选择性动脉栓塞治疗原发性肝癌自发破裂出血的疗效及预后分析

【摘要】 目的 探讨初诊行选择性动脉栓塞（TACE）治疗原发性肝癌自发破裂出血的疗效及预后相关因素。方法 回顾性分析2012年6月至2016年6月,初诊接受选择性TACE治疗的57例原发性肝癌自发破裂出血的患者。末次随访时间为2016年10月。采用Kaplan- Meier法计算累积生存率,Cox回归模型分析生存预后因素。结果 57例患者,中位生存期为208 d,6个月、1年、2年累积生存率分别为50.3%、35.9%、14.7%。多因素Cox回归分析显示:肿瘤直径、Child- Pugh分级、休克病史以及栓塞材料是患者预后的独立相关因素。结论 初诊行选择性TACE治疗肝癌自发破裂出血安全、有效。本研究显示,较大的肿瘤直径,Child- Pugh分级不佳,休克病史与患者预后不良有关。同时,碘油联合明胶海绵颗粒TACE治疗患者可以获得比单纯PVA颗粒栓塞更好的预后。
     

化疗栓塞治疗肝癌合并肝动-静脉分流的生存预后因素分析

【摘要】 目的 探讨PVA联合碘油化疗药乳剂（或化疗药物）在肝癌合并肝动-静脉分流栓塞治疗的生存预后因素。方法 2013年1月—2014年6月,97例肝癌并肝动-静脉分流的患者（慢速型分流21例,中速型分流40例,快速型分流36例）,分别应用PVA-300、PVA-500及PVA-700行末梢性化疗栓塞,其中慢、中速型加用碘油化疗乳剂栓塞,快速型仅加用化疗药物。应用Kaplan-Meier法、Log-Rank检验进行生存分析,Cox比例风险模型进行多因素回归分析。结果 97例肝癌合并肝动-静脉分流的患者中位生存期为281 d,6、12、18个月生存率分别为67%、37.2%、14.2%。多因素分析结果显示:术前AFP≥400 ng/ml（HR=3.763,P=0.002）、门静脉癌栓形成（HR=2.669,P=0.021）及疾病进展（HR=2.55,P=0.039）为独立危险因素;而栓塞次数≥3次（HR=0.216,P=0.001）、分流完全及次全栓塞（HR=0.22,P=0.030）及采用综合治疗（HR=0.181,P＜0.001）为独立保护因素。结论 PVA联合碘油化疗药乳剂（或化疗药物）末梢性化疗栓塞肝癌合并肝动-静脉分流是一种可行、有效的方法。栓塞次数较多、分流完全及次全栓塞以及采用综合治疗的患者预后较好,而术前AFP高水平、门静脉癌栓形成及疾病进展为患者预后危险因素。

     

索拉非尼联合PVA微粒化疗栓塞治疗肝癌并肝动-静脉分流的疗效及预后分析

【摘要】 目的 评价索拉非尼联合PVA化疗栓塞（PVA- TACE）治疗肝癌合并肝动-静脉分流（HAVS）的疗效及预后因素。方法 110例肝癌合并HAVS患者,采用索拉非尼+PVA- TACE治疗（治疗组）17例,PVA- TACE治疗（对照组）93例。依据HAVS的分流速度,采用不同大小的PVA化疗栓塞分流道。随访并分析生存期、并发症等。采用Kaplan- Meier法计算累计生存率,预后因素采用Cox模型分析。结果 治疗组与对照组中位生存期（overall survival,OS）分别为12.8个月和7.7个月,两组有统计学意义（χ2=3.907,P=0.048）。两组6、12个月生存率分别为78.8%、45.5%,66.7%、23.6%。多因素分析结果显示:联合索拉非尼（HR=0.351,P=0.007）及多次栓塞（HR=0.498,P=0.018）为独立保护因素,术前AFP≥400 ng/ml（HR=1.984,P=0.018）为独立危险因素。结论 索拉非尼联合PVA- TACE治疗中晚期肝癌并HAVS安全、有效,疗效优于单纯PVA- TACE;术前AFP低表达及多次栓塞治疗患者的预后较好。
     

经导管化疗栓塞联合经皮微波消融治疗中晚期肝癌64例的预后分析

【摘要】 目的 探讨经导管肝动脉化疗栓塞（TACE）联合经皮微波消融术（MWA）治疗中晚期肝癌预后的影响因素。方法 2011年1月—2012年7月,64例中晚期肝癌患者行TACE联合MWA治疗,收集14项可能影响预后的因素作回顾性单因素与多因素分析。单因素分析采用Kaplan?蛳 Meier模型及Log?蛳 rank检验,多因素分析采用Cox比例风险模型。结果 64例中晚期肝癌患者治疗后1、1.5、2年总生存率分别为75.8%、48.4%、33.9%。单因素分析及Cox回归分析结果显示肿瘤大小、肿瘤数目、门静脉癌栓、血清AFP值、肿瘤期别、服用索拉菲尼等6项因素与预后有关。结论 肿瘤大小、肿瘤数目、门静脉癌栓、血清AFP值、肿瘤期别是影响介入综合治疗预后的危险因素,服用索拉菲尼是影响预后的保护性因素。     

术后预防性肝动脉化疗栓塞对肝癌患者生存的影响及预后相关因素分析

【摘要】 目的 探讨术后行预防性肝动脉化疗栓塞（TACE）对肝细胞癌（HCC）患者生存的影响及预后相关因素分析。方法 回顾性分析我院2008年1月—2012年11月确诊肝癌行根治性肝切除且术后行TACE治疗的92例患者的临床和随访资料。将术后2个月内影像学检查未发现病灶行预防性TACE者为预防组;按期随访直至复发再行TACE者为对照组,用Kaplan?蛳 Meier法比较两组生存差异,并采用COX回归分析影响肝癌术后患者生存及预后的相关因素。结果 92例患者中预防组为38例,对照组54例,两组患者基线资料比较差异无统计学意义。预防组1、2、3年生存率分别为85.1%、56.8%、56.8%,中位生存时间为39个月;对照组分别为65.2%、43.4%、30.4%,中位生存时间为21个月。预防组和对照组累计生存率差异有统计学意义（P = 0.021）。在单因素分析中门脉癌栓、肿瘤直径、腹水、凝血酶原时间及是否行预防性TACE是可能影响预后的相关因素。多因素分析中,是否行预防性TACE及肿瘤直径是显著影响预后的独立相关因素。结论 肝癌患者术后行预防性TACE可明显提高患者的生存率,另外肿瘤直径也是显著影响预后的独立相关因素。     

原发性肝癌TACE后合并肝癌破裂八例

【摘要】 目的 总结原发性肝癌经导管动脉内化疗栓塞（TACE）术后发生肝癌破裂出血的相关危险因素、诊疗方法及预后,以提高对该并发症的认识。方法 对2007年9月—2013年9月间原发性肝癌行TACE治疗术后并发肝癌破裂出血的患者进行回顾性分析。结果 共678例原发性肝癌患者进行1 379次TACE术。其中,8例患者在TACE术后出现肝癌破裂出血,例数发生率为1.2%,例次发生率为0.6%。8例患者的肿瘤最大直径平均为（11.5 ± 2.6）cm（7.6 ~ 15.9 cm）,病灶均位于肝包膜边缘,多数突向表面生长,5例合并有门静脉高压;TACE术中平均碘油使用量为（14.9 ± 4.5）ml（8 ~ 20 ml）。行急症肝动脉栓塞治疗（TAE）4例,行内科保守治疗4例,7例患者积极抢救后无效死亡,仅1例患者TAE止血成功后恢复出院。结论 原发性肝癌TACE术后肝癌破裂出血虽较为少见,但其后果却极为严重;其发生可能与病变特征（如肿瘤巨大、位于肝脏边缘突向表面生长或合并门静脉高压）及介入栓塞方法（如注入碘油后未使用颗粒栓塞剂加强栓塞）等因素有关。     

高强度聚焦超声补救治疗TACE失败肝癌的临床应用

【摘要】 目的 评价高强度聚焦超声（HIFU）补救性治疗经选择性肝动脉化疗栓塞（TACE）失败的晚期肝细胞肝癌（HCC）患者的有效性和安全性。方法 回顾性分析44例应用HIFU治疗的经TACE治疗失败的晚期HCC患者临床资料。结果 患者总生存时间为12.8个月（95%CI:10.4 ～ 15.0）,1年生存率为46.7%,2年生存率为11.4%。单因素分析显示,肿瘤分期（P = 0.001）、肿瘤大小（P ＜ 0.001）、门静脉癌栓（P = 0.030）、AFP水平（P = 0.001）和消融效果（P ＜ 0.001）为预后的影响因素。多因素分析显示肿瘤大小（P = 0.002）及临床分期（P = 0.010）是影响患者总生存时间的独立预测因素。3/4级不良反应包括发热（4.5%）贫血（4.5%）、腹部不适（4.5%）、皮肤烧伤（9.1%）、乏力（4.5%）、出血（2.3%）等,未出现严重并发症。结论 对于TACE治疗失败的HCC患者,应用HIFU可有效降低肿瘤负荷,延长生存时间。
     

超早期栓塞治疗对破裂颅内动脉瘤患者预后的影响

【摘要】 目的 分析超早期栓塞治疗对破裂颅内动脉瘤患者预后的影响。方法 根据栓塞时间将270例患者分成2组:A组（动脉瘤破裂后24 h内行栓塞治疗）135例和B组（动脉瘤破裂24 h后行栓塞治疗）135例,对两组患者的临床特征进行单因素和多因素分析,观察超早期栓塞对临床治疗效果的影响。结果 A、B两组患者入院时具有相似的临床及影像学特征。术后6个月临床结果显示,A组患者中预后良好（mRS 0 ~ 2分）122例（90.4%）,而B组患者中预后良好110例（81.5%）,两组比较,差异有统计学意义（P = 0.036）。多因素Logistic回归分析显示,超早期栓塞治疗（P = 0.021;OR,2.536;95%CI:1.637 ~ 5.116）为患者预后的一个独立影响因素。结论 颅内动脉瘤破裂后24 h内进行栓塞治疗能够改善患者的预后。
     

TACE术中灌注氟尿嘧啶、奥沙利铂及吡柔比星治疗原发性肝癌的临床效果分析

目的 观察评价肝动脉化疗栓塞（TACE）联合灌注奥沙利铂（OXA）、氟尿嘧啶（5 Fu）及吡柔比星（THP）方案治疗原发性肝癌的疗效和安全性。方法 回顾分析采用TACE术中动脉灌注OXA/5 Fu/THP化疗药物治疗的原发性肝癌患者65例,及同期行单纯肝动脉栓塞（TAE）治疗的原发性肝癌患者21例,分为TACE组和TAE组。对TACE灌注OXA/5 Fu/THP的疗效、不良反应发生率、无进展生存时间（PFS）及总生存期（OS）进行综合评价,并与单纯肝动脉栓塞进行对比分析研究。结果 TACE联合OXA/5 Fu/THP治疗的65例患者中,客观缓解率（ORR）55.4%,疾病控制率（DCR）81.5%;患者的中位PFS时间为11.5个月,中位OS时间为18.5个月;单因素分析中,Child Pugh A级、无门脉癌栓、无肿瘤转移、肿瘤直径小及TACE治疗次数多的患者预后较好,差异有统计学意义（P＜0.05）;巴塞罗那分期（BCLC）B期的患者预后优于C期的患者,差异有统计学意义（P=0.000）;Cox多因素分析中门脉癌栓及肿瘤远处转移是患者预后的独立危险因素。与单纯TAE相比,TACE联合OXA/5 Fu/THP可提高患者的mPFS。结论 TACE术中动脉灌注OXA/5 Fu/THP治疗原发性肝癌的疗效较好,不良反应少。     

大肝癌的微创介入治疗

【摘要】 肝癌是最常见的恶性肿瘤之一，其中单个瘤体直径≥5 cm的肝癌被称为大肝癌。目前手术切除仍是治疗大肝癌的首选方法，但由于肝癌起病隐匿、进展迅速，大多数患者在初次确诊时已失去手术机会。经导管肝动脉化疗栓塞术（TACE）介入治疗是治疗中晚期肝癌的推荐治疗方法，然而单一的栓塞化疗很难获得肿瘤的完全坏死，常需要连续多次治疗，严重影响患者的预后。以RFA和MWA为代表的局部肿瘤消融术的肿瘤微创治疗技术，以其安全可靠、疗效显著，广泛应用于小肝癌的临床治疗。但对于大肝癌的治疗，消融联合TACE可以取得良好的疗效。目前，临床上逐步形成了以TACE术为基础的微创介入联合治疗新模式，已成为不能手术切除大肝癌的主要治疗方法。本文就TACE、局部肿瘤消融、TACE联合局部肿瘤消融和/或其它方法的治疗现状和发展趋势进行综述。

     

Investigation on combustion of high-sulfur coal catalyzed with industrial waste slags

With the exhaustion and deterioration of coal resource, a lot of research has been focused on improving the combustion efficiency all over the world, especially in China, in recent years. In this study, several industrial waste slags, which can decrease the ignition temperature, including the gasification slag, deactivated methanol catalyst and furnace slag, are reused as catalysts to improve the combustion efficiency of high-sulfur coal. The kinetic analysis of combustion reaction using Coats-Redfern's model indicates that the industrial waste slags could efficiently reduce the activation energy of coal ignition. By comparing and analyzing the composition of the waste slags with TG-DTG, XRD and XRF, the efficiency of combustion-supporting of the waste slags was confirmed and optimized.     

Energy recovery from high temperature slags

Molten slags represent one of the largest untapped energy sources in metal manufacturing operations. The waste heat of slags amounting to ∼220 TWh/year at temperatures in the range of 1200–1600 °C, presents an opportunity to lower the energy intensity of metal production. Currently, three types of technologies are under development for utilizing the thermal energy of slags; recovery as hot air or steam, conversion to chemical energy as fuel, and thermoelectric power generation. The former route is most developed with its large scale trials demonstrating recovery efficiencies up to 65%. The latter two are emerging as the next generation methods of waste heat recovery. An evaluation of these methods shows that for both thermal and chemical energy recovery routes, a two-step process would yield a high efficiency with minimal technical risk. For thermoelectric power generation, the use of phase change materials appears to solve some of the current challenges including the mismatch between the slag temperature and operating range of thermoelectric materials.     

Dissolution of steelmaking slags in acetic acid for precipitated calcium carbonate production

A promising option for long-term storage of CO₂ is to fixate carbon dioxide as magnesium- and calcium carbonates. Slags from iron and steel works are potential raw materials for carbonation due to their high contents of calcium silicates. Precipitated calcium carbonate (PCC) is used as filler and coating materials in paper. If slag could be used instead of limestone for producing PCC, considerable energy savings and carbon dioxide emissions reductions could be achieved. In this paper, the leaching of calcium from iron and steel slags using acetic acid was investigated. Thermodynamic equilibrium calculations at atmospheric gas pressures showed that extraction of calcium is exothermic and feasible at temperatures lower than 156 °C, while the precipitation of calcium carbonate is endothermic and feasible at temperatures above 45 °C. The formation of calcium- and magnesium acetate in the solution was found to be thermodynamically possible. Laboratory-scale batch experiments showed that iron and steel slags rapidly dissolve in acetic acid in a few minutes and the exothermic nature of the reaction was verified. While silicon was successfully removed by filtration using solution temperatures of 70–80 °C, further separation methods are required for removing iron, aluminum and magnesium from the solution.     

CO2 capture using carbide slag modified by propionic acid in calcium looping process for hydrogen production

Lime enhanced gasification (LEGS) process based on calcium looping in which CaO is employed as CO₂ sorbent is an emerging technology for hydrogen production and CO₂ capture. In this work, carbide slag which was an industrial solid waste was utilized as CO₂ sorbent in hydrogen production process. Modification of carbide slag by propionic acid was proposed to improve its reactivity. The CO₂ capture behavior of raw and modified carbide slags was investigated in a dual fixed-bed reactor (DFR) and a thermo-gravimetric analyzer (TGA). The results show that modification of carbide slag by propionic acid enhances its CO₂ capture capacity in the multiple calcination/carbonation cycles. The favorable carbonation temperature and calcination temperature for modified carbide slag are 680–700 °C and 850–950 °C, respectively. Prolonged carbonation treatment is beneficial to CO₂ capture of raw and modified carbide slags. The prolonged carbonation for 9 h in the 21st cycle increases the conversions of raw and modified carbide slags in this cycle. And then the carbonation conversions of the two sorbents were also improved in the subsequent cycles. Calcined modified carbide slag shows more porous microstructure compared with calcined raw one for the same number of cycles. Modification of carbide slag by propionic acid increases the surface area, pore volume and pore area. In addition, the volume and area of the pores in 20–100 nm in diameter were improved, which had been proved to be more effective to capture CO₂. The microstructure of calcined modified carbide slag favors its higher CO₂ capture capacity in the multiple calcination/carbonation cycles.     

一种电炉钢液的高效脱氢方法

钢的纯洁度的不断提高 ,对钢液中氢含量提出了新的要求。影响电炉钢中氢含量的因素有 :大气水分 ,大气相对湿度、炉渣特性 ,电炉 ,钢包和中间包的耐火衬 ,合金添加剂 ,钢中硫含量和脱硫剂及脱氧剂 ,钢中氧含量 ,废钢和铁水。采用 10 0 t真空炉真空精炼电炉钢钢水 ,控制 6 7Pa高真空度、高真空时间、吹氩强度、真空温降、精炼渣量 ,能使真空脱氢率在 70 %以上 ,钢中氢含量最低为 0 .5× 10 - 6     

Understanding reactions between water and steelmaking slags: Iron distribution,hydrogen generation,and phase transformations

Environmentally friendly energy harvesting can be achieved by the H₂O thermochemical treatment of steelmaking slags. Hot slag from steel manufacturing is used as a sacrificial material to produce H₂ in a stream of steam. In parallel, this process enhances the magnetic properties of the slag, benefitting the Fe recovery. In this work, the occurrence states of different iron species in slags, as well as their reactivity and phase transformations in H₂O, were investigated. The results showed that Fe²⁺ was mainly distributed in olivine (Ca, Fe, Mg, Mn)₂SiO₄ when the basicity was low. As the basicity increased, a gradual enrichment of Fe²⁺ in RO phase (divalent oxides solid solution, R = Fe, Mg, Mn etc.) was observed. In addition to steelmaking slags, the H₂O splitting reactions of synthetic model iron compounds, RO phase (Mg_1–xFe_xO, x = 0.36, 0.63, 0.77) and kirschsteinite (CaFeSiO₄) were also tested. RO phase exhibited fast kinetics, with its activity proportional to the FeO content. Oxidation of the magnesia-rich RO phase resulted in the phase segregation of iron-depleted magnesiowüstite (Mg,Fe_depleted)O and iron-rich spinel (Mg,Fe_rich)₃O₄. The H₂O splitting of CaFeSiO₄ suffered from extremely low kinetics below 900 °C, which could be enhanced by raising the temperature. The H₂ production capacity of steelmaking slags was strongly affected by the basicity, which improved when more Fe²⁺ existed as RO phase rather than CaFeSiO₄. After oxidation in steam at 850 °C, the slag sample with a basicity of 1.83 produced 29.3 cm³?g^?1_material hydrogen at 850 °C for 60 min, with a conversion ratio of 80.1%.     

The properties and thermal effects of ash deposits in coal-fired furnaces

The physical and chemical character of fireside ash deposits depend on the processes by which deposits are formed and subsequent reactions within the deposit and with furnace gases. The properties influencing heat transfer, absorptivity for radiative transfer and thermal conductivity for conductive transfer are shown from many measurements to depend on this character.

The literature data for the properties are reviewed and are shown to depend principally on the physical ash character and whether the deposits have a particulate character or are sintered or fused. Bounds for the range of properties and expected variations with temperature and deposit porosity and other physical properties are suggested and compared with those for pure oxides and salts. For the radiative properties, theoretical predictions based on the optical properties are shown to predict trends with temperature and particle size for particulate ash and the observed transfer to higher emittance values for slags found at higher temperatures. The influence of the variation of these properties on radiative transfer is then quantified using mathematical models of furnaces.     

Fixation of CO2 by carbonating calcium derived from blast furnace slag

Industrial waste materials, such as steelmaking slags, appear to be potential raw materials for reducing CO₂ emissions by carbonation. The suitability of applying a carbonation route based on acetic acid leaching to produce carbonates from blast furnace slag is presented in this study. The effect of solution pH, temperature, and CO₂ pressure on the precipitation of carbonates was experimentally studied. A simple thermodynamic model was used to verify our results. The feasibility of the process was also discussed, addressing energy input requirements and the consumption of chemicals.     

Hydrogen production by hydrothermal oxidation of FeO under acidic conditions

The production of H₂ by oxidation of FeO, taken here as model compound for steel slags, has been investigated both in pure water and under acidic aqueous conditions in the 373–573 K temperature range. Whereas after 65 h, H₂ yield was negligible in pure water at 423 K, the reaction 3 FeO_(s) + H₂O_(l) → Fe₃O_4(s) + H_2(aq) reached near completion at the same temperature within 10 h in a solution containing 0.05 mol/l acetic acid. Increasing acetic acid concentration by one order of magnitude did not yield significantly more H₂. At identical initial pH, acetic acid was found to be more efficient than oxalic acid and hydrochloric acid at enhancing H₂ production. Acidic conditions increased FeO dissolution kinetics and, consequently, improved H₂ yield. The specific efficiency of acetic acid resides in its thermal stability as well as in the potential of ligand-promoted Fe(II) dissolution. We show that the positive kinetics effect of mild acetic acid solutions over H₂ yield evidenced on FeO does not apply directly to steel slags which buffer the pH to high values due to the presence of large amounts of CaO.     

Working experience with a foundry solar furnace

Literature reveals that a low order priority has been given to foundry applications of the solar furnace for temperatures upto about 1000°C. In the present work, the performance of a solar furnace capable of melting small quantities of foundry-grade metals and alloys had been studied under various conditions. Crucibles of different materials and shapes were tried and the effect of having different heat-shield materials was also studied. Al---bronze crucible with cavity, and well-polished stainless stell heat-shield were found to be most effective in enhancing the efficiency of the furnace. Many important industrial applications of the present solar furnace, such as the recovery of metallic zinc from slags, had also been realised.