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(xué)》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(qiáng)CT表現(xiàn)與病理分級(jí)的關(guān)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(qiáng)CT表現(xiàn)與腫瘤病理分級(jí)、腫瘤大小間的關(guān)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(qiáng)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(qiáng)化模式。并分析了上述征象與腫瘤病理分級(jí)的關(guān)系;同時(shí)分析了強(qiáng)化模式與瘤體大小的關(guān)系。結(jié)果:所選影像征象在腫瘤病理不同分級(jí)間的表現(xiàn)無(wú)統(tǒng)計(jì)學(xué)差異。強(qiáng)化模式在不同大小瘤體間的表現(xiàn)有統(tǒng)計(jì)學(xué)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(dòng)脈期明顯強(qiáng)化,延遲期退出;大瘤體組表現(xiàn)為動(dòng)脈期明顯強(qiáng)化,延遲期持續(xù)強(qiáng)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(jí)并無(wú)明顯的關(guān)聯(lián)性,提示CT掃描對(duì)于預(yù)測(cè)腫瘤的惡性程度價(jià)值不大。病灶強(qiáng)化方式多變,與瘤體大小有一定的關(guān)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(dòng)脈化療栓塞聯(lián)合動(dòng)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(shù)后靶動(dòng)脈留置微導(dǎo)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(shù)或肝穿刺活檢病理、免疫組化證實(shí)。手術(shù)方案:術(shù)中經(jīng)導(dǎo)管注入奧沙利鉑及超液化碘油混懸液,術(shù)后留置導(dǎo)管于腫瘤主要供血血管,緩慢(1小時(shí))微泵奧沙利鉑(100-120mg)。影像學(xué)復(fù)查及治療間期為4周。不良反應(yīng)主要依據(jù)CTCAE V4.03標(biāo)準(zhǔn)并結(jié)合WHO規(guī)定的抗癌藥物常見毒副反應(yīng)分級(jí)標(biāo)準(zhǔn)制定,分別對(duì)術(shù)后嘔吐、發(fā)熱、肝區(qū)疼痛、肝功能損傷、穿刺點(diǎn)周圍血腫情況進(jìn)行評(píng)估;局部控制率評(píng)估采用m RECIST標(biāo)準(zhǔn),應(yīng)用腹部CT/MRI增強(qiáng)評(píng)估;隨訪計(jì)算疾病無(wú)進(jìn)展時(shí)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(yīng),包括:嘔吐0-1級(jí)共134例次(80.7%)、嘔吐2級(jí)共32例次(19.3%);發(fā)熱0-1級(jí)共140例次(84.3%),發(fā)熱2級(jí)共26例次(15.7%);肝區(qū)疼痛0-1級(jí)共45例次(27.1%),疼痛2級(jí)共115例次(69.3%),疼痛3級(jí)共6例次(3.6%);有4名患者在多次介入治療過(guò)程中分別發(fā)生過(guò)1次穿刺點(diǎn)周圍小血腫。嚴(yán)重并發(fā)癥:肝膿腫、急性腎衰竭、術(shù)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(shí)仍未見腫瘤進(jìn)展,中位無(wú)疾病進(jìn)展時(shí)間(PFS):44.0個(gè)月(95%CI,19.52-68.49)。結(jié)論:TACE+動(dòng)脈留置導(dǎo)管微泵灌注奧沙利鉑是一項(xiàng)安全的治療方案,相比傳統(tǒng)的TACE或TAE術(shù),不良反應(yīng)發(fā)生率無(wú)明顯升高,有較高的客觀緩解率,對(duì)于已經(jīng)失去手術(shù)機(jī)會(huì)的神經(jīng)內(nèi)分泌腫瘤肝轉(zhuǎn)移患者是一個(gè)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(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.4;R730.44

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