發(fā)布時間：2018-07-07 14:51

  本文選題：神經(jīng)內(nèi)分泌腫瘤 + 肝轉(zhuǎn)移��； 參考：《第二軍醫(yī)大學》2017年碩士論文

【摘要】：第一部分 神經(jīng)內(nèi)分泌腫瘤肝轉(zhuǎn)移灶的增強CT表現(xiàn)與病理分級的關系研究目的:分析神經(jīng)內(nèi)分泌腫瘤肝轉(zhuǎn)移病灶的三期增強CT表現(xiàn)與腫瘤病理分級、腫瘤大小間的關系。研究方法:搜集2000年1月至2016年1月期間在我院病理確診的肝內(nèi)神經(jīng)內(nèi)分泌腫瘤并有完整三期腹部CT增強影像資料的患者;共納入本研究49例患者�；仡櫡治鲇跋裾飨�,包括數(shù)目、尺寸、定位、腫瘤邊界、囊變/壞死、門脈侵犯及強化模式。并分析了上述征象與腫瘤病理分級的關系;同時分析了強化模式與瘤體大小的關系。結(jié)果:所選影像征象在腫瘤病理不同分級間的表現(xiàn)無統(tǒng)計學差異。強化模式在不同大小瘤體間的表現(xiàn)有統(tǒng)計學差異(χ2=37.533,P0.05),組間兩兩比較提示小瘤體組多表現(xiàn)為動脈期明顯強化,延遲期退出;大瘤體組表現(xiàn)為動脈期明顯強化,延遲期持續(xù)強化(χ2=11.75,P0.0125)。結(jié)論:神經(jīng)內(nèi)分泌腫瘤的肝內(nèi)轉(zhuǎn)移灶表現(xiàn)出多樣的CT特征,但這些征象與腫瘤病理分級并無明顯的關聯(lián)性,提示CT掃描對于預測腫瘤的惡性程度價值不大。病灶強化方式多變,與瘤體大小有一定的關系。在臨床工作中要注意結(jié)合其他檢查結(jié)果,避免誤診。第二部分 肝動脈化療栓塞聯(lián)合動脈置泵灌注奧沙利鉑治療神經(jīng)內(nèi)分泌瘤肝轉(zhuǎn)移的安全性和療效:單臂回顧性研究研究目的:分析TACE+術后靶動脈留置微導管微泵奧沙利鉑治療神經(jīng)內(nèi)分泌腫瘤肝轉(zhuǎn)移的安全性和有效性。研究方法:搜集2000年1月至2016年1月間本院放射介入科治療的35例神經(jīng)內(nèi)分泌瘤伴肝轉(zhuǎn)移的患者,排除11例,回顧性分析其余24例患者。所有病例均經(jīng)手術或肝穿刺活檢病理、免疫組化證實。手術方案:術中經(jīng)導管注入奧沙利鉑及超液化碘油混懸液,術后留置導管于腫瘤主要供血血管,緩慢(1小時)微泵奧沙利鉑(100-120mg)。影像學復查及治療間期為4周。不良反應主要依據(jù)CTCAE V4.03標準并結(jié)合WHO規(guī)定的抗癌藥物常見毒副反應分級標準制定,分別對術后嘔吐、發(fā)熱、肝區(qū)疼痛、肝功能損傷、穿刺點周圍血腫情況進行評估;局部控制率評估采用m RECIST標準,應用腹部CT/MRI增強評估;隨訪計算疾病無進展時間(PFS)。結(jié)果:共行166例次TACE+TAI泵注化療藥物后,所有患者均出現(xiàn)了不同程度的不良反應,包括:嘔吐0-1級共134例次(80.7%)、嘔吐2級共32例次(19.3%);發(fā)熱0-1級共140例次(84.3%),發(fā)熱2級共26例次(15.7%);肝區(qū)疼痛0-1級共45例次(27.1%),疼痛2級共115例次(69.3%),疼痛3級共6例次(3.6%);有4名患者在多次介入治療過程中分別發(fā)生過1次穿刺點周圍小血腫。嚴重并發(fā)癥:肝膿腫、急性腎衰竭、術后30天內(nèi)死亡均未出現(xiàn);局部控制率:CR0例(0.00%)、PR15例(62.50%)、SD6例(25.00%)、PD3例(12.50%),客觀緩解率(ORR,CR+PR):15例(62.5%)。3名患者在隨訪中失訪,4名患者在隨訪結(jié)束時仍未見腫瘤進展,中位無疾病進展時間(PFS):44.0個月(95%CI,19.52-68.49)。結(jié)論:TACE+動脈留置導管微泵灌注奧沙利鉑是一項安全的治療方案,相比傳統(tǒng)的TACE或TAE術,不良反應發(fā)生率無明顯升高,有較高的客觀緩解率,對于已經(jīng)失去手術機會的神經(jīng)內(nèi)分泌腫瘤肝轉(zhuǎn)移患者是一個很好的選擇。
[Abstract]:The relationship between enhanced CT performance and pathological grading in the first part of neuroendocrine tumor liver metastases. Objective: to analyze the relationship between three phase enhanced CT manifestations of neuroendocrine tumor liver metastases and the relationship between tumor pathological grading and tumor size. Methods: to collect intrahepatic nerves confirmed by pathology in our hospital from January 2000 to January 2016 Patients with endocrine tumors and complete three phases of abdominal CT enhanced imaging data were included; 49 patients were included in this study. The image features, including number, size, location, tumor boundary, cystic degeneration / necrosis, portal vein invasion and intensification patterns, were analyzed. The relationship between the above signs and the tumor pathological classification was analyzed, and the intensification patterns and tumor bodies were analyzed. Results: there was no statistical difference between the selected image signs in different tumor pathological grades. There was a statistical difference between the different sizes of the tumor (x 2=37.533, P0.05). The 22 comparison between the groups showed that the small tumor group showed obvious arterial phase enhancement, delayed phase exit, and the large tumor group showed arterial phase. Conclusion: the intrahepatic metastasis of neuroendocrine tumor showed a variety of CT characteristics, but there was no significant correlation with the pathological classification of tumor, suggesting that the CT scan was of little value in predicting the malignancy of the tumor. The enhancement mode of the tumor was changeable, and the size of the tumor was certain to the size of the tumor. To avoid misdiagnosis in clinical work. Second part of hepatic arterial chemoembolization combined with oxaliplatin infusion of oxaliplatin in the treatment of neuroendocrine tumor liver metastasis: the objective of retrospective study of single arm: the analysis of oxaliplatin treatment for target arteria microductus arteria microduction after TACE+ The safety and effectiveness of neuroendocrine tumor liver metastases. Methods: 35 patients with neuroendocrine tumor and liver metastases were collected from January 2000 to January 2016. 11 cases were excluded and 24 patients were retrospectively analyzed. All cases were confirmed by surgery or liver biopsy and immunohistochemistry. Case: intraoperative injection of oxaliplatin and super liquified lipiodol suspension through the catheter, the main blood vessels were retained after the operation, and the micropump of oxaliplatin (100-120mg) was slow (1 hours). The imaging reexamination and the interval of treatment were 4 weeks. The adverse reaction was mainly based on the standard of CTCAE V4.03 and combined with the classification standard of the common toxic and side effects prescribed by WHO. Formulation, evaluation of postoperative vomiting, fever, liver pain, liver function injury, and hematoma surrounding the puncture point; local control rate assessment using M RECIST standard, abdominal CT/MRI enhancement assessment, follow-up time to calculate the disease progression free time (PFS). Results: after 166 cases of TACE+TAI pump chemotherapy drugs, all patients were different The degree of adverse reactions, including 134 cases of vomiting (80.7%), and vomiting of class 2, 32 (19.3%), fever 0-1 in 140 cases (84.3%), fever 2 and 26 times (15.7%). There were 1 small hematoma around 1 punctures. Severe complications: liver abscess, acute renal failure, and no death within 30 days after operation; local control rate: CR0 (0%), PR15 (62.50%), SD6 (25%), PD3 (12.50%), ORR (CR+PR): 15 (62.5%).3 patients were lost in follow-up and 4 patients still had no tumor at the end of follow-up. Progression free time for disease progression (PFS): 44 months (95%CI, 19.52-68.49). Conclusion: TACE+ arterial infusion of oxaliplatin is a safe treatment. Compared with traditional TACE or TAE, the incidence of adverse reactions is not significantly increased, and there is a higher objective remission rate and the neuroendocrine, which has lost the opportunity of operation. Patients with tumor liver metastases are a good choice.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.4;R730.44

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