Diagnostic efficacy of combined detection of different tumor markers for primary hepatic carcinoma

Objective:To explore the clinical diagnostic value of combined detection of different tumor markers for primary hepatic carcinoma, and to provide the reference for the clinical diagnosis. Methods: 72 patients who were diagnosed with primary hepatic carcinoma were collected as observation group, 65 patients with benign liver disease as benign liver disease group and 80 cases of health examination as healthy control group, the contents of tumor markers alpha fetoprotein(AFP), carcinoembryonic antigen(CEA), carbohydrate antigen-199(CA199), carbohydrate antigen-125(CA125) and carbohydrate antigen-153(CA153) were determined by electrochemiluminescence in all subjects, then the results of five kinds of tumor markers and the positive rates of each index between the two groups were compared, the diagnostic value of separate and combined detection of different tumor markers in primary hepatic carcinoma were analyzed.Results: The values of AFP, CA199 and CA153 in the observation group were higher than the benign liver disease group, the values of AFP, CEA, CA199, CA125 and CA153 in the observation group were higher than the control group, the values of CA199 and CA125 in the benign liver disease group were higher than the control group, the differences were statistically significant (P<0.05). The positive rates of AFP, CEA, CA199 and CA153 in the observation group were higher than the benign liver disease group, the positive rates of AFP, CEA, CA199 and CA125 in the observation group were higher than the control group, the positive rates of AFP, CEA, CA199 and CA125 in the benign liver disease group were higher than the control group, the differences were statistically significant (P<0.05). The sensitivity of combined detection of all indicators for primary hepatic carcinoma was 86.4%, specificity, correct index, misdiagnosis rate and missed diagnosis rate were 86.4%, 89.2%, 75.6%, 13.6% and 10.8% respectively, and the combined detection was higher than the correct index of each index.Conclusion: Combined detection of serum tumor markers AFP, CEA, CA199, CA125 and CA153 can improve the sensitivity and specificity of diagnosis of primary hepatic carcinoma, it has better diagnostic value for primary hepatic carcinoma.

Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma

BACKGROUND Primary hepatic carcinoma(PHC)has an insidious onset and is usually diagnosed in the middle and late stages.Although transcatheter arterial chemoembolization(TACE)is the preferred option for treating middle-and advanced-stage PHC,it has limited efficacy in killing tumor cells and poor long-term efficacy.TACE plus percutaneous microwave coagulation therapy(PMCT)is more effective than interventional therapy alone and can improve survival time.However,there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC.AIM To investigate the effect of PMCT+TACE on serum tumor markers and the prognosis of middle-late PHC.METHODS This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People’s Hospital between March 2018 and February 2021.Patients were divided into a single group(treated with TACE,n=75)and a combined group(treated with TACE+PMCT,n=75).Before and after treatment,the clinical efficacy and serum tumor marker levels[carbohydrate antigen 19-9(CA19-9),alpha-fetoprotein(AFP),and carcinoembryonic antigen(CEA)]of both groups were observed.The 1-year survival rates and prognostic factors of the two groups were analyzed.RESULTS The combined group had 21 and 35 cases of complete remission(CR)and partial remission(PR),respectively.The single group had 13 and 25 cases of CR and PR,decreased,with the decrease in the combined group being more significant(P<0.05).The 1-year survival rate of the combined group(80.00%)was higher than that of the single group(60.00%)(P<0.05).The average survival time within 1 year in the combined group was 299.38±61.13 d,longer than that in the single group(214.41±72.97 d,P<0.05).COX analysis revealed that tumor diameter,tumor number,and the treatment method were prognostic factors for patients with middle-late PHC(P<0.05).CONCLUSION TACE+PMCT is effective in treating patients with mid-late PHC.It reduces the levels of tumor markers,prolongs survival,and improves prognosis.

STUDY ON THE RFLPs AND AMPLICATION AND REARRANGEMENT OF THE TRANSFORMING GENES IN PRIMARY HEPATIC CARCINOMA, GASTRIC CARCINOMA AND BRAIN TUMOR WITH SIX HUMAN ONCOGENE PROBES

By using c-Ha-ras-1, N-ras Wigler (left sequence) and P52C.(right sequence), c-sis, v-erbB, c-myc and v-fos oncogenes as probes, restriction fragment length polymorphisms (RFLPs) of tumor tissue DNAs of 95 patients with gastric carcinoma, primary hepatic carcinoma and brain tumor, and those of 90 normal individuals were studied with the techniques of Southern blot and dot blot. Gene amplification and recombination were also examined in some tumors simultaneously. Some alleles of oncogene are reported in Chinese population for the first time. Moreover, the characteristic frequency of some "rare" alleles and genotypes occurred in some tumor samples is significantly higher than that occured in normal individuals. Pedigree analysis for 2 patients showed that some "rare" alleles are also abandant. Besides, gene amplification and recombination were found in some tumors.

Clinical Study on TACE Combined with Elemene Injection and Cinobufagin Injection Respectively for Middle and Advanced Primary Hepatic Carcinoma

Objective: To observe and compare the differences in the clinical effect and the incidences of adverse reactions oftranscatheter arterial chemoembolization(TACE) combined with elemene injection and cinobufagin injection respectively for middleand advanced primary hepatic carcinoma. Methods: A total of 104 cases of patients with middle and advanced primary hepaticcarcinoma who were treated in the oncology department from August 2018 to January 2020 were included as the study objects, andwere randomly divided into two groups according to different treatment regimens, 52 cases in each group. Both groups were treatedwith TACE once;the cinobufagin injection group was given intravenous infusion with 500 mL of 5% glucose injection and 10 mLof cinobufagin injection once a day. The elemene injection group was given intravenous infusion with elemene injection of 0.4 geach time and once a day. Both groups were treated for two courses, 15 days of continuous treatment with a rest of 15 days beingone course. The clinical effect, the changes in the indexes of liver function including alanine amino transferase(ALT), aspartatetransaminase(AST) and total bilirubin(TBil), the scores of alpha-fetoprotein(AFP) and Karnofsky (KPS) and tumor volumes aswell as the difference in the incidences of adverse reactions between the two groups were observed and compared. Results: Thetotal clinical effective rate was 88.46% in the elemene injection group and 71.15% in the cinobufagin injection group, and thedifference was significant(P<0.05). After treatment, the levels of ALT, AST and TBil in serum in the two groups were significantlydecreased when compared with those before treatment, differences being significant(P<0.05). There was no significant differencebeing found in the comparison of the levels of ALT, AST and TBil in serum between the two groups (P>0.05). After treatment, thedecrease of AFP, tumor volume and the increase of KPS scores in the elemene injection group were significantly more than thosein the cinobufagin injection group, differences being significant (P<0.01). During treatment, there was no significant differencebeing found in the comparison of the total incidences of adverse reactions between the two groups(P>0.05). The adverse reactionsin the cinobufagin injection group were mainly nausea and vomiting, with higher incidence than that in the elemene injection group,the difference being significant (P<0.05). The adverse reactions in the elemene injection group were mainly pain at the injectionsite, with higher incidence than that in the cinobufagin injection group, the difference being significant (P<0.05). Conclusion: Thetherapy of elemene injection combined with TACE for middle and advanced primary hepatic carcinoma has better clinical effect thanthat of cinobufagin injection, but the occ.

Primary hepatic neuroendocrine tumor: A case report and literature review

Primary hepatic neuroendocrine tumors(PHNETs) are extremely rare and difficult to distinguish from other liver tumors, such as hepatocellular carcinoma(HCC) and cholangiocarcinoma, based on medical imaging findings. A 70-year-old man was referred for evaluation of liver mass incidentally discovered on abdominal computed tomography. The characteristic finding from dynamic liver magnetic resonance imaging led to a diagnosis of HCC. The patient underwent right hepatectomy. Histopathological and immunohistochemical examination revealed grade 2 neuroendocrine tumor. The postoperative 24-h urinary excretion of 5-hydroxy-indolacetic acid was within the normal range. Further imaging investigations were performed. No other lesions were found making probable the diagnosis of PHNET. This case shows that the diagnosis of PHNET is a medical challenge, requiring differentiation of PHNETs other hepatic masses and exclusion of occult primary neuroendocrine tumors. The diagnosis of PHNET can be ascertained after long term follow-up to exclude another primary origin.

High incidence combination of multiple primary malignant tumors of the digestive system

BACKGROUND Clinical reports of multiple primary malignant tumors(MPMTs)in the digestive system are increasing.In China,although the survival rate of patients with MPMTs is increasing,the quality of life is very low.Many patients have reached the advanced stage when the second primary tumor is found,resulting in no early intervention and treatment.This is due to the misunderstanding of MPMTs by clinicians,who treat such tumors as metastases.Therefore,before a patient has a second primary tumor,doctors should understand some common combinations of digestive system MPMTs to provide clinical guidance to the patient.AIM To explore the high incidence combination of digestive system MPMTs under heterochronism and synchronization.METHODS A total of 1902 patients with MPMTs at Peking Union Medical College Hospital were analyzed retrospectively.They were divided into metachronous MPMT and synchronous MPMT groups,and then the high incidence combinations of the first primary cancer and the second primary cancer in metachronous cancer and synchronous cancer were sorted.Sex and age differences between metachronous and synchronous tumors were tested by the chi square test and t test,respectively.A P value<0.05 was considered as statistically significant,and SPSS version 26.0(SPSS Inc.,Chicago,Illinois,United States)was used for statistical analysis.RESULTS Among the 1902 patients with MPMTs confirmed by pathology,1811(95.2%)cases were secondary primary cancers,89(4.7%)cases were tertiary primary cancers,and 2(0.1%)cases were quaternary primary cancers.Most(88.2%)of the secondary primary cancers were identified as metachronous multiple primary cancers six months after diagnosis of the first primary cancer.The top ten most common MPMTs in the first primary cancer group ranged from high to low as follows:Breast cancer,thyroid cancer,nonuterine cancer,lung cancer,colon cancer,kidney cancer,uterine cancer,bladder cancer,rectal cancer,and gastric cancer.The highest incidence rate of the first primary cancer in male metachronous cancer was lung cancer(11.6%),the highest incidence rate of the second primary cancer was still lung cancer(24.9%),the highest incidence rate of the first primary cancer in female metachronous cancer was breast cancer(32.7%),and the highest incidence rate of the second primary cancer was lung cancer(20.8%).Among them,breast cancer,nonuterine cancer and uterine cancer were female-specific malignant tumor types,and thyroid cancer also accounted for 79.6%of female patients.The top five metachronous cancer combinations,independent of female-specific malignant tumor types and thyroid cancer,were colon cancer and lung cancer(26 cases),kidney cancer and lung cancer(25 cases),rectal cancer and lung cancer(20 cases),gastric cancer and lung cancer(17 cases),and bladder cancer and lung cancer(17 cases).The most common synchronous cancer combination was colon cancer and rectal cancer(15 cases).CONCLUSION Screening for lung cancer should be performed six months after the detection of colon cancer while rectal cancer screening should be performed within six months.

Traditional Chinese Medicine Combined with Hepatic Arterial Chemotherapy and Embolization in Tresting Primary Hepatocellular Carcinoma

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血清PIVKA-Ⅱ、AFP、GGT及ALP检测对原发性肝癌的诊断价值

目的:探究血清异常凝血酶原(PIVKA-Ⅱ)、甲胎蛋白(AFP)、γ-谷氨酰转移酶(GGT)与碱性磷酸酶(ALP)检测对原发性肝癌(PHC)的诊断价值。方法:选取41例初治PHC患者为PHC组,39例肝硬化患者为肝硬化组,40例健康体检者为健康对照组。对各组血清PIVKA-Ⅱ、AFP、GGT及ALP水平进行定量检测,并比较各组间水平,同时分析各指标单独和联合检测PHC时的灵敏度、特异度及受试者工作特征曲线(ROC)下面积(AUC)。结果:PHC组患者血清PIVKA-Ⅱ、AFP、GGT及ALP均高于肝硬化组和健康对照组(P<0.05);PIVKA-Ⅱ、AFP、GGT和ALP单项检测的AUC分别为0.839、0.834、0.837和0.799。联合检测AUC均高于各指标单项检测AUC,其中PIVKA-Ⅱ、AFP、GGT及ALP联合检测的AUC最高(0.939),敏感度最高(90.24%),PIVKA-Ⅱ与AFP联合检测的特异度最高(97.47%)。结论:血清PIVKA-Ⅱ、AFP、GGT及ALP联合检测可提高对PHC的诊断效能,四者联合有利于PHC的早期筛查与诊断。

腹部超声对原发性肝癌患者门静脉高压及门静脉癌栓的诊断价值

目的:探讨腹部超声对原发性肝癌患者门静脉高压及门静脉癌栓的诊断价值。方法:选取118例原发性肝癌患者为研究对象,均行腹部超声检查,根据是否存在门静脉高压分为门静脉高压组(n=80)和无门静脉高压组(n=38)。比较两组患者门静脉内径(Dpv)、脾静脉内径(Dsv)、门静脉血流速度(Vpv)和脾静脉血流速度(Vsv),分析门静脉高压组患者Dpv和Dsv与食管胃底静脉曲张程度的相关性;根据是否存在门静脉癌栓分为门静脉癌栓组(n=43)和无门静脉癌栓组(n=75),比较两组患者肝动脉主干直径和肝动脉血流速度。结果:门静脉高压组患者Dpv和Dsv大于无门静脉高压组(P<0.05);Vpv和Vsv小于无门静脉高压组(P<0.05);Dpv和Dsv与食管胃底静脉曲张程度正相关(P<0.05)。门静脉癌栓组患者肝动脉主干直径大于无门静脉癌栓组(P<0.05),肝动脉血流速度高于无门静脉癌栓组(P<0.05)。结论:腹部超声能够鉴别原发性肝癌患者是否合并有门静脉高压及门静脉癌栓,且临床诊断价值较高,有利于指导临床治疗。

原发性肝癌病人经肝动脉持续灌注化疗的护理研究进展

从原发性肝癌的分类和治疗,肝动脉持续性灌注化疗(hepatic artery infusion chemotherapy, HAIC)的术前、术中、术后护理现状、常见并发症的护理、出院后的护理及HAIC护理目前的不足与展望等进行综述,以期为行HAIC治疗的病人护理提供参考。

TACE联合射频消融对原发性肝细胞癌患者肿瘤相关血清标志物水平的影响

目的观察肝动脉化疗栓塞(TACE)联合射频消融(RFA)对原发性肝细胞癌患者肿瘤相关血清标志物的影响,旨在为临床相关疾病治疗提供科学参考。方法采用随机数字表法将该院2019年2月至2021年2月收治的78例原发性肝细胞癌分为对照组(39例,TACE治疗)与联合组(39例,TACE+RFA治疗),对比2组近期疗效、相关血清标志物[血清中E钙蛋白(EC)、甲胎蛋白(AFP)、基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)、谷丙转氨酶(ALT)、总胆红素(TBIL)、谷氨酸转移酶(GGT)、糖类抗原199(CA199)]及生存情况。结果联合组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。2组疾病控制率比较,差异无统计学意义(P>0.05)。治疗结束时2组血清EC、VEGF、MMP-9、AFP、ALT、TBIL、CA199、GGT表达均下降,且联合组上述血清标志物表达水平均低于对照组,差异有统计学意义(P<0.05)。2组6个月、1年生存率比较,差异无统计学意义(P>0.05),但联合组2年生存率高于对照组,差异有统计学意义(P<0.05)。结论TACE与RFA联合治疗原发性肝细胞癌利于提高患者近期疗效,改善血清肿瘤标志物,安全性良好,且可提高患者2年内生存率。

联合检测AFP和CEA肿瘤标志物对原发性肝癌与转移性肝癌的鉴别诊断价值

目的探讨联合检测甲胎蛋白（AFP）和癌胚抗原（CEA）对原发性肝癌（PHC）与转移性肝癌（MHC）的鉴别诊断价值。方法用微粒子化学发光免疫分析法检测132例PHC，47例MHC和100例健康对照者血清AFP和CEA。结果PHC患者AFP极度升高，达3685．2±5964．3μg／L，明显比MHC组（25．2±81．6μg／L）和健康对照组（4．1±2．6μg／L）高（F=27．8，P〈0．01），81．8％的PHC患者AFP阳性，其中76．5％的患者AFP〉500μg／L；12．8％的MHC患者AFP阳性，但均〈200μg／L。AFP对PHC诊断的灵敏度（SE），特异度（SP），阳性预测值（PPV），阴性预测值（NPV），准确度（AC）分别为81．8％，87．2％，94．7％，63．1％，83．2％；CEA对MHC诊断的SE，SP，PPV，NPV，AC分别为72．3％，53．8％，35．8％，84．5％，58．7％。结论联合检测AFP和CEA能较好地诊断和鉴别诊断PHC与MHC。

原发性肝癌及肝外转移瘤的^(125)I粒子植入治疗

目的:评价CT导向下125I粒子植入术治疗原发性肝癌及肝外转移瘤的临床价值及疗效。方法:本组病例31例,病灶总数为65个,平均直径为3.5cm,其中肝内病灶20个,肺转移瘤25个,淋巴结转移15个,骨转移瘤5个。全部病例经CT、MRI检查或病理穿刺活检证实。术前采用治疗计划系统(TPS)计算布源,术中将活度为0.8mCi的125I粒子在CT导向下植入肿瘤内。粒子按照0.5～1.0cm平面插植。肿瘤周边匹配剂量(MPD)100～150Gy。结果:2个月后CT复查,完全缓解(CR)4例;部分缓解(PR)18例;无变化(NC)3例;进展(PD)6例,总有效率71.1%(22/31),疼痛缓解率72.7%(8/11)。65个病灶中完全缓解(CR)18个;部分缓解(PR)35个;无变化(NC)8个;进展(PD)4个,局部控制率81.5%(53/65)。2例患者死于远处转移,3例死于肝功能衰竭。2个月随访过程中发现8颗粒子在肝脏内游走,5颗粒子迁徙至肺内;2例出现气胸,肺压缩在30%以下,术后2例患者出现轻度白细胞下降,白细胞计数≥3.0×109/L,经保守治疗后均恢复正常。所有手术均顺利完成,未见放射性肺炎、大出血、胆汁瘘、胰瘘等严重并发症。结论:125I粒子植入术治疗原发性肝癌及肝外转移瘤疗效确切,创伤小,并发症少。

血清AFP、GP73和GPC3联合检测在原发性肝癌诊断中的应用

目的探讨甲胎蛋白(AFP)、高尔基体蛋白73(GP73)、磷脂酰肌醇蛋白聚糖3(GPC3)联合检测在原发性肝癌(PHC)诊断中的临床应用价值。方法采用酶联免疫吸附试验(ELISA)检测148例PHC患者、73例肝硬化(LC)患者、57例慢性乙型肝炎(CHB)患者及85名健康人(正常对照组)血清GP73、GPC3含量,同时采用免疫化学发光法检测血清AFP含量,并对检测结果进行比较。结果 PHC组GP73、GPC3、AFP血清水平分别为346.9±208.7、143.1±66.9和(690.3±402.5)μg/L,与LC组、CHB组和正常对照组血清水平比较差异具有统计学意义(P均<0.01);血清AFP、GP73、GPC3联合检测诊断PHC的敏感性为95.9%,准确性为89.2%。结论血清AFP、GP73、GPC3联合应用能弥补单项肿瘤标志物临床应用的不足,对提高PHC的阳性检出率及鉴别诊断具有重要的临床意义。

经动脉灌注化疗联合^(125)I粒子条治疗原发性肝癌合并门脉癌栓的疗效分析

目的比较肝动脉化疗栓塞(TACE)联合腔内植入125I粒子条治疗原发性肝癌合并门脉广泛癌栓的疗效。方法对72例接受TACE治疗的原发性肝癌合并门静脉癌栓患者的资料进行回顾性分析,其中32例(A组)在门静脉内植入125I粒子条,同时行TACE治疗肝脏原发灶;40例(B组)仅行TACE治疗。分别对两组患者的门脉癌栓情况、生存期及相关不良事件进行分析。对治疗前后各测量值的改变采用配对样本t检验,计数资料采用χ2检验,用Kaplan-Meier法分析生存时间。结果门静脉内植入125I粒子条的技术成功率为100%,无严重相关不良事件发生。两组患者中位生存期分别为210 d(A组)及141 d(B组),P=0.012,差异有统计学意义。结论门静脉内植入125I粒子条能显著延长原发性肝癌伴门静脉广泛癌栓患者的生存期。

乙型肝炎病毒相关肝癌血清差异表达蛋白的筛选、鉴定及其诊断价值

目的:筛选、鉴定乙型肝炎病毒(HBV)相关肝癌的血清差异表达蛋白,探讨其可能的早期诊断价值。方法:采用蛋白芯片及表面增强激光解析电离飞行时间质谱(surface-enhanced laser desorption/ionization time-of-flight mass spectrometry,SELDI-TOF-MS)技术对正常人、HBV相关肝炎、肝硬化患者及原发性肝癌患者术前血清分别进行检测,筛选肝癌血清差异表达蛋白;通过离子交换柱分离纯化其中表达差异最明显的蛋白,并进行质谱鉴定。根据筛选结果,建立肝癌诊断决策树模型,评价其诊断肝癌的准确性和敏感度。结果:与正常组相比,肝癌组有44个差异蛋白质波峰(P<0.05),其中21个上调,23个下调;与肝硬化组相比,肝癌组有51个差异蛋白质波峰(P<0.05),其中47个上调,4个下调。质荷比为5805的蛋白质表达在正常人群<慢性肝炎组<肝硬化组<肝癌组,在肝癌组中表达最高,差异具有统计学意义(P<0.01);对其酶解消化产物进行肽指纹谱(PMF)鉴定发现其中有2条肽段序列与硫酸软骨素合酶Ⅱ部分序列相匹配。根据筛选的差异表达蛋白成功建立肝癌诊断决策树模型,其判断肝癌的准确率为94.82%[(23+32)/58]、敏感性88.46%(23/26)、特异性100%(32/32)。结论:成功筛选HBV相关肝癌血清差异表达蛋白,其中差异最显著蛋白(质荷比为5805)酶解产物中有2条肽段与硫酸软骨素合酶Ⅱ部分序列相匹配;根据筛选结果建立的肝癌诊断决策树模型有助于早期诊断HBV相关肝癌。

联合检测血清AFU、AFP肿瘤标志物在原发性肝癌诊断中的临床价值

目的探讨血清-αL-岩藻糖苷酶(AFU)和甲胎蛋白(AFP)在原发性肝癌诊断中的临床意义。方法采用化学比色速率法和微粒子酶法,测定88例原发性肝癌患者、56例肝良性疾病患者血清AFU和AFP水平,并与68例正常对照组进行比较。结果原发性肝癌组患者血清AFU、AFP水平〔(789.4±475.2)μmol/L,(977.3±637.4)ng/mL〕,高于肝良性病组〔(378.3±127.9)μmol/L,(6.09±1.57)ng/mL〕和正常对照组〔(347.8±119.6)μmol/L,(4.17±1.26)ng/mL〕,差异有统计学意义(P<0.001)。在肝癌小于或等于5cm或大于或等于10cm时,AFU水平差异无统计学意义(P>0.05);AFP水平差异有统计学意义(P<0.001)。以血清AFU、AFP水平为指标检测原发性肝癌的敏感性、特异性分别为77.3%、68.2%,86.8%、97.1%,两项联合检测的敏感性、特异性则分别为92.0%,82.3%。结论血清AFU在原发性肝癌的检测中敏感性高于AFP,若两项指标联合检测,起到优势互补作用,可显著增加阳性检出率,有助于原发性肝癌的诊断、病情变化判别及治疗效果观察。

50例原发性肝癌血清多肿瘤标志物的联合检测研究

目的观察原发性肝癌(PHC)患者血清多肿瘤标志物联合检测的阳性检出率。方法应用多肿瘤标志物蛋白质芯片诊断系统,观察50例PHC、13例其他恶性肿瘤患者、43例炎症性疾病患者以及220例正常对照的血清AFP、CA19-9、CA125、CEA、CA242的阳性表达率。结果PHC组AFP、CA19-9、CA125、CEA、CA242的阳性检出率分别为86%、42%、38%、24%、18%,该5项肿瘤标志物联合检测,阳性检出率可达96.00%。结论联合检测AFP、CA19-9、CA125、CEA、CA242等肿瘤标志物,有利于提高PHC的诊断率。

经皮经肝穿刺注射碘油化疗药物治疗原发性肝癌门静脉癌栓的临床研究

目的观察彩色多普勒超声定位引导下经皮注射碘油化疗药物乳剂治疗原发性肝癌并发门静脉癌栓的临床疗效。方法对21例患者,以21G注射针经皮经肝穿刺进入门静脉癌栓内,在超声监视下缓慢注射吡柔比星与超液化碘化油乳剂。结果21例患者前后共接受56次序贯治疗。治疗2～3次后15例患者癌栓缩小,其内可见条状静脉血流通过,有效率为71.43%。结论经皮经肝穿刺门静脉癌栓序贯注射碘油化疗药物乳剂是原发性肝癌并发门静脉癌栓的有效治疗手段。

肝动脉化疗栓塞术后应用奥沙利铂联合替吉奥治疗晚期原发性肝癌的临床观察

目的:观察肝动脉化疗栓塞术后应用奥沙利铂联合替吉奥治疗晚期原发性肝癌的疗效和安全性。方法:选取我院2011年4月-2013年4月的晚期原发性肝癌患者120例,按照随机数字表法分为对照组和观察组,各60例。两组患者均行肝动脉化疗栓塞术。对照组患者术后给予奥沙利铂注射液0.08 g/m^2,经导管动脉泵注,4 h内泵注完毕;观察组患者在对照组基础上给予替吉奥胶囊40 mg/m^2,po,bid。两组患者均治疗4个月。观察两组患者临床疗效、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)和直接胆红素(DBIL)]和甲胎蛋白(AFP)水平,记录治疗过程中不良反应发生情况以及随访1、2、3年的生存率。结果:治疗前,两组患者肝功能指标、AFP水平比较,差异均无统计学意义(P>0.05)。治疗后,观察组患者的疾病控制率(78.33%)和临床受益率(93.33%)均明显高于对照组(48.33%和71.67%),差异均有统计学意义(P<0.05);两组患者ALT、AST、TBIL和DBIL水平均明显升高,但观察组明显低于对照组,差异均有统计学意义(P<0.05);两组患者AFP水平明显降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组患者随访1、2、3年的生存率均明显高于对照组,差异均有统计学意义(P<0.05)。结论:肝动脉化疗栓塞术后应用奥沙利铂联合替吉奥治疗晚期原发性肝癌患者疗效较好,且安全性好。