OR:3.426,95%CI:1.241~9.460,P=0.017)及微血管侵犯(OR:3.127,95%CI:1.301~7.514,P=0.011)是术后出现CNLC III/IV复发的危险因素,以此为基础建立相应线上预测计算器,该预测模型时间依赖性受试者工作特征曲线下面积(AUC)为0.862,校正C指数为0.850。结论:HCC患者术后出现CNLC III/IV期复发与诸多因素相关,通过本研究所建立的网页计算器,临床医生可快速简便地识别高危人群并尽早予以干预措施,对临床工作具有指导意义。  相似文献   

13.
肝癌及癌旁组织中端酶检测的临床意义   总被引:6,自引:0,他引:6  
Fu J  Zhang W  Jin S 《中华肿瘤杂志》1998,20(6):434-436
目的 研究端粒酶作为原发性肝细胞癌(HCC)肿瘤标志物的可能性。方法 采用TRAP方法检测了33例原发性肝细胞癌及其33例癌旁组织、4例肝转移癌及其4例癌旁组织、6例肝良性肿瘤和6例正常肝组织中的端粒酶活性。结果 33例原发性肝细胞癌组织中,有30例端粒酶表达阳性,其阳性率为90.9%。33例癌旁组织中,有9例端粒酶表达阳性,其阳性率为27.3%。4例肝转移癌端粒酶活性均阳性,4例癌旁组织中,2例  相似文献   

14.
Purpose: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver and a global health problem. It is often diagnosed at advanced stage where hopeless for effective therapies. Identification of more reliable biomarkers for early detection of HCC is urgently needed. circulating tumor cells (CTCs) represent a unique liquid biopsy carrying comprehensive biological information of the primary tumor. Herein, we sought to develop a novel score based on the combination of the most significant CTCs biomarkers with and routine laboratory tests for accurate detection of HCC. Methods: Cytokeratin 18 (CK18), Cytokeratin 19 (CK19), albumin, platelets count, and α-fetoprotein were assayed in HCC patients (42), liver cirrhosis patients (83) and healthy control (20). Results: Areas under receiving operating curve (AUCs) were calculated and used for construction on novel score. A novel score named HCC-CTCs = AFP (U/L) × 0.08 - Albumin (g/dl) × 84 + CK 18 % × 2.9 + CK19 × 3.1- Platelets count (×109)/L× 0.75– 510. HCC-CTCs score produce AUC of 1 for differentiate patients with HCC from those with liver cirrhosis with sensitivity and specificity of a cut-off 0. Conclusions: HCC-CTCs score could replace AFP during screening of HCV patients and early detection of HCC.  相似文献   

15.
Wang Y  Wu MC  Sham JS  Zhang W  Wu WQ  Guan XY 《Cancer》2002,95(11):2346-2352
BACKGROUND: Amplifications of 1q21, c-myc at 8q24.1, and AIB1 at 20q12 are genetic alterations that are detected frequently in hepatocellular carcinoma (HCC). The authors evaluated the association of these amplifications with the prognosis of patients with HCC. METHODS: In the current study, amplification of 1q21, c-myc, and AIB1 was analyzed in 560 specimens from 400 patients with HCC and 20 patients with benign liver lesions using fluorescence in situ hybridization with high-throughput tissue microarray. Differences of amplification patterns were compared between small and large HCC, single nodular and multiple nodular HCC, primary and metastatic HCC, and primary and recurrent HCC. RESULTS: Significant differences between single nodular and multiple nodular HCC were detected in c-myc amplification (12% vs. 38%; P < 0.01) and AIB1 amplification (16% vs. 30%; P < 0.05). More frequent c-myc amplification was detected in metastatic HCC (45%) compared with primary HCC (29%) and in recurrent HCC (60%) compared with primary HCC (38%). Similarly, more frequent AIB1 amplification was observed in metastatic HCC (41%) compared with primary HCC (23%) and in recurrent HCC (60%) compared with primary HCC (29%). However, no significant differences in 1q21 amplification were observed. CONCLUSIONS: The current results strongly suggest that amplifications of the c-myc and AIB1 oncogenes are late genetic alterations in the progression of HCC and are correlated with a poor prognosis.  相似文献   

16.
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the sixth leading cause of cancer and the third leading cause of cancer-related mortality. Patient stratification and treatment allocation are based on tumor stage, liver function, and performance status. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate stage HCC, including those with large or multinodular HCC, well-preserved liver function, and no cancer-related symptoms or evidence of vascular invasion or extrahepatic spread. Two TACE techniques have been used since 2004, conventional TACE (cTACE) and TACE with drug-eluting beads (DEB-TACE). cTACE was evidenced first to treat intermediate stage HCC patients. It combines the transcatheter delivery of chemotherapy using Lipiodol-based emulsion plus an embolizing agent to achieve strong cytotoxic and ischemic effects. Drug-eluting beads (DEBs) were developed in order to slowly release chemotherapeutic agents, and to increase ischemia intensity and duration. Recent advances allow TACE treatment of both early stage patients (i.e. those with a solitary nodule or up to 3 nodules under 3 cm) and some advanced stage patients. Here we review recent clinical evidence related to TACE treatment of patients with early, intermediate, and advanced stage HCC. Based on the 2014 TACE algorithm of Raoul et al., this international expert panel proposes an updated TACE algorithm and provides insights into TACE use for patients at any HCC stage.  相似文献   

17.
The purpose of these studies was to select and isolate cells with increased liver-metastasizing potential from heterogeneous primary human colon carcinomas (HCCs). Cells derived from a primary HCC classified as Dukes' stage B2 were directly established in culture or were injected into the subcutis, cecum, or spleen of nude mice. Progressively growing tumors were excised, dissociated, and established in culture. Subsequent to implantation into the cecum or spleen of nude mice, cells from all four lines produced only a few liver tumor foci. HCC cells from the few liver metastases were expanded in culture and then injected into the spleen of nude mice to provide a source for further cycles of selection. With each successive in vivo selection cycle, the metastatic ability of the isolated propagated cells increased. Four cycles of selection yielded cell lines with a very high metastatic efficiency in nude mice. In parallel studies using another primary HCC classified as Dukes' stage D, we isolated cell lines that were highly metastatic in nude mice. Successive selection cycles for growth in the liver increased the metastatic properties of the HCC cells, albeit to a lesser extent than it did those of the Dukes' B2 stage HCC. The ability of the HCC cells to produce liver metastases was not due to simple trapping in the liver. In vivo distribution studies using [125I] iododeoxyuridine-labeled tumor cells revealed that, shortly after injection into the spleen, a comparable number of cells with either low or high metastatic properties arrested in the liver. The differences between the low- and high-degree metastatic cells became apparent by 24 h after injection and, by 72 h, only highly metastatic cells survived in the liver. These results demonstrate that hepatic metastasis by HCC cells is a selective process and that the nude mouse model can be useful for isolating highly metastatic HCC cells and for studying the relevant host organ factors that regulate the pathogenesis of metastasis.  相似文献   

18.
姚相巍 《现代肿瘤医学》2018,(22):3606-3608
目的:研究腹部超声、CT联合血清甲胎蛋白(AFP)诊断原发性肝癌的价值。方法:回顾性分析我院于2017年1月至2018年1月期间收治的50例确诊原发性肝癌患者作为肝癌组,另选取同期收治的50例肝脏良性肿瘤患者作为良性组及50例来院参加健康体检的志愿者作为对照组。以病理结果为标准,对比三组受检者的腹部超声、CT诊断阳性率,血清AFP水平,联合诊断的敏感度、特异度、阳性预测值及阴性预测值,并研究联合诊断不同分期原发性肝癌的阳性率。结果:三组受检者对比,肝癌组患者的腹部超声、CT诊断阳性率及AFP水平均高于良性组及对照组,且良性组高于对照组,差异均有统计学意义(P<0.05)。腹部超声、CT及AFP联合诊断Ⅰ-Ⅱ期及Ⅲ-Ⅳ期肝癌的阳性率高于单项诊断,差异均有统计学意义(P<0.05)。诊断效能对比,腹部超声、CT及AFP联合诊断的特异度、敏感度、阴性预测值及阳性预测值均高于单项诊断,差异均有统计学意义(P<0.05)。结论:腹部超声、CT联合血清AFP诊断原发性肝癌,较各单项诊断阳性率高,且联合诊断的敏感性及特异性更好,可有效明确肝癌分期,值得在临床上推广。  相似文献   

19.
BACKGROUND: Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer, the clinicopathological features of which have rarely been reported in detail. The aim of this study was to clarify the characteristics of cHCC-CC in comparison with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). METHODS: The clinicopathological features of 26 cHCC-CC patients, who were surgically treated, were reviewed by comparing them with the features of patients suffering from ordinary hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). RESULTS: The cHCC-CC patients showed greater similarity with HCC patients than with CC patients with regard to male/female ratio, status of hepatitis viral infection, serum alpha-fetoprotein (AFP) level, and non-tumor liver histology. The disease stage of the cHCC-CC patients was more advanced than that of either the HCC or CC patients. The cHCC-CC tumors were significantly more invasive to the portal vein than the HCC tumors and were comparable to the CC tumors. The overall 3-, 5-, and 10-year survival rates and the median survival times (95% confidence interval) were 34.6%, 23.1%, 11.5% and 1.8 (0.7-3.0) years for cHCC-CC patients, 86.7%, 66.2%, 46.8% and 4.6 (4.3-5.0) years for HCC patients, and 68.5%, 32.3%, 23.9% and 1.9 (1.1-2.7) years for CC patients, respectively. Survival of patients with cHCC-CC was significantly poorer than that of HCC or CC patients. Among the 26 patients, six survived for >5 years. CONCLUSIONS: In most cases, cHCC-CC seems to be a variant of ordinary HCC with cholangiocellular features, rather than a true intermediate disease entity between HCC and CC. The surgical approach is recommended for selected patients with cHCC-CC.  相似文献   

20.
目的探讨小核仁RNA87(snoRNA87)在原发性肝癌患者肝癌组织中的表达及意义。方法取100例原发性肝癌患者的肝癌组织及对应的癌旁组织,免疫组化法检测snoRNA87的阳性表达率,分析其与原发性肝癌患者临床特征的关系。荧光定量逆转录聚合酶链反应(RT-PCR)检测snoRNA87的相对表达量,并据此分为高表达组(n=62)和低表达组(n=38),Kaplan-Meier法绘制生存曲线,生存率的比较采Log-rank检验,比较两组患者平均生存时间、中位无进展生存期(PFS)和总生存期(OS)。探讨snoRNA87对原发性肝癌的诊断价值。结果肝癌组织中snoRNA87的阳性表达率为91%,明显高于癌旁组织的14%,差异有统计学意义(P<0.01)。不同分化程度、TNM分期、血清甲胎蛋白(AFP)浓度原发性肝癌患者肝癌组织中snoRNA87阳性表达率比较,差异均有统计学意义(P<0.05)。高表达组患者的5年生存率为14.52%(9/62),明显低于低表达组患者的42.11%(16/38),高表达组患者的5年平均生存时间为(2.13±0.50)年,明显短于低表达组患者的(3.56±1.01)年,差异均有统计学意义(P<0.01)。高表达组患者的中位PFS为10.6个月,长于低表达组患者4.5个月,中位OS为20.4个月,短于低表达组患者的32.2个月。snoRNA87诊断原发性肝癌的ROC曲线下面积(AUC)为0.734(0.577~0.980),当截断值为38.12时,诊断灵敏度为93.12%,特异度为94.25%;当截断值为17.59时,诊断灵敏度为97.58%,特异度为91.32%。结论snoRNA87在原发性肝癌患者肝癌组织中阳性表达率较高,且可能与原发性肝癌患者的分化程度、TNM分期和血清AFP浓度有关,对原发性肝癌的诊断价值较高。  相似文献   

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