经肝动脉化疗栓塞联合微波消融治疗中晚期肝癌的临床疗效观察
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摘要
目的:探讨经导管肝动脉化疗栓塞(TACE)联合微波消融(MCT)治疗中晚期肝癌的临床疗效及临床应用价值。
方法:回顾分析2004年12月至2006年9月间在广西肿瘤医院接受TACE及TACE+PMCT治疗的资料完整的中晚期肝癌患者共83例,其中以单纯行TACE治疗的55例患者做为对照组,行TACE+PMCT治疗的28例患者为实验组(两组资料具有可比性)。两组病人首次行TACE术治疗:经导管予肿瘤供血动脉内灌注5-氟尿嘧啶(5-FU)750~1000mg及表阿霉素(EPI)40~60mg或顺铂(DDP)40~60mg;用丝裂霉素(MMC)10~14mg及碘化油(LP)10~30ml混合乳剂对肿瘤供血动脉进行栓塞,必要时加用明胶海绵颗粒强化栓塞;对合并有肝动门脉瘘者(HAPS)先行瘘口栓塞,闭塞瘘口后再行肿瘤栓塞。常规每次TACE治疗后3~4周复查CT或肝动脉造影,根据碘油缺失、瘘口再通、癌灶残留及病灶进展等情况综合评定,再选择性行TACE或PMCT治疗,连续治疗3次为一个周期。观察比较两组有效率、AFP平均下降率、毒副作用、复发转移率、生存期。评价TACE联合PMCT治疗中晚期肝癌的临床疗效。
结果:两组病例经治疗后临床症状均得到改善,生存质量明显提高;⑴有效率:一个周期结束后,经肝脏增强CT扫描评价,实验组有效率为67.86%,对照组为40.00%,两组比较差异有统计学意义(P<0.05),实验组高于对照组;⑵治疗后AFP平均下降率:实验组为76.00%,对照组为47.92%,两组差异有统计学意义(P<0.05);⑶生存时间:实验组中位生存期为30个月,对照组中位生存期24个月,两组0.5年、1年、1.5年、2年累积生存率分别为100%、93%、79%、61%、和95%、84%、65%、38%,两组疗法的生存期对比差异有显著性意义(P<0.05);⑷复发转移率:实验组和对照组治疗中晚期肝癌患者的0.5年、1年、2年累积复发转移率分别为7.14%、14.29%、32.14%和9.09%、34.55%、65.45%,两组差别有统计学意义(P<0.05),实验组复发转移率明显低于对照组;⑸毒副作用:两组毒副作用相似,均未发生严重并发症;(6)肝动-门脉瘘:对照组8例经TACE术反复封堵后仍有3例发生瘘口再通,实验组5例经TACE+PMCT治疗后未出现瘘口再通。
结论:TACE联合PMCT综合治疗中晚期肝癌是安全、可行、有效的治疗方法,其临床疗效优于单纯行TACE治疗,可延长患者生存期,降低复发率,不增加毒副作用。
Objective:To evaluate the clinical effect and application value of transcatheter hepatic arterial chemoembolization(TACE) combined with percutaneous microwave ablation therapy(PMCT) in patients with advanced liver cancer.
Methods:Retrospective analysis of 83 patients with advanced liver cancer rece- ived TACE and TACE combined with PMCT in GuangXi Cancer Hospital from Dec- ember 2004 to September 2006 . 55 patients performed only in TACE were enrolled in control group. 28 patients were treated with TACE+PMCT as the therapy group . The patients were performed firstly in TACE and received 5-FU (750~1000mg) +EPI (40~60mg) or DDP (40~60mg)+the emulsion(10~30ml) constituted by MMC(10~14 mg )and LP (10~30ml) to chemoembolization feeding artery of liver cancer;And gelatin sponge particles were used to Strengthen the embolization necessarily. The HAPS were blocked up before cure tumor .CT inspection was performed after every post-Treatment 3~4 weeks.TACE or TACE+PMCT was selected to patients again accor- ding to the condition of fistula and tumor.The continuous three treatments was a period of treatment.Then followed up the therapeutic effect rates,reduced rates of AFP,side effects,the rates of recurrence and metastasis,survival time of the two groups .
Results: The effect rates were 67.86% and 40.00% in the therapy group and the control group ,respectively(P<0.05);The average reduced rates of AFP was 76.00% and 47.92% in the therapy group and control group ,respectively(P<0.05);The med- ian survival time and 0.5-,1-,1.5-,2-year cumulative survival rate were 30 months、100% 93%、79%、61%and 24months、95%、84%、65%、36% in the therapy group and control group ,respectively(P<0.05);The 0.5-,1-,2-year cumulative recurrence and metastasis rate were 7.14%、14.29%、32.14% and 9.09%、34.55%、65.45% in the therapy group and control group ,respectively(P<0.05);The side effects of two groups were similar and the serious complications were not found;8 HAPS in the control group were blocked up repeatedly with TACE , 3 of them were recanalized yet. 5 HAPS in the therapy group were completely blocked, none of them was recanalized again.
Conclusions:TACE combined with PMCT could safely and effectively treat the Patients with anvanced liver cancer,and extend life span, reduce recurrence rate and not increase side effects.
方法:回顾分析2004年12月至2006年9月间在广西肿瘤医院接受TACE及TACE+PMCT治疗的资料完整的中晚期肝癌患者共83例,其中以单纯行TACE治疗的55例患者做为对照组,行TACE+PMCT治疗的28例患者为实验组(两组资料具有可比性)。两组病人首次行TACE术治疗:经导管予肿瘤供血动脉内灌注5-氟尿嘧啶(5-FU)750~1000mg及表阿霉素(EPI)40~60mg或顺铂(DDP)40~60mg;用丝裂霉素(MMC)10~14mg及碘化油(LP)10~30ml混合乳剂对肿瘤供血动脉进行栓塞,必要时加用明胶海绵颗粒强化栓塞;对合并有肝动门脉瘘者(HAPS)先行瘘口栓塞,闭塞瘘口后再行肿瘤栓塞。常规每次TACE治疗后3~4周复查CT或肝动脉造影,根据碘油缺失、瘘口再通、癌灶残留及病灶进展等情况综合评定,再选择性行TACE或PMCT治疗,连续治疗3次为一个周期。观察比较两组有效率、AFP平均下降率、毒副作用、复发转移率、生存期。评价TACE联合PMCT治疗中晚期肝癌的临床疗效。
结果:两组病例经治疗后临床症状均得到改善,生存质量明显提高;⑴有效率:一个周期结束后,经肝脏增强CT扫描评价,实验组有效率为67.86%,对照组为40.00%,两组比较差异有统计学意义(P<0.05),实验组高于对照组;⑵治疗后AFP平均下降率:实验组为76.00%,对照组为47.92%,两组差异有统计学意义(P<0.05);⑶生存时间:实验组中位生存期为30个月,对照组中位生存期24个月,两组0.5年、1年、1.5年、2年累积生存率分别为100%、93%、79%、61%、和95%、84%、65%、38%,两组疗法的生存期对比差异有显著性意义(P<0.05);⑷复发转移率:实验组和对照组治疗中晚期肝癌患者的0.5年、1年、2年累积复发转移率分别为7.14%、14.29%、32.14%和9.09%、34.55%、65.45%,两组差别有统计学意义(P<0.05),实验组复发转移率明显低于对照组;⑸毒副作用:两组毒副作用相似,均未发生严重并发症;(6)肝动-门脉瘘:对照组8例经TACE术反复封堵后仍有3例发生瘘口再通,实验组5例经TACE+PMCT治疗后未出现瘘口再通。
结论:TACE联合PMCT综合治疗中晚期肝癌是安全、可行、有效的治疗方法,其临床疗效优于单纯行TACE治疗,可延长患者生存期,降低复发率,不增加毒副作用。
Objective:To evaluate the clinical effect and application value of transcatheter hepatic arterial chemoembolization(TACE) combined with percutaneous microwave ablation therapy(PMCT) in patients with advanced liver cancer.
Methods:Retrospective analysis of 83 patients with advanced liver cancer rece- ived TACE and TACE combined with PMCT in GuangXi Cancer Hospital from Dec- ember 2004 to September 2006 . 55 patients performed only in TACE were enrolled in control group. 28 patients were treated with TACE+PMCT as the therapy group . The patients were performed firstly in TACE and received 5-FU (750~1000mg) +EPI (40~60mg) or DDP (40~60mg)+the emulsion(10~30ml) constituted by MMC(10~14 mg )and LP (10~30ml) to chemoembolization feeding artery of liver cancer;And gelatin sponge particles were used to Strengthen the embolization necessarily. The HAPS were blocked up before cure tumor .CT inspection was performed after every post-Treatment 3~4 weeks.TACE or TACE+PMCT was selected to patients again accor- ding to the condition of fistula and tumor.The continuous three treatments was a period of treatment.Then followed up the therapeutic effect rates,reduced rates of AFP,side effects,the rates of recurrence and metastasis,survival time of the two groups .
Results: The effect rates were 67.86% and 40.00% in the therapy group and the control group ,respectively(P<0.05);The average reduced rates of AFP was 76.00% and 47.92% in the therapy group and control group ,respectively(P<0.05);The med- ian survival time and 0.5-,1-,1.5-,2-year cumulative survival rate were 30 months、100% 93%、79%、61%and 24months、95%、84%、65%、36% in the therapy group and control group ,respectively(P<0.05);The 0.5-,1-,2-year cumulative recurrence and metastasis rate were 7.14%、14.29%、32.14% and 9.09%、34.55%、65.45% in the therapy group and control group ,respectively(P<0.05);The side effects of two groups were similar and the serious complications were not found;8 HAPS in the control group were blocked up repeatedly with TACE , 3 of them were recanalized yet. 5 HAPS in the therapy group were completely blocked, none of them was recanalized again.
Conclusions:TACE combined with PMCT could safely and effectively treat the Patients with anvanced liver cancer,and extend life span, reduce recurrence rate and not increase side effects.
引文
1.钱骏,冯敢生.原发性肝癌的综合介入治疗[J].中华肿瘤杂志,2003,25(5):417-419.
2.樊代明,韩国宏,孟祥杰.提高肝癌介入治疗的疗效[J] .中华消化杂志,2006 , 26 (5) : 289 - 290.
3. ParkM,KimK,YuJ etal. Radiologic Findings of Gastrointestinal Tract Involvement in HePatocellular Carcinoma.Joumal of ComPuter Assisted TomograP,2002,26(1):95-101.
4.孙燕.内科肿瘤学.北京:人民卫生出版社,2001,994-99.
5.殷晓煜,谢晓燕,等.超声引导经皮复合热消融技术治疗中、大肝细胞癌.中华外科杂志[J].2004,42(17):1029-1032.
6.吴孟超.原发性肝癌的诊断和治疗进展。中国肿瘤;1999,8(1):18-20.
7.汤钊猷.原发性肝癌的研究进展.中国肿瘤临床;1998,25(2):137-141.
8.Acunas,-B;Rozanes,-I.Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. Eur-J-Radiol. 1999 Oct;332(1):86-89.
9. Poon RT , Fan ST , Lo CM , et al. Intrahepatic recurrence after curative resection of hepatocellular carcinoma : long term results oftreatment and prongostic factors. Ann Surg , 1999 ; 229 (2) : 216 -222.
10.Yamada R , Kishi K, Terada M , et al. Transcatheter arterial chemoembolization for unresectalbe hepatocellular carcinoma.Spring Verlag , 1992 ; 259 - 262.
11. NagashimaJ,OkudaK,TanakaM,etal.Prognostic benefit in eytoreduetive surgery for curatively unreseetable hepatocellular carcinoma coparison to transcatheter arterial chemoemblization.Int.J Oncol,1999,15(6):1117-1123.
12.Kan Z,Ivancev K, Lunderquist A,et al.In vivo microscopy of hepatic tumorsin animal models:A dynamic investigation of blood supply to hepatic metastases. Radiology,1993,187:162.
13.董宝玮,张晶,梁萍,等,肝癌经皮微波凝固治疗前后局部免疫细胞浸润影像因素分析.中华医学杂志,2002,82(6):393.
14.Dong BW,Zhang J,Liang P,et al.Sequential pathological and immunologic analysis of percutaneous microwave coagulation therapy of hepatocellular carcinoma. Int J Hyperthermia,2003,19(2):119
15.LuMD, Chen JW, Xie XY , et al. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy. Radiology,2001, 221: 167-172.
16.何文,梁晓宁,徐利群,等.超声引导微波介入治疗大肝癌临床评价.中华医学超声杂志, 2004, 1: 13-15.
17. Wright AS, Sampson LA, Warner TF, et al. Radiofrequency versus microwave ablation in a hepatic porcine model [J]. Radiology,2005, 236(1): 132-139
18 .Ishida T , Murakami T , Shibata T , et al . Precutaneous microwave tumor coagulation for hepatocellular carcinoma wit h interruption of segmental hepatic blood flow[J ] . J Vasc Interv Radio ,2002 ,13 (2 pt1) :185-191
19.马爱英,沈杰,王海洁,等.肝动脉化疗栓塞联合经皮微波凝固治疗晚期肝癌.介入放射学杂志,2007,16(3):201-203.
20.陈灏珠.实用内科学[M].11版.北京:人民卫生出版社.2001:1872-1873.
21.Takayasu K, A rii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients[J ]. Gastroentero logy, 2006, 131 (2) :461-469.
22.OhnishiK,YoshiokaH,KosakaK,etal.Treatment of hyPervaseular small hepatocellular carcinoma with ultrasound guided Pereutaneous acetic acid injection:comparison with segmental transcatheter arterial embolization. Am .JGastroenterol,1996,91:2574.
23. Kuo NT ,Benhayon D ,Przybylski RJ ,et al . Prolonged hypoxia increases vascular endothelial growth factor mRNA and protein in adult mouse brain [J ] . J Appl Physiol ,1999 ;86 :260-264.
24.崔艳峰,祖茂衡,徐浩,等.肝细胞癌TACE术后严重并发症分析.中国介入影像与治疗学,2005,2(1):31-33.
25.Izaki K, Sugimoto K, Sugimura K, et al . Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma. Radiat Med ,2004 , 22 :155.
26.罗鹏飞,陈晓明,张良明,等.肝癌合并动静脉瘘的处理方法探讨.中华放射学杂志,2002 ,36 :114.
27.关守海,单鸿,姜在波,等.经微导管局部灌注无水乙醇治疗肝癌高流量性动静脉瘘.中华放射学杂志,2002 ,36 :997
28.吴汉平,梁惠民,郑传胜,等.TACE联合局部热疗治疗肝癌并肝动脉门脉瘘的短期疗效观察.临床放射学杂志,2006,25(5):455-458.
1.樊代明,韩国宏,孟祥杰.提高肝癌介入治疗的疗效[ J ] .中华消化杂志,2006 , 26 (5) : 289 - 290.
2. SalaM, Llovet JM, Vilana R, et al. Initial response to percutaneous ablation p redicts survival in patients with hepatocellular carcinoma [ J ].Hepatology, 2004, 40 (6) : 135221360.
3. Yamamoto J,Okada S,Shimada K,et al.Treatment strategy for small hepato-Cellular carcinoma:comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology,2001,34:707-713
4.郭佳,杨甲梅,吴孟超.B超普探头引导肝穿刺无水酒精注射治疗肝癌1500例.肝胆外科杂志,1999,7(1):11～12.
5. Luigi S.New applications of ultrasongraphy:interventional ultrasound.Eur J Radiol,1998,27(2):200～206.
6.Lencioni R, CioniD, Crocetti L, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous imageguided radiofrequency ablation [ J ]. Radiology, 2005, 234 ( 3 ) : 961-967.
7.Clark T, Soulen M. Chemical Ablation of Hepatocellular Carcinoma.JVIR 2002;245-252.
8.Tanaka K, Nakamura S, Numata K,et al. Hepatocellular carcinoma:treat-Ment with percutaneous ethanol injection and transcatheter arterial emBolization. Radiology,1992,185:457-460.
9 .汪东文,马庆久,杜锡林,等.肝癌患者集束电极射频治疗后T淋巴细胞亚群及Sil-2R的改变.实用癌症杂志,2001,6(4):348
10. Dong BW, Zhang J,Liang P,et al.Sequential pathological and immunologicanalysis of percutaneous microwave coagulation therapy of hepatocellular Carcinoma.Int J Hyperthermia,2003,19(2):119
11.杜锡林,马庆久,鲁建国,等.射频治疗肝癌前后红细胞免疫功能的改变.肝胆外科杂志,2003,11(5):352
12.王月香,董宝玮,于晓玲,等.超声引导微波凝固治疗肝癌前后血清转化生长因子-β1的变化及意义.肿瘤防治研究,2004,31(5):287
13. Mulier S , Ni Y, Jamart J, et al . Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg, 2005, 242: 158-171.
14. Rossi S ,Di StasiM ,Buscarini E, et al. Percutaneous radiofrequence interstitjal thermal ablation in the treatment of small hepatocellullar carcinoma. Cancer J Sci Am, 1995, 1: 73.
15. Choi D, Lim HK, Kim MJ, et al. Recurrent hepatocellul arcarcinoma:percutaneous radiofrequency ablation after hepatectomy.Radiology,2004,230(1):135.
16. Liovet JM , Vilana R , Bru C , et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology , 2001 ,33 :1124-1129.
17. Livraghi T , Goldberg SN , Lazzaroni S , et al. Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology , 2000 ,214 :761-768.
18.董玮宝,梁萍,于晓玲,等.超声引导经皮微波治疗原发性肝癌远期疗效的评价.中华肿瘤杂志,2002,24(3):282~284.
19. Dong B, Liang P, Yu X,et al.Percutaneous sonographically guided micro-Wave coagulation therapy for hepatocellular carcinoma: result in 234 patIents.AJR,2003,180:1547.
20. LuMD, Chen JW, Xie XY , et al. Hepatocellular carcinoma: US- guided percutaneous microwave coagulation therapy. Radiology,2001, 221: 167-172.
21.何文,梁晓宁,徐利群,等.超声引导微波介入治疗大肝癌临床评价.中华医学超声杂志, 2004, 1: 13-15.
22. Pacella CM ,Bizzurri G,M agnolfi F.et a1.Laser thermal ablation in the treatment of small hepacellular carcinoma : resuIts in74 patients.Radiology,2001,221(3):712-720.
23. MackMG, Straub R, Eichler K, et al. Breast cancer metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology, 2004, 233: 400-409.
24. Vogl TJ, Straub R, Eichler K, et al. Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology, 2004, 230: 450-458.
25. Wu F,Wang ZB, Chen WZ, et al. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience. UltrasoundMed Biol, 2004, 30: 245-260.
26. Seki T, Tanagara T. Combination therapy with transcatheter arterial embolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma.Can-CER,2000,89,(6):1245-1251.
27. Yamakado K, Nakatsuka A, Ohmori S,et al.Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma:treatment response based on Tumor size and morphology.JVIR,2002,13(12):1225-1232.
28. Wang SM,Zhang JR,PENG irresectable liver lulnors by QP.el a1.The treatment of percutancous targeted Ar-Heryoablation[J].Int J ModemCancer ther,2000,3(1):16-18.
29. Sheen A J,Poston G.J,Shedoek D J.Cryotherapeutie ablation of liver tumors[J].British Journal of Surgery,2002,89(1):1396-1401.
30. Charles C, Lee FT, Rikkers LE, et al.Rationale for the combination of cryoablation with surgical resection of hepatic tumors [ J] .Gastrointest Surg, 2001, 5: 206 - 213.
31. Solbiati L , Ierace T , Goldberg SN, et al. Percutaneous US-guided radio-requency tissue ablation of liver metastases: treatment and follow-up in 16 patients. Radiology, 1997, 202: 195-203.
32. Lencioni R, CioniD, Crocetti L, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous imageguided radiofrequency ablation [ J ]. Radiology, 2005, 234 ( 3 ) : 961- 967.
33.陈晔,陈建民,李杏梅,等.原发性小肝癌氩氦刀与无水酒精注射治疗对比研究.医学信息手术学分册,2007,3(20):221-223.
2.樊代明,韩国宏,孟祥杰.提高肝癌介入治疗的疗效[J] .中华消化杂志,2006 , 26 (5) : 289 - 290.
3. ParkM,KimK,YuJ etal. Radiologic Findings of Gastrointestinal Tract Involvement in HePatocellular Carcinoma.Joumal of ComPuter Assisted TomograP,2002,26(1):95-101.
4.孙燕.内科肿瘤学.北京:人民卫生出版社,2001,994-99.
5.殷晓煜,谢晓燕,等.超声引导经皮复合热消融技术治疗中、大肝细胞癌.中华外科杂志[J].2004,42(17):1029-1032.
6.吴孟超.原发性肝癌的诊断和治疗进展。中国肿瘤;1999,8(1):18-20.
7.汤钊猷.原发性肝癌的研究进展.中国肿瘤临床;1998,25(2):137-141.
8.Acunas,-B;Rozanes,-I.Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. Eur-J-Radiol. 1999 Oct;332(1):86-89.
9. Poon RT , Fan ST , Lo CM , et al. Intrahepatic recurrence after curative resection of hepatocellular carcinoma : long term results oftreatment and prongostic factors. Ann Surg , 1999 ; 229 (2) : 216 -222.
10.Yamada R , Kishi K, Terada M , et al. Transcatheter arterial chemoembolization for unresectalbe hepatocellular carcinoma.Spring Verlag , 1992 ; 259 - 262.
11. NagashimaJ,OkudaK,TanakaM,etal.Prognostic benefit in eytoreduetive surgery for curatively unreseetable hepatocellular carcinoma coparison to transcatheter arterial chemoemblization.Int.J Oncol,1999,15(6):1117-1123.
12.Kan Z,Ivancev K, Lunderquist A,et al.In vivo microscopy of hepatic tumorsin animal models:A dynamic investigation of blood supply to hepatic metastases. Radiology,1993,187:162.
13.董宝玮,张晶,梁萍,等,肝癌经皮微波凝固治疗前后局部免疫细胞浸润影像因素分析.中华医学杂志,2002,82(6):393.
14.Dong BW,Zhang J,Liang P,et al.Sequential pathological and immunologic analysis of percutaneous microwave coagulation therapy of hepatocellular carcinoma. Int J Hyperthermia,2003,19(2):119
15.LuMD, Chen JW, Xie XY , et al. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy. Radiology,2001, 221: 167-172.
16.何文,梁晓宁,徐利群,等.超声引导微波介入治疗大肝癌临床评价.中华医学超声杂志, 2004, 1: 13-15.
17. Wright AS, Sampson LA, Warner TF, et al. Radiofrequency versus microwave ablation in a hepatic porcine model [J]. Radiology,2005, 236(1): 132-139
18 .Ishida T , Murakami T , Shibata T , et al . Precutaneous microwave tumor coagulation for hepatocellular carcinoma wit h interruption of segmental hepatic blood flow[J ] . J Vasc Interv Radio ,2002 ,13 (2 pt1) :185-191
19.马爱英,沈杰,王海洁,等.肝动脉化疗栓塞联合经皮微波凝固治疗晚期肝癌.介入放射学杂志,2007,16(3):201-203.
20.陈灏珠.实用内科学[M].11版.北京:人民卫生出版社.2001:1872-1873.
21.Takayasu K, A rii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients[J ]. Gastroentero logy, 2006, 131 (2) :461-469.
22.OhnishiK,YoshiokaH,KosakaK,etal.Treatment of hyPervaseular small hepatocellular carcinoma with ultrasound guided Pereutaneous acetic acid injection:comparison with segmental transcatheter arterial embolization. Am .JGastroenterol,1996,91:2574.
23. Kuo NT ,Benhayon D ,Przybylski RJ ,et al . Prolonged hypoxia increases vascular endothelial growth factor mRNA and protein in adult mouse brain [J ] . J Appl Physiol ,1999 ;86 :260-264.
24.崔艳峰,祖茂衡,徐浩,等.肝细胞癌TACE术后严重并发症分析.中国介入影像与治疗学,2005,2(1):31-33.
25.Izaki K, Sugimoto K, Sugimura K, et al . Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma. Radiat Med ,2004 , 22 :155.
26.罗鹏飞,陈晓明,张良明,等.肝癌合并动静脉瘘的处理方法探讨.中华放射学杂志,2002 ,36 :114.
27.关守海,单鸿,姜在波,等.经微导管局部灌注无水乙醇治疗肝癌高流量性动静脉瘘.中华放射学杂志,2002 ,36 :997
28.吴汉平,梁惠民,郑传胜,等.TACE联合局部热疗治疗肝癌并肝动脉门脉瘘的短期疗效观察.临床放射学杂志,2006,25(5):455-458.
1.樊代明,韩国宏,孟祥杰.提高肝癌介入治疗的疗效[ J ] .中华消化杂志,2006 , 26 (5) : 289 - 290.
2. SalaM, Llovet JM, Vilana R, et al. Initial response to percutaneous ablation p redicts survival in patients with hepatocellular carcinoma [ J ].Hepatology, 2004, 40 (6) : 135221360.
3. Yamamoto J,Okada S,Shimada K,et al.Treatment strategy for small hepato-Cellular carcinoma:comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology,2001,34:707-713
4.郭佳,杨甲梅,吴孟超.B超普探头引导肝穿刺无水酒精注射治疗肝癌1500例.肝胆外科杂志,1999,7(1):11～12.
5. Luigi S.New applications of ultrasongraphy:interventional ultrasound.Eur J Radiol,1998,27(2):200～206.
6.Lencioni R, CioniD, Crocetti L, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous imageguided radiofrequency ablation [ J ]. Radiology, 2005, 234 ( 3 ) : 961-967.
7.Clark T, Soulen M. Chemical Ablation of Hepatocellular Carcinoma.JVIR 2002;245-252.
8.Tanaka K, Nakamura S, Numata K,et al. Hepatocellular carcinoma:treat-Ment with percutaneous ethanol injection and transcatheter arterial emBolization. Radiology,1992,185:457-460.
9 .汪东文,马庆久,杜锡林,等.肝癌患者集束电极射频治疗后T淋巴细胞亚群及Sil-2R的改变.实用癌症杂志,2001,6(4):348
10. Dong BW, Zhang J,Liang P,et al.Sequential pathological and immunologicanalysis of percutaneous microwave coagulation therapy of hepatocellular Carcinoma.Int J Hyperthermia,2003,19(2):119
11.杜锡林,马庆久,鲁建国,等.射频治疗肝癌前后红细胞免疫功能的改变.肝胆外科杂志,2003,11(5):352
12.王月香,董宝玮,于晓玲,等.超声引导微波凝固治疗肝癌前后血清转化生长因子-β1的变化及意义.肿瘤防治研究,2004,31(5):287
13. Mulier S , Ni Y, Jamart J, et al . Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg, 2005, 242: 158-171.
14. Rossi S ,Di StasiM ,Buscarini E, et al. Percutaneous radiofrequence interstitjal thermal ablation in the treatment of small hepatocellullar carcinoma. Cancer J Sci Am, 1995, 1: 73.
15. Choi D, Lim HK, Kim MJ, et al. Recurrent hepatocellul arcarcinoma:percutaneous radiofrequency ablation after hepatectomy.Radiology,2004,230(1):135.
16. Liovet JM , Vilana R , Bru C , et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology , 2001 ,33 :1124-1129.
17. Livraghi T , Goldberg SN , Lazzaroni S , et al. Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology , 2000 ,214 :761-768.
18.董玮宝,梁萍,于晓玲,等.超声引导经皮微波治疗原发性肝癌远期疗效的评价.中华肿瘤杂志,2002,24(3):282~284.
19. Dong B, Liang P, Yu X,et al.Percutaneous sonographically guided micro-Wave coagulation therapy for hepatocellular carcinoma: result in 234 patIents.AJR,2003,180:1547.
20. LuMD, Chen JW, Xie XY , et al. Hepatocellular carcinoma: US- guided percutaneous microwave coagulation therapy. Radiology,2001, 221: 167-172.
21.何文,梁晓宁,徐利群,等.超声引导微波介入治疗大肝癌临床评价.中华医学超声杂志, 2004, 1: 13-15.
22. Pacella CM ,Bizzurri G,M agnolfi F.et a1.Laser thermal ablation in the treatment of small hepacellular carcinoma : resuIts in74 patients.Radiology,2001,221(3):712-720.
23. MackMG, Straub R, Eichler K, et al. Breast cancer metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology, 2004, 233: 400-409.
24. Vogl TJ, Straub R, Eichler K, et al. Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology, 2004, 230: 450-458.
25. Wu F,Wang ZB, Chen WZ, et al. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience. UltrasoundMed Biol, 2004, 30: 245-260.
26. Seki T, Tanagara T. Combination therapy with transcatheter arterial embolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma.Can-CER,2000,89,(6):1245-1251.
27. Yamakado K, Nakatsuka A, Ohmori S,et al.Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma:treatment response based on Tumor size and morphology.JVIR,2002,13(12):1225-1232.
28. Wang SM,Zhang JR,PENG irresectable liver lulnors by QP.el a1.The treatment of percutancous targeted Ar-Heryoablation[J].Int J ModemCancer ther,2000,3(1):16-18.
29. Sheen A J,Poston G.J,Shedoek D J.Cryotherapeutie ablation of liver tumors[J].British Journal of Surgery,2002,89(1):1396-1401.
30. Charles C, Lee FT, Rikkers LE, et al.Rationale for the combination of cryoablation with surgical resection of hepatic tumors [ J] .Gastrointest Surg, 2001, 5: 206 - 213.
31. Solbiati L , Ierace T , Goldberg SN, et al. Percutaneous US-guided radio-requency tissue ablation of liver metastases: treatment and follow-up in 16 patients. Radiology, 1997, 202: 195-203.
32. Lencioni R, CioniD, Crocetti L, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous imageguided radiofrequency ablation [ J ]. Radiology, 2005, 234 ( 3 ) : 961- 967.
33.陈晔,陈建民,李杏梅,等.原发性小肝癌氩氦刀与无水酒精注射治疗对比研究.医学信息手术学分册,2007,3(20):221-223.