目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者...目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者均接受mFOLFOX6或FOLFIRI方案化疗,观察组接受奥氮平、托烷司琼及地塞米松三联止吐方案预防化疗引起的恶心呕吐(chemotherapy-induced nausea and vomiting,CINV),对照组接受托烷司琼及地塞米松两联止吐方案。比较两者CINV完全缓解率、控制率、对生活质量影响及不良反应。结果奥氮平组在急性期、延迟期及全期完全缓解率均明显高于对照组(88.9%∶69.2%,P=0.078;74.1%∶42.3%,P=0.019;61.5%∶38.5%,P=0.020)。奥氮平组全期无明显恶心患者比例有优于对照组的趋势(70.4%∶30.8%,P=0.075),奥氮平组FLI-E评分更高,生活质量更好。2组最常见不良反应为便秘(66.7%∶61.5%,P=0.697),奥氮平组较对照组有更高的嗜睡(59.3%∶19.2%,P=0.003)、头晕(44.4%∶23.1%,P=0.101)等不良反应的发生,失眠方面,奥氮平组发生率较低(18.5%∶46.2%,P=0.031)。结论本研究首次证实了在接受MEC方案(FOLFOX6/FOLFIRI)化疗同时合并高危致吐风险因素的消化道肿瘤患者中,奥氮平联合5-羟色胺3受体拮抗剂及地塞米松,较好地控制了CINV,特别是对于延迟期及恶心的控制明显优于对照组,提高了患者生活质量。展开更多
Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency （RF） ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal he...Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency （RF） ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.Methods Three hundred and flfty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients （0. 8% ）. The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.Results Two patients with liver metastasis and one hepatocellular carcinoma （HCC） patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four （80%） of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date.Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.展开更多
Backoround Hepatocellular carcinoma （HCC） often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of he...Backoround Hepatocellular carcinoma （HCC） often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound （CEUS） and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Methods Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules （RNs）, dysplastic nodules （DNs）, or DNs with focus of HCC （DN-HCC）, were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns： type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase （washout）; type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）; and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）. The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test. Results Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows： type I, 49 （37.1%）; type II, 27 （20.5%）; type III, 28 （21.2%）; type IV, 9 （6.8%）; type V, 19 （14.4%）. Nodules with type I enhancement showed dysplasia in 5 （10.2%） cases; nodules with type II were dysplastic in 11 （40.7%） of cases; nodules with type III enhancement pattern were dysplastic in 22 （78.6%）, and those with type IV enhancement contained dysplasia in 7 （77.8%） of cases. Type V enhancement corresponded to DN-HCC in 19 （100%） of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis （Trend chi-square test, P 〈0.001）. Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC. Conclusion Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.展开更多
Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation ...Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） patients with poor liver function （Child-Pugh class C）, who are not suitable for surgery or hepatic artery chemo-embolization.Methods Thirteen HCC patients （the number of tumors was 17） with liver function of Child-Pugh C （scores： 10.2±0.4）were included in the study. Among the patients, 8 were male and 5 were female with the average age of （61.6±10.9）years old. The average size of HCC was （3.8±1.0） cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors （2-3 tumors）. All the patients were treated with RFA.Results There were 22 RFA sessions （1-4 sessions per patient） in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients （69.2%）, in 7 of them, the liver enzyme returned to pre-RFA level in 1-3 months. One month after RFA, the Child-Pugh grading was 10.3±0.8 （Child-Pugh C）, while that of pre-RFA was 10.2±0.4 （Child-Pugh C）, with no significant difference. Computer tomography （CT） one month after RFA showed that the tumor necrosis rate was 88.2% （15/17）. Five patients had 2-4 repeated RFA due to HCC recurrence.During the follow-up of 2-69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% （3/22 sessions）, including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.Conclusions Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.展开更多
Background Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofr...Background Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation. Methods Between June 2001 and January 2009, 638 patients with hepatic malignancies （405 with hepatocellular carcinoma, and 233 with liver metastasis） who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher＇s exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate. Results Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% （17/955） with an average onset time of 12 weeks （2-36 weeks）. Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration （P=-0.034） and treatment session 〉4 times （P=0.025） were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group （P=0.043）. Conclusions The incidence of biliary injury was not frequent （1.8%）. Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients＇ long-term survival. Additionally, risk factors may be helpful for selecting radiofrequency ablation candidates and predicting biliary complications.展开更多
Conventional ultrasound （US） is the most widely used imaging modality in routine clinical practice worldwide. The limitations of conventional ultrasound in the detection of aortic lesions versus multi-slice compute...Conventional ultrasound （US） is the most widely used imaging modality in routine clinical practice worldwide. The limitations of conventional ultrasound in the detection of aortic lesions versus multi-slice computed tomography angiography （MS-CTA） are well known.展开更多
文摘目的评估奥氮平联合托烷司琼及地塞米松三联方案对接受中危致吐方案同时具有高危致吐风险因素的胃肠道肿瘤患者的止吐效果。方法选取2017年9月至2018年9月在北京大学深圳医院肿瘤内科接受化疗的胃肠道肿瘤53例患者为研究对象,所有患者均接受mFOLFOX6或FOLFIRI方案化疗,观察组接受奥氮平、托烷司琼及地塞米松三联止吐方案预防化疗引起的恶心呕吐(chemotherapy-induced nausea and vomiting,CINV),对照组接受托烷司琼及地塞米松两联止吐方案。比较两者CINV完全缓解率、控制率、对生活质量影响及不良反应。结果奥氮平组在急性期、延迟期及全期完全缓解率均明显高于对照组(88.9%∶69.2%,P=0.078;74.1%∶42.3%,P=0.019;61.5%∶38.5%,P=0.020)。奥氮平组全期无明显恶心患者比例有优于对照组的趋势(70.4%∶30.8%,P=0.075),奥氮平组FLI-E评分更高,生活质量更好。2组最常见不良反应为便秘(66.7%∶61.5%,P=0.697),奥氮平组较对照组有更高的嗜睡(59.3%∶19.2%,P=0.003)、头晕(44.4%∶23.1%,P=0.101)等不良反应的发生,失眠方面,奥氮平组发生率较低(18.5%∶46.2%,P=0.031)。结论本研究首次证实了在接受MEC方案(FOLFOX6/FOLFIRI)化疗同时合并高危致吐风险因素的消化道肿瘤患者中,奥氮平联合5-羟色胺3受体拮抗剂及地塞米松,较好地控制了CINV,特别是对于延迟期及恶心的控制明显优于对照组,提高了患者生活质量。
基金This study was supported by a grant from the Foundation of CapitalMedicine Development (No.ZD199909).
文摘Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency （RF） ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.Methods Three hundred and flfty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients （0. 8% ）. The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.Results Two patients with liver metastasis and one hepatocellular carcinoma （HCC） patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four （80%） of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date.Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.
文摘Backoround Hepatocellular carcinoma （HCC） often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound （CEUS） and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Methods Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules （RNs）, dysplastic nodules （DNs）, or DNs with focus of HCC （DN-HCC）, were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns： type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase （washout）; type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）; and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）. The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test. Results Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows： type I, 49 （37.1%）; type II, 27 （20.5%）; type III, 28 （21.2%）; type IV, 9 （6.8%）; type V, 19 （14.4%）. Nodules with type I enhancement showed dysplasia in 5 （10.2%） cases; nodules with type II were dysplastic in 11 （40.7%） of cases; nodules with type III enhancement pattern were dysplastic in 22 （78.6%）, and those with type IV enhancement contained dysplasia in 7 （77.8%） of cases. Type V enhancement corresponded to DN-HCC in 19 （100%） of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis （Trend chi-square test, P 〈0.001）. Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC. Conclusion Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.
文摘Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） patients with poor liver function （Child-Pugh class C）, who are not suitable for surgery or hepatic artery chemo-embolization.Methods Thirteen HCC patients （the number of tumors was 17） with liver function of Child-Pugh C （scores： 10.2±0.4）were included in the study. Among the patients, 8 were male and 5 were female with the average age of （61.6±10.9）years old. The average size of HCC was （3.8±1.0） cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors （2-3 tumors）. All the patients were treated with RFA.Results There were 22 RFA sessions （1-4 sessions per patient） in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients （69.2%）, in 7 of them, the liver enzyme returned to pre-RFA level in 1-3 months. One month after RFA, the Child-Pugh grading was 10.3±0.8 （Child-Pugh C）, while that of pre-RFA was 10.2±0.4 （Child-Pugh C）, with no significant difference. Computer tomography （CT） one month after RFA showed that the tumor necrosis rate was 88.2% （15/17）. Five patients had 2-4 repeated RFA due to HCC recurrence.During the follow-up of 2-69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% （3/22 sessions）, including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.Conclusions Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.
文摘Background Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation. Methods Between June 2001 and January 2009, 638 patients with hepatic malignancies （405 with hepatocellular carcinoma, and 233 with liver metastasis） who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher＇s exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate. Results Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% （17/955） with an average onset time of 12 weeks （2-36 weeks）. Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration （P=-0.034） and treatment session 〉4 times （P=0.025） were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group （P=0.043）. Conclusions The incidence of biliary injury was not frequent （1.8%）. Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients＇ long-term survival. Additionally, risk factors may be helpful for selecting radiofrequency ablation candidates and predicting biliary complications.
文摘Conventional ultrasound （US） is the most widely used imaging modality in routine clinical practice worldwide. The limitations of conventional ultrasound in the detection of aortic lesions versus multi-slice computed tomography angiography （MS-CTA） are well known.
