肝癌介入治疗模式的探讨

目的探讨肝癌介入治疗的合理模式。方法回顾性总结1000例以不同方式进行介入治疗的肝癌病例资料,通过分析其病理、生化、影像及生存率等临床因素,比较各种治疗方式的价值及优缺点结果经导管节段性肝动脉栓塞化疗(S-TOCE)与常规肝动脉注射碘油抗癌药混悬剂栓塞化疗(C-TOCE)比较,前者对肿瘤的杀伤作用大,对非癌肝组织的损害较C-TOCE轻,生存率优于C-TOCE;经皮无水酒精注射术(PEI)联合栓塞治疗可起到杀死残余癌灶的作用,对非癌肝组织未造成明显损害,生存率较单纯栓塞明显提高。对肝癌的各种并发症采取不同方式的介入治疗,能不同程度地改善患者生存质量或提高生存率。结论肝癌的介入治疗应根据肿瘤大小和类型选择/不同的介入治疗方式;对肝癌的各种并发症采取积极的介入治疗是有效和必要的。     

肝癌介入治疗模式的探讨(英文)

目的探讨肝癌介入治疗的合理模式。方法回顾性总结1000例以不同方式进行介入治疗的肝癌病例资料,通过分析其病理、生化、影像及生存率等临床因素,比较各种治疗方式的价值及优缺点。结果经导管节段性肝动脉栓塞化疗(S-TOCE)与常规肝动脉注射碘油抗癌药混悬剂栓塞化疗(C-TOCE)比较,前者对肿瘤的杀伤作用大,对非癌肝组织的损害较 C-TOCE 轻,生存率优于 C-TOCE;经皮无水酒精注射术(PEI)联合栓塞治疗可起到杀死残余癌灶的作用,对非癌肝组织未造成明显损害,生存率较单纯栓塞明显提高。对肝癌的各种并发症采取不同方式的介入治疗,能不同程度地改善患者生存质量或提高生存率。结论肝癌的介入治疗应根据肿瘤大小和类型选择不同的介入治疗方式;对肝癌的各种并发症采取积极的介入治疗是有效和必要的。     

8cm以上肝癌术后残癌的肝动脉栓塞化疗预后因素分析

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。     

经皮肝穿刺注射无水乙醇配合肝动脉化疗栓塞术治疗原发性肝癌

目的：研究ＣＴ引导下经皮肝穿注射无水乙醇配合肝动脉化疗栓塞术治疗原发性肝癌的疗效。方法：对６８例肝癌进行肝动脉化疗栓塞术和ＣＴ引导下经皮肝穿刺注射无水乙醇治疗,并与同期５３例单纯肝动脉化疗栓塞术组（对照组）比较疗法。结果：治疗组的肿瘤缩小率,ＡＦＰ下降,累计生存率及局部复发率显优于对照组。结论：ＣＴ引导下经皮肝穿刺注射无水乙醇配合肝动脉化疗栓塞术为肝癌较好的一种综合治疗方法。     

肝脾双介入疗法在原发性肝癌伴脾亢中的应用

目的探讨肝脾双介入治疗原发性肝癌并发脾功能亢进(HCC-HS)的临床价值.方法对19例原发性肝癌伴程度不同肝硬化,门静脉高压和脾肿大、白细胞、血小板低下具有明确的脾亢患者采用部分脾动脉栓塞术(PSE)和肝动脉化疗栓塞术(TOCE)双介入治疗,术后观察外周血细胞改变.结果本组病例肝脾双介入治疗后外周白细胞、血小板均有显著提高,与术前比较,在统计学上有显著差异(P＜0.05),部分脾栓塞可以缓解脾功能亢进,保证肝动脉化疗栓塞(TOCE)的顺利进行,减轻门静脉压力,减少TOCE的并发症,而术后增加脾栓塞的反应一般都能忍受.结论肝脾动脉双介入栓塞是一种损伤小、安全程度高、副反应少,疗效较好的办法,可部分替代外科切脾手术,是治疗肝癌并脾亢(HCC-HS)最佳选择,值得普及推广.     

肝癌栓塞化疗后的远期生存率评价

本文对肝细胞性肝癌（ＨＣＣ）行经导管肝动脉栓塞化疗后的１、２、３、４、５年生存率作了综述。影响ＨＣＣ栓塞化疗远期生存率的因素包括栓塞化疗方式、肿瘤大小、肿瘤类型、生长方式、门脉是否受侵、肝功能拳头及磺油沉积方式。栓塞化疗的联合经皮穿刺无水乙醇注射（ＰＥＩ）可明显提高远期生存率。     

中晚期肝癌508例的化疗栓塞疗效及影响因素分析

目的：探讨中晚期肝癌化疗栓塞治疗的疗效及影响生存的因素。方法：对1990年1月－2000年10月间508例中晚期肝癌行选择性肝动脉插管灌注化疗和（或）栓塞治疗共2025次,其中行选择性肝动脉插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一、二、三年生存率分别为81．3％、38．6％、21．6％;单纯灌注化疗一、二、三年生存率分别为54．3％、21．3％、9．6％。肿瘤分类、门静脉是否有癌栓、侧支循环的形成、碘油沉积情况以及栓塞技术是否得当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可作为中晚期肝癌的常规治疗,远期疗效明显优于单纯灌注化疗。     

肝动脉化疗栓塞治疗原发性肝癌的预后因素分析

目的：探讨影响肝动脉化疗栓塞治疗原发性肝癌预后的相关因素,为原发性肝癌患者选择个体化治疗方案及估计预后提供参考。方法：回顾性分析2003年6月-2012年6月石河子大学医学院第一附属医院实施肝动脉化疗栓塞的153例患者的临床资料及随访数据,生存分析采用生命表法,相关因素分析行 Log -rank 检验,多因素分析采用 Cox 模型,筛选出影响预后的因素。结果：随访至2013年6月30日153例患者失访15例（9.8%）,原发性肝癌患者经肝动脉化疗栓塞后1、3、5年生存率分别为55.92%、31.02%、21.18%。单因素分析结果显示肝功能分级、甲胎蛋白（AFP）、肿瘤大小、肿瘤数目、门脉癌栓及治疗次数是影响预后的因素;Cox 风险回归分析显示肝功能分级、肿瘤数目、门脉癌栓及治疗次数是影响预后的独立因素（P <0.05）。结论：肝功能分级、肿瘤数目、门脉癌栓为影响原发性肝癌介入治疗预后的独立危险因素,而治疗次数是影响预后的保护性因素。     

大肝癌患者行 TACE 序贯射频消融的疗效及复发因素

目的：探讨经导管肝动脉化疗栓塞（TACE）联合序贯射频消融术（RFA）治疗大肝癌患者的疗效及复发因素。方法：选取我院2013年1月－2015年1月肿瘤外科中晚期原发性大肝癌患者110例并分为肝动脉化疗栓塞组（TACE 组）与肝动脉化疗栓塞联合序贯经皮射频消融术组（TACE ＋RFA 组）各55例,TACE 组患者行一次或多次单一肝动脉化疗治疗;TACE ＋RFA 组在肝动脉化疗治疗结束后1～2周再行序贯经皮射频消融术治疗。结果：TACE 组与 TACE ＋RFA 组总有效率分别为63．64％（35／55）、94．54％（52／55）。TACE ＋RFA 组1年生存率为72．7％（40／55）,2年生存率为20．0％（11／55）,而 TACE 组分别为56．36％（31／55）、7．27％（4／55）。Log －rank 检验结果显示肿瘤数量、分期、血清甲胎蛋白水平等为大肝癌患者预后的因素,与患者预后有一定关系。结论：经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗原发性中晚期大肝癌可以有效提高患者生存率,延长患者的生存期。肿瘤数量、直径、分期等是影响患者复发的危险因素。     

不能切除的肝癌术中治疗模式的探讨

自１９６４年４月－１９９３年７月对２００例不能切除的肝癌术中多种模式治疗。患者均经手术及病理证实。按治疗方法分为两组。１组：１１５例单纯作肝动脉插管化疗（ＨＡＩ），其１、２年生存率分别为１０．４％和１．７％，仅１例生存６５个月；Ⅱ组：８６例术中作肝动脉栓塞化疗（ＨＡＣＥ）和加用肝动脉结扎（ＨＡＬ）或伴有波刀肿瘤固化（ＭＩＣ）、或伴有纯酒精肿瘤内注射（ＥＩＴ）的多模式治疗，其中１、２、３和５年生存率     

Oily chemoembolization of hepatoma

Since 1983 we have performed transcatheter oily chemoembolization (TOCE) using adriamycin (40-100 mg), Lipiodol (5-20 ml) and Gelfoam in the treatment of 100 cases with unresectable hepatocellular carcinoma. Adriamycin was dissolved in a fluid equal in specific gravity to Lipiodol and the adriamycin solution was mixed with 3 volumes of Lipiodol, making an adriamycin-in-oil emulsion (AOE). After TOCE, the blood concentration of adriamycin was obviously lower than that after one-shot injection because of the slow release of adriamycin from the AOE. Also, in cases of hepatic resection after TOCE, there was a clear difference in the adriamycin concentration between the tumor and the normal hepatic tissue. The cumulative survival rates for the 100 patients treated by TOCE were: 6 months 81.9%, 1 year 53.8% and 2 years 36.5%. Thus, improvement was found in comparison with the cumulative survival rates for 104 patients who underwent hepatic embolization without Lipiodol, which were 6 months 67.4%, 1 year 45.2% and 2 years 16.3%. AOE retained in the tumor as microemboli brings about the slow-releasing effect of adriamycin. Furthermore, by adding the effect of Gelfoam embolization, TOCE has a strong antitumor effect.     

原发性肝癌介入治疗的研究进展

介入治疗被认为是原发性肝癌非手术疗法中的首选方法。肝癌介入治疗可分为经皮经血管治疗技术和经皮非血管治疗技术．主要为经肝动脉途径化疗栓塞和影像导向下的消融治疗。介入治疗在原发性肝癌治疗中的合理应用。可以大大提高治疗效果，对部分原发性肝癌非常有效。介入治疗是一种安全有效的技术，要综合灵活应用，也可以作为肝脏外科手术的辅助治疗方法．建立一个合理的治疗程式是非常必要的。     

原发性肝癌综合介入治疗的疗效分析

目的探讨原发性肝癌综合介入治疗的疗效。方法回顾性分析1126例原发性肝癌患者手术前后行经导管肝动脉化疗栓塞术(TACE)、TACE后射频消融(RFA)治疗、TACE或经导管肝动脉化疗灌注治疗(TAI)后辅以中药和生物治疗的临床资料,分析患者肝功能、肿瘤标志物、癌灶影像资料和生存率等,比较各种综合介入治疗的价值。结果全组患者1、3、5年生存率分别为67.8%、28.7%和18.8%。其中术前TACE组1、3、5年生存率分别为74.7%、41.4%和36.9%,术后TACE组1、3、5年生存率分别为78.9%、40.4%和37.5%;TACE RFA组的近期有效率为93.4%,1、3年生存率分别为74.5%和36.8%;TACE组的近期有效率为83.2%,1、3、5年生存率分别为69.3%、21.7%和8.4%;TAI治疗的近期有效率为27.5%,1、3年生存率分别为11.6%和0。TACE RFA组和TACE组间肝功能Child降级、瘤内与瘤周血流信号消失和甲胎蛋白转阴率差异均无统计学意义,TACE RFA组、TACE组与TAI组肝功能Child降级差异无统计学意义。结论原发性肝癌手术切除前后TACE效果最佳,手术前与手术后行TACE疗效相近;TACE RFA疗效优于TACE;TAI疗效较差。     

Management of spontaneous rupture of hepatocellular carcinoma: single-center experience.

PURPOSE: To report the management of patients with spontaneous rupture of hepatocellular carcinoma (HCC) in a single center over a 10-year period and to evaluate a two-stage therapeutic approach. PATIENTS AND METHODS: A retrospective study was performed on all 1,716 patients with HCC who presented from 1989 to 1998. The two-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means, followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Results of definitive treatment were compared with patients with no history of rupture during the same study period. RESULTS: During the study period, 154 patients (9%) had spontaneous HCC rupture. Initial intervention to control bleeding included TAE in 42 patients, surgical hemostasis in 35 patients, and conservative management only in 53 patients. The 30-day mortality rate was 38%. Independent factors on presentation affecting 30-day mortality were shock on admission, hemoglobin, serum total bilirubin, and known diagnosis of inoperable tumor. After initial stabilization and clinical evaluation, 33 patients underwent hepatic resection and 30 patients received TOCE. Median survival of the hepatectomy patients was 25.7 months; that of the TOCE patients was 9.7 months. Compared with patients with no rupture, survival after hepatectomy (25.7 months v 49.2 months, P =.003) was inferior but still substantially long, whereas survival after TOCE was comparable (9.7 months v 8.7 months, P =.904). CONCLUSION: Early mortality of spontaneous rupture of HCC was dependent on prerupture disease state, liver function, and severity of bleeding. Although it was a catastrophic presentation, prolonged survival could be achieved in selected patients with second-stage hepatic resection or TOCE.     

Transcatheter arterial chemoembolization prolonged survival in a patient with advanced hepatocellular carcinoma accompanied by tumor thrombus of the portal vein trunk

A 50-year-old man having an advanced hepatocellular carcinoma (HCC) was admitted to our institution. An abdominal computed tomogram showed infiltrative mass in the right liver with tumor thrombus invading into the main trunk and contralateral branch of the portal vein. Repetitive transcatheter arterial chemoembolization reduced a tumor size and shrunken portal vein tumor thrombus. The tumor marker levels such as AFP and PIVKA-II decreased. During follow-up, he was diagnosed as having an impending rupture of HCC with acute abdominal pain. He was successfully treated with interventional technique. He died of liver failure 66 months after the first treatment. Although he had a highly advanced HCC with tumor thrombus of the portal vein, repetitive transcatheter arterial chemoembolization therapy may prolong survival.     

Non-surgical treatment of hepatocellular carcinoma with tumor thrombus in the right atrium

A 65-year-old Japanese man who had been suffering from severe and progressive dyspnea for more than 2 months underwent an extended right hepatectomy for hepatocellular carcinoma (HCC) in August 2001. Radiological examination, performed in August 2003, revealed the mass in the left lobe of the liver extended into the left hepatic vein, the inferior vena cava and the right atrium. Those clinical manifestations were supposedly attributed to HCC tumor thrombus in the right atrium. The decision to carry out the palliative operation for the tumor thrombus was not made because of poor prognosis in light of hemodynamic compromise indicating a reasonable liver function. A sequential course of treatments for the tumor thrombus was performed including transcatheter chemotherapy, transarterial chemoembolization and radiation therapy. Although a radiological response rate was 27% in diameter of the tumor thrombus, the clinical manifestations, such as dyspnea or edema, completely disappeared during the treatment. No surgical standard or interventional regimen for HCC tumor thrombus in the right atrium has been established. However, we here demonstrated the possibility for the treatment of the tumor thrombus with intensive combination therapies.     

恶性胰岛细胞瘤术后肝转移介入治疗临床分析:附8例报道并文献复习

目的:探讨肝动脉化疗栓塞术治疗恶性胰岛细胞瘤外科术后肝转移患者的临床疗效。方法:回顾性分析在我科行介入治疗的8例恶性胰岛细胞瘤术后肝转移患者。原发灶位于胰颈部1例,胰体尾部7例。7例为肝脏多发转移,1例为肝内单一病灶。所有患者均接受1-6次肝动脉化疗栓塞术。结果:8例患者均获得随访,随访0.5-8年。其中部分缓解（PR）6例,稳定（SD）2例,进展（PD）0例。目前仍生存6例,最长已生存8年,死亡2例。1例伴有低血糖患者空腹血糖恢复正常水平,所有患者均出现程度不等的术后反应,但未出现严重并发症。结论:恶性胰岛细胞瘤外科术后肝转移患者行肝动脉化疗栓塞术安全,疗效确切。