化学消融联合肝动脉化疗栓塞治疗原发性肝癌的疗效评价
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摘要
外科切除是原发性肝癌的传统治疗手段,但总体切除率只有30%左右,主要原因是大部分患者合并肝炎后肝硬化,肝功能储备不足。当出现多发病灶时切除率更低。自Goldstein于1976年首次使用肝动脉化疗栓塞术(TACE)治疗肝癌以后,TACE开始在临床广泛应用。现在TACE已成为中晚期原发性肝癌主要的治疗手段,但经TACE治疗后原有的动脉供血系统受到影响,导致侧枝循环的建立,从而影响再次治疗的效果,同时多次TACE治疗会加重肝功能的损害,肿瘤复发后难以进一步治疗。如何进一步提高疗效,降低副作用成为原发性肝癌介入治疗的现实问题。近年来,肿瘤化学消融技术即PEI疗法在原发性肝癌治疗上的成功应用,为原发性肝癌的介入治疗开辟了新途径。为进一步探讨PEI在原发性肝癌综合介入治疗中的作用,笔者将PEI和TACE结合起来,并与单纯行TACE治疗的疗效进行对比性研究,寻找综合介入治疗原发性肝癌的新方法,以达到进一步提高原发性肝癌介入治疗疗效的目的。85例原发性肝癌患者分为A、B两组,A组为TACE组,54例;B组为PEI联合TACE组(联合治疗组),31例。治疗一个疗程后复查两组患者CT及DSA。结果:TACE组肿瘤完全坏死率为20.37%;1、2年生存率分别为72.22%、46.30%;瘤体周围血管再生率为79.63%;复发率为48.15%;治疗后AFP降低的比率为53.19%。联合治疗组相应值分别为80.65%;83.87%、54.84%;32.26%;25.81%;78.57%。两组治疗后肿瘤完全坏死率,第1、2年生存率,瘤体周围血管再生率,复发率,治疗后AFP降低的比率的差异均有显著意义(P<0.01)。联合治疗组疗效明显优于TACE组。PEI联合TACE,两者相互弥补,使较大肝癌的完全坏死率明显提高,从而进一步提高对肝癌的治疗效果。
Purpose:
To investigate the therapeutic effect of chemistry ablation(PEI)combined with transcatheter arterial chemoembolization(TACE)in treating primary hepatocellular carcinoma.
Methods:
To collect a total of 89 cases of primary hepatocellular carcinoma patients, 4 patients were lost, do not take part in grouping statistics. 85 cases of patients with primary hepatocellular carcinoma, 60 cases of right upper quadrant pain was admitted to hospital, for medical examination found 25 cases of intrahepatic space-occupying lesions. Grouped according to the principle of single-date and double-date law, divided into TACE group and combined therapy group. One of 54 cases of pure TACE group, and the combined therapy group were 31 cases of patients 2 weeks after TACE treatment of PEI. TACE alone group and combined therapy group 1~1.5 per month to carry out duplicate treatment, continuous treatment of duplicate 3 times for a course of treatment, all patients had a complete course of treatment. After the completion of a course of treatment, 1.5 per month CT follow-up visit one time, if stable condition, every 3~6 month CT examination, when necessary, DSA inspection trip.
Results:
In TACE group, the complete necrosis rate of tumor was 20.37%; one year and two year survival rate were 72.22%?46.30%; peripheral vessels of neoplasma reproduce rate was 79.63%; the recurrence rate after a course of treatment was 48.15%; the rate of AFP reduce after treatment 53.19%. Respectively corresponding value were 80.65%; 83.87% ? 54.84%; 32.26%;5.81%; 78.57%in therapeutic alliance group. There were significant statistical differences between the two group (p value smaller than 0.01) Conclusion:
chemistry ablation combined with transcatheter arterial chemoem- bolization treatment of hepatocellular carcinoma was superior to pure TACE group, is a safe, effective, more economic, more in line with the clinical treatment study of integrated programs. The two groups the complete necrosis rate of tumor; one year and two year survival rate; peripheral vessels of neoplasma reproduce rate; the recurrence rate after a course of treatment; the rate of AFP reduce after treatment with a significant difference. PHC in the larger treatment should not place undue reliance on TACE surgery should be the comprehensive application of transcatheter arterial chemoembolization and percutaneous ethanol injection and neonatal kill residual tumor cells in order to improve efficacy. Each other to make up for both, so that the larger the complete necrosis of hepatocellular carcinoma was significantly increased, thereby further enhance the therapeutic effect of hepatocellular carcinoma.
Purpose:
To investigate the therapeutic effect of chemistry ablation(PEI)combined with transcatheter arterial chemoembolization(TACE)in treating primary hepatocellular carcinoma.
Methods:
To collect a total of 89 cases of primary hepatocellular carcinoma patients, 4 patients were lost, do not take part in grouping statistics. 85 cases of patients with primary hepatocellular carcinoma, 60 cases of right upper quadrant pain was admitted to hospital, for medical examination found 25 cases of intrahepatic space-occupying lesions. Grouped according to the principle of single-date and double-date law, divided into TACE group and combined therapy group. One of 54 cases of pure TACE group, and the combined therapy group were 31 cases of patients 2 weeks after TACE treatment of PEI. TACE alone group and combined therapy group 1~1.5 per month to carry out duplicate treatment, continuous treatment of duplicate 3 times for a course of treatment, all patients had a complete course of treatment. After the completion of a course of treatment, 1.5 per month CT follow-up visit one time, if stable condition, every 3~6 month CT examination, when necessary, DSA inspection trip.
Results:
In TACE group, the complete necrosis rate of tumor was 20.37%; one year and two year survival rate were 72.22%?46.30%; peripheral vessels of neoplasma reproduce rate was 79.63%; the recurrence rate after a course of treatment was 48.15%; the rate of AFP reduce after treatment 53.19%. Respectively corresponding value were 80.65%; 83.87% ? 54.84%; 32.26%;5.81%; 78.57%in therapeutic alliance group. There were significant statistical differences between the two group (p value smaller than 0.01) Conclusion:
chemistry ablation combined with transcatheter arterial chemoem- bolization treatment of hepatocellular carcinoma was superior to pure TACE group, is a safe, effective, more economic, more in line with the clinical treatment study of integrated programs. The two groups the complete necrosis rate of tumor; one year and two year survival rate; peripheral vessels of neoplasma reproduce rate; the recurrence rate after a course of treatment; the rate of AFP reduce after treatment with a significant difference. PHC in the larger treatment should not place undue reliance on TACE surgery should be the comprehensive application of transcatheter arterial chemoembolization and percutaneous ethanol injection and neonatal kill residual tumor cells in order to improve efficacy. Each other to make up for both, so that the larger the complete necrosis of hepatocellular carcinoma was significantly increased, thereby further enhance the therapeutic effect of hepatocellular carcinoma.
引文
[1] Yuen MF, Chan AO, Wong BC, Hui CK, Ooi GC, Tso WK, Yuan HJ, Wong DK, Lai CL. Transarterial chemoembolization for inoperable, early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B:results of a comparative study in 96 Chinese patients[J].Am J Gastroenterol, 2003,98:1181-1185.
[2] Song BC, Sub DJ, Yang SH, Lee HC, Chung YH, Sung KB, Lee YS. Lens culinaris agglutinin-reactive alpha-fetoprotein as a prognostic marker in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization[J].J Clin Gastroenterol, 2002,35:398-402.
[3] O'Suilleabhain CB, Pooh RT, Yong JL, Ooi GC, Tso WK, Fan ST. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma[J].Br J Surg,2003,90:325-331.
[4] Lee JK, Chung YH, Song BC, Shin JW, Choi WB, Yang SH, Yoon HK, Sung KB, Lee YS, Sub DJ.Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization[J].J Gastroenterol Hepatol,2002,17:52-58.
[5] Sotiropoulos GC, Lang H, Frilling A,et al. Resectability of hepatocellular carcinoma:evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature[J]. Hepatogastr- oenterology,2006, 53(69):322-329.
[6]吴孟超.肝脏恶性肿瘤[M].见:吴阶平,裘法祖,主编.黄家驷外科学.北京:人民卫生出版社,2002,1230-1231.
[7] ADACHI E,METSUMATA T,NISHIZAKI T, et al. Effects of preoperative hepatic artery chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis [J]. Cancer,1993,72 (9): 3593- 3598.
[8]杉蒲信子,高良健司,藤大正雄,等.超音波影像下经皮的肿瘤内エタノヘⅣ注入江上う小肝细胞癌の治疗[J].肝脏,1983,24(8):920(10)
[9] Qin LX,Tang ZY.The prognostic of clinical and pathological features in hepatocellular carcinoma[J].World J Gastroenterol,2002,8(2):193-199.
[10]徐永茂,张南征,张国龙,等.经皮肿瘤内注入无水乙醇结合TACE治疗中晚期原发性肝癌的疗效观察[J].中国肿瘤临床与康复,2002,9(4):78-80.
[11]陈晓明,罗鹏飞,林华欢,等.经导管肝动脉化疗栓塞联合经皮无水乙醇注射治疗肝癌的长期疗效观察[J].癌症,2004,23(7):829-832.
[12]李忱瑞.肝癌的介入治疗[J].中国医刊,2002 ,3(37):16-18.
[13] Shiina S, Tagawa K, Uhuma T, et al. Percutaneous ethanol injection therapy for the treatment of hepatocelluar carcinoma[J]. AJR,1990, 154:947.
[14]徐峰,杨甲梅.小肝癌合并严重肝硬化的治疗[J].中华肝胆外科杂志,2003, 9(4): 241-242.
[15] Pompili M, Rapccini GL, Luca F, et al.Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutan- eous ethanol injection[J].Cancer,1997,79: 1501-1504.
[16]周信达,刘银坤.肝癌复发转移防治的临床与基础[J].中国肿瘤,2001,102:65-67.
[17]李忱瑞,史仲华,郝玉芝,等.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[J].中华肿瘤杂志,2001,23:490-492.
[18]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[J].肝胆外科杂志,1999,7(1):11-12.
[19]李波,吴孟超,陈汉,等.术后复发性肝癌瘤内酒精注射治疗[J].中华肿瘤杂志,1995,7(5):371-373.
[20] Fan J,Tang ZY,Yu YQ,et al.Improved survival with resection after tra- nscatheter arterial chemoembolization(TACE)for unresectable hepatocellular carcinoma[J].Dig Surg,1998,15:674-678.
[21]王鑫森,李佳睿,张海峰,等.化学消融联合肝动脉化疗栓塞治疗原发性肝癌疗效的评价[J].中国老年学杂志,2007,27(19):1895-1897.
[22] Nakai M, Sato M, Yamada K, et al. Percutaneous hot ethanol injection therapy (PHEIT) for hepatocellular carcinoma[J]. Gan To Kagaku Ryoho,2001,28(11):1633-1637.
[23]刘扬,张柏和,钱光相,等.TACE联合PEI治疗原发性肝癌血液循环性肝癌细胞的变化及意义[J].肝胆胰外科杂,2001,13(4):192-194.
[24]周信达.肝癌外科的新进展及发展趋势[J].中国实用外科杂志,1999,19:15-16.
[25]何生,薛华.原发性肝癌治疗现状与评价[J].肝胆外科杂志,2000,8,162-164.
[26]黄建富.肝癌的综合治疗[J].肝胆外科杂志,2000,8:164.
[27]董宝玮,梁萍.肝癌的介人治疗[J].中国超声医学杂志,2000,16:219-221.
[28] Jiao LR,Hansen PD,Havlik R,et al. Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors[J].Am J Surg,1999,177:303-306.
[29]李玉亮,韩斌,张力明,等.肝细胞癌PCN A基因表达与肝亚段动脉化学栓塞疗效的相关性研究[J].实用放射学杂志,2003,19(12):1117-1120. LI YL,HAN B,ZANG LM,et al. The liver cell cancer PCNA gene expression and an artery of liver chemistries bolt the relativity research of fill the curative effect[J].Practical Project to Learn the Magazine,2003,19(12):1117-1120.Chinese
[30]王克全,李中华,常占民.肝癌化疗栓塞后联合经皮无水酒精注射术[J].实用医学影像杂志,2001,2(2):95-96.WANG KQ,LI ZHH,CHAG ZHM. The cancer of the liver chemotherapy unite to was note by the skin absolute alcohol after bolt fill archery[J]. The Practical Medical Science Image Magazine,2001,2(2):95-96. Chinese
[31] FOLKMAN J. What is the evidence that tum ors are angiogenesis dependent[J]. Nat J Cancer Inst,1990,82(1):4-6.
[32] BICKNELL R,HARRIS AJ. Novel growth regulatory factors and tumor angiogenesis[J].Eur J Cancer,1991,27(6):781-784.
[33] IVSHIKAWA F,MIYAZONA K,HELLMAN U,et al. Identification of angiogenic activity and the cloning and expression of platelet-derived endothelial growth factor[J]. Nature,1989,338(6216):557-562.
[34]罗鹏飞,陈晓明.肝癌介入治疗中的完全性充填法[J].中华放射学杂志1996,30(2):79.
[35]罗鹏飞,陈晓明,张良明.原发性肝癌介入治疗的现状与展望[J].实用医学杂志,2001,17(4):275-277.
[36]郭启勇.介入放射学[M].北京:人民卫生出版社,2000.11
[37] Carditello A,Scisca C,David A,et al. Treatment of hepatocellular in primary and secondary liver tumors[J].Chir Ital,2002,54(1):83-86.
[38]李正欣.经导管肝动脉灌注化疗及栓塞治疗原发性肝癌80例临床分析[J].临床消化病杂志,2001,13(6):278-279.
[39]王建华,周康荣.肝癌综合性介入治疗规范化方案(草案)[J].临床放射学杂志,2002,21(7):497.
[40] Poggi G,Gatti C,Teragni C,et al. Radiofrequency ablation combined with percutaneous ethanol injection in the treatment of hepatocellular carcinoma and portal vein neoplastic thrombosis[J].Anticancer Res,2004,24(4):2419-2421.
[41]徐辉,王滨,高志芹,等.肝动脉化疗栓塞对肝癌肿瘤新生血管生成的影响[J].实用放射学杂志,2004,20(7):620-622.
[42]吴沛宏,李立,张益民,等.肝动脉栓塞化疗联合CT导向下碘油乙醇注射治疗原发性肝细胞癌疗效观察[J].中华肿瘤杂志,1998,20(5):393.
[43]林杜民,唐朝辉.原发性肝癌切除术后联合肝动脉化疗栓塞临床观察[J].中国现代医学杂志,2002,12(4):84-85.
[44]唐承富,李晓祥.肝动脉栓塞联合经皮穿刺注射无水乙醇治疗巨块型肝癌[J].中国现代医学杂志,1998,8(7):37-38.
[45] KOBAYASHI N,ISHII M,UENO Y,et al. Co-expression of Bel-2protein and vascular endothelial growth factor in hepatocellular carcinom as treated by chemoembolization[J]. Liver,1999,19(1):25-28.
[46]吴沛宏,张福君.原发性肝细胞癌介入治疗基本模式的转变[J].中华放射学杂志,2003,37(10):870-871.
[47]罗鹏飞,胡景钤,邵培坚等.肝癌肝动脉栓塞术后并发柏-查综合征四例报告[J].中华放射学杂志,1994,28(1):28-31.
[48]罗鹏飞,符力,陈晓明等.肝癌介入治疗后胆汁瘤的形成与临床意义[J].中华放射学杂志,2000,34(11):757-759.
[49] Yu As , Keeffc EB.Management of hepatocellular carcinoma[J].Rev Gastroenterol Disord,2003,3:8-24.
[50] Lee WC,Jeng LB,Chen MF.Estimation of prognosis after hepatectomy for hepatocellular carcinoma[J].Br J Surg,2002,89:311-316.
[51]吴孟超.原发性肝癌治疗.见:吴孟超,主编.肝脏外科学.上海:上海科学技术文献出版社,2000,345-346.
[2] Song BC, Sub DJ, Yang SH, Lee HC, Chung YH, Sung KB, Lee YS. Lens culinaris agglutinin-reactive alpha-fetoprotein as a prognostic marker in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization[J].J Clin Gastroenterol, 2002,35:398-402.
[3] O'Suilleabhain CB, Pooh RT, Yong JL, Ooi GC, Tso WK, Fan ST. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma[J].Br J Surg,2003,90:325-331.
[4] Lee JK, Chung YH, Song BC, Shin JW, Choi WB, Yang SH, Yoon HK, Sung KB, Lee YS, Sub DJ.Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization[J].J Gastroenterol Hepatol,2002,17:52-58.
[5] Sotiropoulos GC, Lang H, Frilling A,et al. Resectability of hepatocellular carcinoma:evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature[J]. Hepatogastr- oenterology,2006, 53(69):322-329.
[6]吴孟超.肝脏恶性肿瘤[M].见:吴阶平,裘法祖,主编.黄家驷外科学.北京:人民卫生出版社,2002,1230-1231.
[7] ADACHI E,METSUMATA T,NISHIZAKI T, et al. Effects of preoperative hepatic artery chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis [J]. Cancer,1993,72 (9): 3593- 3598.
[8]杉蒲信子,高良健司,藤大正雄,等.超音波影像下经皮的肿瘤内エタノヘⅣ注入江上う小肝细胞癌の治疗[J].肝脏,1983,24(8):920(10)
[9] Qin LX,Tang ZY.The prognostic of clinical and pathological features in hepatocellular carcinoma[J].World J Gastroenterol,2002,8(2):193-199.
[10]徐永茂,张南征,张国龙,等.经皮肿瘤内注入无水乙醇结合TACE治疗中晚期原发性肝癌的疗效观察[J].中国肿瘤临床与康复,2002,9(4):78-80.
[11]陈晓明,罗鹏飞,林华欢,等.经导管肝动脉化疗栓塞联合经皮无水乙醇注射治疗肝癌的长期疗效观察[J].癌症,2004,23(7):829-832.
[12]李忱瑞.肝癌的介入治疗[J].中国医刊,2002 ,3(37):16-18.
[13] Shiina S, Tagawa K, Uhuma T, et al. Percutaneous ethanol injection therapy for the treatment of hepatocelluar carcinoma[J]. AJR,1990, 154:947.
[14]徐峰,杨甲梅.小肝癌合并严重肝硬化的治疗[J].中华肝胆外科杂志,2003, 9(4): 241-242.
[15] Pompili M, Rapccini GL, Luca F, et al.Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutan- eous ethanol injection[J].Cancer,1997,79: 1501-1504.
[16]周信达,刘银坤.肝癌复发转移防治的临床与基础[J].中国肿瘤,2001,102:65-67.
[17]李忱瑞,史仲华,郝玉芝,等.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[J].中华肿瘤杂志,2001,23:490-492.
[18]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[J].肝胆外科杂志,1999,7(1):11-12.
[19]李波,吴孟超,陈汉,等.术后复发性肝癌瘤内酒精注射治疗[J].中华肿瘤杂志,1995,7(5):371-373.
[20] Fan J,Tang ZY,Yu YQ,et al.Improved survival with resection after tra- nscatheter arterial chemoembolization(TACE)for unresectable hepatocellular carcinoma[J].Dig Surg,1998,15:674-678.
[21]王鑫森,李佳睿,张海峰,等.化学消融联合肝动脉化疗栓塞治疗原发性肝癌疗效的评价[J].中国老年学杂志,2007,27(19):1895-1897.
[22] Nakai M, Sato M, Yamada K, et al. Percutaneous hot ethanol injection therapy (PHEIT) for hepatocellular carcinoma[J]. Gan To Kagaku Ryoho,2001,28(11):1633-1637.
[23]刘扬,张柏和,钱光相,等.TACE联合PEI治疗原发性肝癌血液循环性肝癌细胞的变化及意义[J].肝胆胰外科杂,2001,13(4):192-194.
[24]周信达.肝癌外科的新进展及发展趋势[J].中国实用外科杂志,1999,19:15-16.
[25]何生,薛华.原发性肝癌治疗现状与评价[J].肝胆外科杂志,2000,8,162-164.
[26]黄建富.肝癌的综合治疗[J].肝胆外科杂志,2000,8:164.
[27]董宝玮,梁萍.肝癌的介人治疗[J].中国超声医学杂志,2000,16:219-221.
[28] Jiao LR,Hansen PD,Havlik R,et al. Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors[J].Am J Surg,1999,177:303-306.
[29]李玉亮,韩斌,张力明,等.肝细胞癌PCN A基因表达与肝亚段动脉化学栓塞疗效的相关性研究[J].实用放射学杂志,2003,19(12):1117-1120. LI YL,HAN B,ZANG LM,et al. The liver cell cancer PCNA gene expression and an artery of liver chemistries bolt the relativity research of fill the curative effect[J].Practical Project to Learn the Magazine,2003,19(12):1117-1120.Chinese
[30]王克全,李中华,常占民.肝癌化疗栓塞后联合经皮无水酒精注射术[J].实用医学影像杂志,2001,2(2):95-96.WANG KQ,LI ZHH,CHAG ZHM. The cancer of the liver chemotherapy unite to was note by the skin absolute alcohol after bolt fill archery[J]. The Practical Medical Science Image Magazine,2001,2(2):95-96. Chinese
[31] FOLKMAN J. What is the evidence that tum ors are angiogenesis dependent[J]. Nat J Cancer Inst,1990,82(1):4-6.
[32] BICKNELL R,HARRIS AJ. Novel growth regulatory factors and tumor angiogenesis[J].Eur J Cancer,1991,27(6):781-784.
[33] IVSHIKAWA F,MIYAZONA K,HELLMAN U,et al. Identification of angiogenic activity and the cloning and expression of platelet-derived endothelial growth factor[J]. Nature,1989,338(6216):557-562.
[34]罗鹏飞,陈晓明.肝癌介入治疗中的完全性充填法[J].中华放射学杂志1996,30(2):79.
[35]罗鹏飞,陈晓明,张良明.原发性肝癌介入治疗的现状与展望[J].实用医学杂志,2001,17(4):275-277.
[36]郭启勇.介入放射学[M].北京:人民卫生出版社,2000.11
[37] Carditello A,Scisca C,David A,et al. Treatment of hepatocellular in primary and secondary liver tumors[J].Chir Ital,2002,54(1):83-86.
[38]李正欣.经导管肝动脉灌注化疗及栓塞治疗原发性肝癌80例临床分析[J].临床消化病杂志,2001,13(6):278-279.
[39]王建华,周康荣.肝癌综合性介入治疗规范化方案(草案)[J].临床放射学杂志,2002,21(7):497.
[40] Poggi G,Gatti C,Teragni C,et al. Radiofrequency ablation combined with percutaneous ethanol injection in the treatment of hepatocellular carcinoma and portal vein neoplastic thrombosis[J].Anticancer Res,2004,24(4):2419-2421.
[41]徐辉,王滨,高志芹,等.肝动脉化疗栓塞对肝癌肿瘤新生血管生成的影响[J].实用放射学杂志,2004,20(7):620-622.
[42]吴沛宏,李立,张益民,等.肝动脉栓塞化疗联合CT导向下碘油乙醇注射治疗原发性肝细胞癌疗效观察[J].中华肿瘤杂志,1998,20(5):393.
[43]林杜民,唐朝辉.原发性肝癌切除术后联合肝动脉化疗栓塞临床观察[J].中国现代医学杂志,2002,12(4):84-85.
[44]唐承富,李晓祥.肝动脉栓塞联合经皮穿刺注射无水乙醇治疗巨块型肝癌[J].中国现代医学杂志,1998,8(7):37-38.
[45] KOBAYASHI N,ISHII M,UENO Y,et al. Co-expression of Bel-2protein and vascular endothelial growth factor in hepatocellular carcinom as treated by chemoembolization[J]. Liver,1999,19(1):25-28.
[46]吴沛宏,张福君.原发性肝细胞癌介入治疗基本模式的转变[J].中华放射学杂志,2003,37(10):870-871.
[47]罗鹏飞,胡景钤,邵培坚等.肝癌肝动脉栓塞术后并发柏-查综合征四例报告[J].中华放射学杂志,1994,28(1):28-31.
[48]罗鹏飞,符力,陈晓明等.肝癌介入治疗后胆汁瘤的形成与临床意义[J].中华放射学杂志,2000,34(11):757-759.
[49] Yu As , Keeffc EB.Management of hepatocellular carcinoma[J].Rev Gastroenterol Disord,2003,3:8-24.
[50] Lee WC,Jeng LB,Chen MF.Estimation of prognosis after hepatectomy for hepatocellular carcinoma[J].Br J Surg,2002,89:311-316.
[51]吴孟超.原发性肝癌治疗.见:吴孟超,主编.肝脏外科学.上海:上海科学技术文献出版社,2000,345-346.