肝细胞癌腹腔内破裂的急诊肝动脉栓塞治疗

近年来US、CT、DSA及MRI设备的迅速发展使肝细胞癌(HCC)的早期诊断率明显上升,随之发展的肝动脉内介入放射学治疗的普及也相应增加了HCC 腹腔内破裂的机会。肝动脉栓塞术(TAE)应用的普及,已可一定程度上取代传统的HCC破裂的手术治疗。一、HCC腹腔内破裂的原因据日本第八次全国HCC调查组资料,HCC有16.4%死于破裂出血,仅次于HCC     

肝细胞癌TACE治疗进展

肝细胞癌（HCC）是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括：经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞（TACE）是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

肝细胞癌TACE治疗进展

肝细胞癌(HCC)是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括:经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞(TACE)是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

肝细胞癌经导管化疗栓塞治疗

肝细胞癌 (ｈｅｐａｔｏｃｅｌｌｕｌａｒｃａｒｃｉｎｏｍａ ,ＨＣＣ)多见于东亚、东南亚、东非、中非和南非。在我国发病率占恶性肿瘤的第二位。 1 985年统计 ,全国有 1 3 .8万新发病例 ,占世界总发病人数的 40 %～ 45 % [1 ] 。临床上有症状的ＨＣＣ患者未经治疗预后很差 ,中位生存时间仅为 1 .6个月。尽管目前对ＨＣＣ有诸多治疗方法 ,但总体疗效仍不能令人满意。外科手术仍然是改善预后的最主要手段 ,但仅适合 1 5 %～ 30 %的早期患者。 1 974年法国Ｄｏｙｏｎ等首先报道了用明胶海绵经导管肝动脉栓塞 (ｔｒａｎｓｃａｔｈｅｔｅｒａｒ…     

HAIC序贯TAE治疗不可切除肝细胞癌的安全性和有效性北大核心CSCD

目的 评估肝动脉灌注化疗(HAIC)序贯肝动脉栓塞术(TAE)治疗不可切除肝细胞癌的安全性及有效性。方法 收集2020年4月至2021年4月采用HAIC序贯TAE治疗的25例肝癌患者的临床资料,以ALBI评分评估患者肝功能变化情况,记录术后出现的不良反应。根据改良实体瘤疗效评价标准(mRECIST)评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),并随访患者的疾病进展时间(TTP)和生存时间(OS)。结果 患者首次治疗后3个月ALBI评分(-2.29±0.53)与术前(-2.32±0.44)相比,差异无统计学意义(t=-0.223,P=0.825)。主要不良反应包括肝功能损伤、骨髓抑制、腹痛、恶心呕吐、发热等,4例患者出现Ⅲ级不良反应(3例ALT升高,1例骨髓抑制),其余均为Ⅰ~Ⅱ级不良反应。术后6周ORR、DCR分别为68%、92%,术后12周ORR、DCR分别为72%、88%,中位TTP为271 d(95%CI:115.9~426.0),中位OS为510 d(95%CI:491.5~528.5)。结论 HAIC序贯TAE治疗不可切除肝癌临床疗效显著,具有良好的耐受性,是安全可行的。     

碘化油化疗药物乳剂联合D-TACE对比cTACE治疗肝细胞癌的临床价值北大核心CSCD

目的 比较碘化油化疗药物乳剂联合载药微球经动脉化疗栓塞(D-TACE)和常规TACE(cTACE)治疗肝细胞癌(HCC)患者的有效性和安全性。方法 纳入接受碘化油化疗药物乳剂联合D-TACE或cTACE治疗的HCC患者146例。57例患者作为实验组,采用碘化油化疗药物乳剂联合D-TACE+cTACE治疗,89例患者作为对照组,采用cTACE治疗。比较实验组与对照组患者的短期疗效、不良反应等。评估TACE治疗后3个月的治疗反应,并对半年内的治疗次数和治疗间隔进行分析。结果 TACE术后3个月,实验组的疾病控制率为89.50%(51/57),高于对照组的75.30%(67/89),差异有统计学意义(P=0.034);实验组的客观缓解率为56.10%(32/57),对照组为46.10%(41/89),差异无统计学意义(P=0.235)。不良反应情况,呕吐实验组有54例(94.7%),对照组有87例(97.8%);发生肝脓肿实验组有4例(7.0%),对照组有1例(1.1%);炎症反应实验组有8例(14.0%),对照组有6(6.7%);发热实验组有14(24.6%),对照组有17(19.1%),组间比较差异均无统计学意义(均P>0.05);疼痛实验组有36例(63.2%),对照组28例(31.5%),差异有统计学意义(P<0.01)。实验组与对照组6个月内按需治疗的总次数为(2.440±1.095)次和(2.312±0.878)次,差异无统计学意义(P=0.879);首次TACE与补充TACE的时间间隔为57.0 (49.0,90.0)d和55.0(49.0,64.2) d,差异有统计学意义(P=0.045)。结论 碘化油化疗药物乳剂联合D-TACE与cTACE相比,短期疾病控制率更佳,治疗间隔较长,对肝功能的影响及术后不良反应均在可接受范围。     

经动脉放射栓塞治疗肝细胞癌的研究进展

肝细胞癌（HCC）是我国常见的恶性肿瘤,其恶性程度高,预后较差。随着临床应用和研究的不断深入,经动脉放射栓塞（TARE）在HCC的局部治疗中扮演了越来越重要的角色。相较于经动脉化疗栓塞（TACE）,此治疗方法疗效好且副作用较小,具有广阔的应用前景,得到国内外学者的广泛关注。笔者围绕TARE治疗HCC的临床应用现状（主要...     

经导管动脉化疗栓塞治疗与联合索拉非尼治疗肝细胞癌合并门静脉癌栓的疗效观察

目的观察经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗与联合索拉非尼治疗肝细胞癌合并门静脉癌栓的疗效。方法回顾性分析2010年7月—2013年11月东南大学附属中大医院江北院区收治的肝细胞癌合并门静脉癌栓患者107例,符合入组条件的40例中,21例接受TACE联合索拉非尼治疗（联合治疗组）,19例接受单纯TACE治疗（TACE组）,观察患者生存时间及严重并发症发生率。结果联合治疗组和TACE组的中位生存时间分别为8.4个月和5.7个月（P<0.001）,疾病无进展生存期分别为7.3个月和4.3个月（P=0.002）,2组严重并发症发生率分别为19.1%和15.8%（P=0.559）。结论TACE联合索拉非尼较单纯TACE治疗肝细胞癌合并门静脉癌栓未增加严重并发症发生率,并可有效延长患者生存时间。     

肝细胞癌合并肝动脉-肝静脉分流的栓塞治疗

目的 探讨肝细胞癌（ＨＣＣ）伴肝动脉－肝静脉分流（ＡＨＶＳ）者的栓塞治疗的可行性与安全性。方法 对１１例ＨＣＣ伴ＡＨＶＳ的患者进行介入栓塞治疗１６次。对肿瘤各支供血动脉分别超选择造影,对有ＡＨＶＳ的分支首先以明胶海绵碎块栓塞,ＡＨＶＳ消失后再以碘油栓塞。结果 造影有明确ＡＨＶＳ者９例,均成功栓塞;２例ＡＨＶＳ在造影时未发现。治疗后部分缓解３例,轻微反应４例,无变化４例。栓塞后无肺部并发症。结论 Ｈ     

分子靶向药物联合TACE在肝癌治疗中的进展

对于那些已经不适宜手术切除的中晚期肝细胞肝癌（HCC）,单纯的经动脉化疗栓塞(TACE)显然并不能明显改善患者的预后,但是随着分子靶向药物的面世,使得HCC的治疗有了新的治疗方案。在治疗HCC的临床试验当中,血管内皮生长抑制剂、多靶点抑制剂、小分子酪氨酸激酶抑制剂以及分子靶向药与TACE的联合已经显示出了潜在的疗效和良好的发展前景。本文对使用血管内皮生长抑制剂、多靶点抑制剂等联合TACE治疗HCC的临床研究现状进行综述。     

中晚期原发性肝癌合并症的介入治疗研究

目的探讨中晚期原发性肝癌合并症的综合介入治疗方法。方法将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共62例,按住院号数的单、双数随机分成两组:对照组(单纯TACE组)32例,综合治疗组(TACE 合并症处理组)30例。综合治疗组行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予综合处理。结果TACE组治疗32例患者,1、2和3年生存率分别为68%、50%和19%,中位生存期1.5年;综合治疗组30例患者1、2和3年生存率分别为87%、75%和48%,中位生存期2.0年。综合治疗组的生存率及生存期均显著高于对照组(P<0.05)。与对照组相比综合治疗组疗效与死亡风险率差异有统计学意义(P<0.05)。结论原发性肝癌合并症的控制可增加TACE的疗效,显著提高原发性肝癌患者生存率,延长生存期。     

Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma

PURPOSE: The aim of this study was to assess the incidence, degree, and predictors of hepatic arterial damage (HAD) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 33 patients with unresectable HCC underwent TACE alone using a mixture of iodized oil, epirubicin, and gelatin sponge. A follow-up angiogram was available for 76 of 109 sessions, and HAD was evaluated at each subsegment of the hepatic artery using a three-grade scale (1, no or slight wall irregularity; 2, overt stenosis; 3, occlusion). Grades 2 and 3 were considered to indicate significant HAD. The predictors of HAD were analyzed by multivariate analysis. RESULTS: A total of 161 hepatic arteries were embolized from the lobar (n = 43), segmental (n = 40), subsegmental (n = 72), or more distal (n = 6) level. The follow-up period between the initial and last sessions ranged from 70 to 1505 days (median 497 days). Significant HAD occurred in 37 of 231 subsegmental hepatic arteries (16%) and in 16 of 33 patients (48%). The accumulated dose of epirubicin per artery (P = 0.001) and Child-Pugh score (P < 0.001) were significant predictors. CONCLUSION: TACE is more likely to induce HAD in cirrhotic patients with impaired liver function and when a high dose of the chemotherapeutic agent was used.     

Combined versus single locoregional therapy in the treatment of unresectable hepatocellular carcinoma

Introduction

Surgical and locoregional therapies are different options in HCC treatment, several locoregional techniques are used.

Purpose

This study aimed to assess the effectiveness of transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and combined therapy, in HCC management.

Materials and methods

The study was conducted at our University Hospital, from August 2011 to February 2013. It included 60 patients with HCC (40 males and 20 females, age ranged between 45 and 70 years). Patients were classified into 3 groups, group 1 treated with TACE, group 2 with RFA, and group 3 with both techniques. Response was assessed by triphasic CT and alpha fetoprotein. Patients were classified into good and poor responders after one and six months and one year. Patients’ survival and incidence of recurrence were recorded.

Results

The percentage of good responders was greater with combined therapy than with TACE and RFA (90%, 70%, and 60% respectively). The overall survival was 75% and the recurrence free survival was 60% in TACE, 90%, and 45% in RFA and 95% and 90% in combined therapy respectively.

Conclusion

Combined therapy is superior regarding good response, overall survival, and free recurrence survival than either TACE or RFA alone.     

Transcatheter arterial chemoembolization in patients with hepatocellular carcinoma and coexisting hepatic cavernous hemangioma

We investigated the consequence of repeated transcatheter arterial chemoembolization (TACE) for coexisting small hepatic hemangioma in the treatment of patients with hepatocellular carcinomas and describe the imaging features of embolized hemangioma on the follow-up Lipiodol CT and MR. Six of 431 patients with biopsy-confirmed hepatocellular carcinomas, who underwent TACE, also had seven small hepatic cavernous hemangiomas (0.8∼2.3 cm) in the same area of embolization. All six patients underwent repeated TACE All lesions were evaluated with CT and/or MR for the post-treatment follow-up. The outcomes and imaging features of these embolized hemangiomas were reviewed for the change of tumor size, Lipiodol deposition, enhancing pattern as well as embolization complications. Six of the seven hemangiomas did not depict changes in the size or enhancement pattern without being ablated. One hemangioma showed a decrease in size, but still persisted after TACE. All of the hemangiomas showed Lipiodol deposition for 2∼15 months, in which five hemangiomas depicted irregular rim patterns. There is no complication caused by the procedures. The differentiation of small hepatic hemangiomas from viable HCC is important in the post-TACE follow-up to avoid unnecessary repeated embolization.     

Radiomic advances in the transarterial chemoembolization related therapy for hepatocellular carcinoma

Radiomics is a hot topic in the research on customized oncology treatment,efficacy evaluation, and tumor prognosis prediction. To achieve the goal of mining the heterogeneity information within the tumor tissue, the image features concealed within the tumoral images are turned into quantifiable data features.This article primarily describes the research progress of radiomics and clinicalradiomics combined model in the prediction of efficacy, the choice of treatment modality, and survival in tran...     

肝癌经动脉灌注化疗栓塞致脊髓损伤(附3例报告)

肝癌在解剖上潜在的供血侧支有26种之多,当化疗栓塞肝动脉时或肿瘤较大且血供丰富的情况下,这些潜在的侧支有可能开放,引起截瘫眼1,2演。在我们近10多年用动脉灌注化疗治疗肝癌中出现下肢抽动及发生酸痛,其中2例发生截瘫,另1例采用了相应措施,避免了截瘫。现简述如下。1临床资料例1:患者女,41岁。外院确诊为贲门癌,累及胃底伴肝转移。于1996年4月在我院作介入治疗,经造影证实导管进入胃左动脉,此时患者出现双下肢大范围抽动,当时认为癔病样表现,随后静脉推注10%葡萄糖酸钙20m l,同时缓慢于导管内推入部分化疗药,又将导管选择至肝动脉,手推造…     

Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma

Purpose The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of sequential transarterial chemoembolization (TACE) for patients with unresectable advanced hepatocellular carcinoma (HCC). Methods Twenty-one consecutive patients with unresectable T3 and T4 HCC were treated by sequential TACE (median time interval between treatments 7 weeks) up to six times with an emulsion of lipiodol, epirubicin, and cisplatin. All TACE procedures were performed as unilobar or whole-liver chemoembolization. Results An average of 3.9 TACE procedures were performed per patient. One primary and two secondary technical failures occurred. No procedural death was observed. After exclusion of the patient with the primary technical failure and 3 patients with extrahepatic disease, the survival rates for the remaining 17 patients at 6, 12, 18, and 24 months were 70.6%, 52.9%, 44.1%, and 33.1%, respectively. Conclusion Sequential TACE is a safe procedure in patients with unresectable advanced HCC and feasible in most cases. It seems to prolong the survival time compared with historical series of untreated patients.     

Emerging Trends in the Treatment of Advanced Hepatocellular Carcinoma: A Radiological Perspective

This is a narrative review of various treatment modalities for advanced hepatocellular carcinoma (HCC), with a focus on recent updates in radiological treatments, as well as novel treatment concepts related to immune checkpoint inhibitors and combination therapies with locoregional treatments. Interventional radiologists have made efforts toward developing alternative and/or combination treatments for first-line systemic treatment of patients with advanced HCC. Locoregional treatments with or without systemic therapy may be considered in the selected patients. Various treatment modalities for advanced HCC are emerging, and several randomized controlled trials, including those of combination treatments with immunotherapy, are ongoing.     

Dual input computed tomography perfusion in evaluating the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma

Objective

To assess diagnostic role of multi-detector computed tomographic perfusion in evaluating the therapeutic response of trans-arterial chemo-embolization in hepatocellular carcinoma.