神经内分泌肿瘤肝转移灶的增强CT表现与病理分级的关系及改良式经血管介入治疗的安全性和疗效研究

发布时间：2018-07-07 14:51

本文选题：神经内分泌肿瘤 + 肝转移　；参考：《第二军医大学》2017年硕士论文

【摘要】：第一部分神经内分泌肿瘤肝转移灶的增强CT表现与病理分级的关系研究目的:分析神经内分泌肿瘤肝转移病灶的三期增强CT表现与肿瘤病理分级、肿瘤大小间的关系。研究方法:搜集2000年1月至2016年1月期间在我院病理确诊的肝内神经内分泌肿瘤并有完整三期腹部CT增强影像资料的患者;共纳入本研究49例患者。回顾分析影像征象,包括数目、尺寸、定位、肿瘤边界、囊变/坏死、门脉侵犯及强化模式。并分析了上述征象与肿瘤病理分级的关系;同时分析了强化模式与瘤体大小的关系。结果:所选影像征象在肿瘤病理不同分级间的表现无统计学差异。强化模式在不同大小瘤体间的表现有统计学差异(χ2=37.533,P0.05),组间两两比较提示小瘤体组多表现为动脉期明显强化,延迟期退出;大瘤体组表现为动脉期明显强化,延迟期持续强化(χ2=11.75,P0.0125)。结论:神经内分泌肿瘤的肝内转移灶表现出多样的CT特征,但这些征象与肿瘤病理分级并无明显的关联性,提示CT扫描对于预测肿瘤的恶性程度价值不大。病灶强化方式多变,与瘤体大小有一定的关系。在临床工作中要注意结合其他检查结果,避免误诊。第二部分肝动脉化疗栓塞联合动脉置泵灌注奥沙利铂治疗神经内分泌瘤肝转移的安全性和疗效:单臂回顾性研究研究目的:分析TACE+术后靶动脉留置微导管微泵奥沙利铂治疗神经内分泌肿瘤肝转移的安全性和有效性。研究方法:搜集2000年1月至2016年1月间本院放射介入科治疗的35例神经内分泌瘤伴肝转移的患者,排除11例,回顾性分析其余24例患者。所有病例均经手术或肝穿刺活检病理、免疫组化证实。手术方案:术中经导管注入奥沙利铂及超液化碘油混悬液,术后留置导管于肿瘤主要供血血管,缓慢(1小时)微泵奥沙利铂(100-120mg)。影像学复查及治疗间期为4周。不良反应主要依据CTCAE V4.03标准并结合WHO规定的抗癌药物常见毒副反应分级标准制定,分别对术后呕吐、发热、肝区疼痛、肝功能损伤、穿刺点周围血肿情况进行评估;局部控制率评估采用m RECIST标准,应用腹部CT/MRI增强评估;随访计算疾病无进展时间(PFS)。结果:共行166例次TACE+TAI泵注化疗药物后,所有患者均出现了不同程度的不良反应,包括:呕吐0-1级共134例次(80.7%)、呕吐2级共32例次(19.3%);发热0-1级共140例次(84.3%),发热2级共26例次(15.7%);肝区疼痛0-1级共45例次(27.1%),疼痛2级共115例次(69.3%),疼痛3级共6例次(3.6%);有4名患者在多次介入治疗过程中分别发生过1次穿刺点周围小血肿。严重并发症:肝脓肿、急性肾衰竭、术后30天内死亡均未出现;局部控制率:CR0例(0.00%)、PR15例(62.50%)、SD6例(25.00%)、PD3例(12.50%),客观缓解率(ORR,CR+PR):15例(62.5%)。3名患者在随访中失访,4名患者在随访结束时仍未见肿瘤进展,中位无疾病进展时间(PFS):44.0个月(95%CI,19.52-68.49)。结论:TACE+动脉留置导管微泵灌注奥沙利铂是一项安全的治疗方案,相比传统的TACE或TAE术,不良反应发生率无明显升高,有较高的客观缓解率,对于已经失去手术机会的神经内分泌肿瘤肝转移患者是一个很好的选择。
[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.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4;R730.44

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