巨块型肝癌合并门静脉癌栓的治疗:附15例报告

目的 探讨外科手术、肝动脉化疗栓塞及联合或不联合门静脉灌注化疗治疗巨块型肝癌伴门静脉癌栓的效果。方法 15例伴有门静脉癌栓的巨块型肝癌 ,均采用切除原发癌灶并取尽癌栓治疗 ,其中 5例患者留置门静脉化疗泵 ,术后 2周行肝动脉化疗栓塞或联合门静脉化疗。结果 全组术后无严重并发症发生。 6,12 ,18个月生存期分别为 10 0 % (15 /15 ) ,80 .0 % (12 /15 ) ,60 .0 %(9/15 )。结论 手术仍是治疗巨块型肝癌合并门静脉癌栓的有效方法 ,手术后辅以介入为主的综合治疗能有效提高生存率。

Application of Superselective Artery Embolization in Nasopharyngeal Angiofibroma before Operation

Objective： To evaluate the clinical application of superselective transcatheter arterial embolization （TAE） in nasopharyngeal angiofibroma before operation. Methods： Superselective angiography was done via femoral. TAE with polyvinyl alcohol particles and/or gelfoam （GF） was performed in 12 patients with nasopharyngeal angiofibroma. All patients underwent surgical removal of devascularized tumors in 3 to 7 days after TAE. Results： During digital subtraction angiography, tumor staining was seen in 12 patients. Embolization of maxillary artery was performed in 12 cases and additional embolization of ascending pharyngeal artery in 8 cases. Conclusion： Superselective angiographic diagnosis, embolization and appropriate embolic particle size are important for successful treatment of nasopharyngeal angiofibroma. TAE is safe and effective in decreasing haemorrhage during surgical operation for nasopharyngeal angiofibroma.

Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus

The prognosis of patients with hepatocellular cardnorna （HCC） accompanied by portal vein tumor thrombus （PVTT） is generally poor if leo untreated： a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization （TACE） has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 （range 4.5-11.8） mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.

Branched-chain amino acid treatment before transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM： To examine the significance of branched-chain amino acid （BCAA） treatment before transcatheter arterial chemoembolization （rACE） for hepatocellular carcinoma （HCC）.METHODS： This study included 99 patients who underwent TACE therapy for HCC at our hospital and were followed up without treatment for at least 6 mo between January 2004 and January 2010. They were divided into 2 groups： those receiving BCAA granules （/7 = 40） or regular diet （n = 59, control）. Data obtained were retrospectively analyzed （prior to TACE, and 1 wk, 1, 3, and 6 mo after TACE） in terms of nutritional condition and clinical laboratory parameters （serum albumin level and Child-Pugh score）, both of which are determinants of hepatic functional reserve.RESULTS： The BCAA group comprised 27 males and 13 females with a mean age of 69,9 ：E 8,8 years, The patients of the BCAA group were classified as follows： Child-Pugh A/B/C in 22/15/3 patients, and Stage Ⅱ/Ⅲ/ /IVA HCC in 12/23/5 patients, respectively. The controlgroup comprised 32 males and 27 females with a mean age of 73.2 ± 10.1 years. In the control group, 9 patients had chronic hepatitis, Child-Pugh A/B/C in 39/10/1 patients, and Stage Ⅰ/Ⅱ/Ⅲ/IVA HCC in 1/11/35/12 patients, respectively. Overall, both serum albumin level and Child-Pugh score improved significantly in the BCAA group as compared with the control 3 and 6 mo after TACE （P 〈 0.05）. Further analysis was performed by the following categorization： （1） child-Pugh classification; （2） liver cirrhosis subgroup with a serum albumin level 〉 3.5 g/dL; and （3） epirubicin dose. A similar trend indicating a significant improvement of all variables in the BCAA group was noted （P 〈 0.05）.CONCLUSION： Treatment with BCAA granules in patients who have undergone TACE for HCC is considered useful to maintain their hepatic functional reserve.

Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis

AIM: To evaluate the efficacy of different treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and investigate factors influencing prognosis.METHODS: One hundred and seventy-nine HCC patients with macroscopic PVTT were enrolled in this study. They were divided into four groups and underwent different treatments: conservative treatment group (n = 18),chemotherapy group (n = 53), surgical resection group (n = 24) and surgical resection with postoperative chemotherapy group (n = 84). Survival rates of the patients were analyzed by the Kaplan-Meier method. A log-rank analysis was performed to identify group differences. Cox's proportional hazards model was used to analyze variables associated with survival.RESULTS: The mean survival periods of the patients in four groups were 3.6, 7.3, 10.1, and 15.1 mo respectively.There were significant differences in the survival rates among the groups. The survival rates at 0.5-, 1-, 2-, and 3-year in surgical resection with postoperative chemotherapy group were 55.8%, 39.3%, 30.4%, and 15.6% respectively, which were significantly higher than those of other groups (P＜0.001). Multivariate analysis revealed that the strategy of treatment (P＜0.001) and the number of chemotherapy cycles (P = 0.012) were independent survival predictors for patients with HCC and PVTT.CONCLUSION: Surgical resection of HCC and PVTT combined with postoperative chemotherapy or chemoembolization is the most effective therapeutic strategy for the patients who can tolerate operation.Multiple chemotherapeutic courses should be given postoperatively to the patients with good hepatic function reserve.

Prognosis following transcatheter arterial embolization for 121 patients with unresectable hepatocellular carcinoma with or without a history of treatment

AIM： To retrospectively evaluate the prognosis of patients with hepatocellular carcinoma （HCC） with or without a history of therapy for HCC following transcatheter arterial embolization （TAE）. METHODS： One hundred and twenty-one patients with HCC treated with TAE from 1992 to 2004 in our hospital were enrolled in this study. Eighty-four patients had a history of treatment for HCC, while 37 did not. At the time of entry, patients with extra-hepatic metastasis, portal vein tumor thrombosis, or Child-Pugh class C were excluded. TAE was repeated when recurrence of HCC was diagnosed by elevated tumor markers, or ultrasonography or dynamic computed tomography findings. RESULTS： Tumor size was larger and the number of tumors was fewer in patients without past treatment （P〈0.01）. However, there were no differences in tumor node metastasis （TNM） stage or survival rate between the 2 groups. A bilobular tumor and high level of α-fetoprotein （AFP） （〉100 ng/mL） were factors related to a poor prognosis in patients with a history of HCC. CONCLUSION： The prognosis following TAE is similar between HCC patients with and without past treatment. Early diagnosis of HCC or recurrent HCC and obtaining good local control against HCC before entry to a repeated TAE course can improve prognosis.

Rare pulmonary and cerebral complications after transarterial chemoembolisation for hepatocellular carcinoma:A case report

We report a rare case of acute pulmonary and cerebral complication after transarterial chemoembolisation (TACE) for inoperable hepatocellular carcinoma. The case involved a large tumor and hepatic vein invasion. Nonspecific pulmonary and cerebral symptoms such as acute dyspnoea and transient consciousness loss developed in the patient, a 49-year-old woman, following the TACE due to pulmonary and cerebral oil embolism. The chest and brain conditions of this patient improved after some supportive therapies and nursing interventions. She also subsequently completed the other three procedures of TACE.

The value and limitation of transcatheter arterial chemoembolization in preventing recurrence of resected hepatocellular carcinoma

AIM: To evaluate the value and limitation of postoperative transcatheter arterial chemoembolization (TACE) in preventing recurrence of hepatocellular carcinoma (HCC). METHODS: In the first group, 987 postoperative patients with HCC, who did not have any evidence of recurrence in the first preventative TACE but were found to have recurrence at different times during the follow-up survey, were analyzed. In the second group, 643 postoperative patients with HCC had no TACE for compared study. To study the relationship between the recurrence time and the number of TACE treatments was analyzed. RESULTS: The 6-, 12-, and 18-mo recurrence rates in the first and second groups were 22.2% (210 cases) vs 61.6% (396 cases), 78.0% (770 cases) vs74.7% (480 cases) and 88.6% (874 cases) vs80.1% (515 cases). There were significant differences between the recurrence rates of the two groups at 6 mo (P＜0.0001).CONCLUSION: The principal role of TACE after HCC operation is to suppress, detect early and treat micrometastasis. It has a good effect of preventing recurrence of HCC in 6 mo, but such an effect is less satisfactory in a longer period. When it is uncertain whether HCC is singlecentral or multi-central and if there is cancer residue or metastasis after operation, TACE is valuable to prevent recurrence.

Embolization of an unusual metastatic site of hepatocellular carcinoma in the humerus

Hepatocellular carcinoma （HCC） is the fish most common cancer in the world. This case documents an unusual metastatic presentation of HCC in the humerus. Preoperative palliative arterial embolization of the tumor was performed to arrest severe tumor bleeding caused by the biopsy. Embolization turned out to be useful also in limiting/preventing potential uncontrolled bleeding during subsequent amputation.

Is hepatic arterial infusion chemotherapy effective treatment for advanced hepatocellular carcinoma resistant to transarterial chemoembolization?

AIM:To evaluate the effectiveness of hepatic arterial infusion chemotherapy(HAIC) for advanced hepatocellular carcinoma(HCC) resistant to transarterial chemoembolization(TACE).METHODS:This study was conducted on 42 patients who received HAIC for advanced HCC between 2001and 2010 at our hospital.5-fluorouracil(5-FU) was administered continuously for 24 h from day 1 to day 5 every 2-4 wk via an injection reservoir.Intra-arterial cisplatin or subcutaneous interferon was administered in combination with the 5-FU.The patients enrolled in this retrospective study were divided into two groups according to whether or not they fulfilled the criteria for resistance to TACE proposed by the Japan Society of Hepatology in 2010(written in Japanese);one group of patients who did not fulfill the criteria for TACE resistance(group A,n = 23),and another group who fulfilled the criteria for TACE resistance(group B,n = 19).We compared the outcomes in terms of the response and survival rates between the two groups.RESULTS:Both the response rate and tumor suppression rate following HAIC were significantly superior in group A than in group B(response rate:48% vs 16%,P = 0.028,tumor suppression rate:87% vs 53%,P = 0.014).Furthermore,both the progression-free survival rate and survival time were significantly superior in group A than in group B(3-,6-,12-,and 24-mo = 83%,70%,29% and 20% vs 63%,42%,16% and 0%,respectively,P = 0.040,and 9.8 mo vs 6.2 mo,P = 0.040).A multivariate analysis(Cox proportional hazards regression model) showed that resistance to TACE was an independent predictor of poor survival(P = 0.007).CONCLUSION:HAIC administrating 5-FU was not effective against advanced HCC resistant to TACE.Other tools for treatment,i.e.,molecular-targeting agents may be considered for these cases.

Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma

AIM: To evaluate the efficacy of sequential use of transarterial chemoembolization (TACE) and percutaneous cryosurgery for unresectable hepatocellular carcinoma (HCC). METHODS: Four hundred and twenty patients were enrolled in this study. The patients, who were considered to have unresectable tumors due to their location or size or comorbidity, were divided into sequential TACE-cryosurgery (sequential) group (n = 290) and cryosurgery alone (cryoalone) group (n = 130). Patients in the sequential group tended to have larger tumors and a greater number of tumors than those in the cryo-alone group. Tumors larger than 10 cm in diameter were only seen in the sequential group. TACE was performed with the routine technique and percutaneous cryosurgery was conducted under the guidance of ultrasound 2-4 wk after TACE. RESULTS: During a mean follow-up period of 42 ± 17 mo (range, 24-70 mo), the local recurrence rateat the ablated area was 17% for all patients, 11% and 23% for patients in sequential group and cryoalone groups, respectively (P = 0.001). The overall 1-, 2-, 3-, 4and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1and 2-year survival rates (71% and 61%) in sequential group were similar to those (73% and 54%) in cryo-alone group (P = 0.69 and 0.147), while the 4and 5-year survival rates were 49% and 39% in sequential group, higher than those (29% and 23%) in cryo-alone group (P = 0.001). Eighteen patients with large HCC (> 5 cm in diameter) survived for more than 5 years after sequential TACE while no patient with large HCC (> 5 cm in diameter) survived more than 5 years after cryosurgery. The overall complication rate was 24%, and the complication rates were 21% and 26% for the sequential and cryo-alone groups, respectively (P = 0.06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P = 0.02). Liver crack only occurred in two patients of the cryoalone group. CONCLUSION: Pre-cryosurgical TACE can increase the cryoablation efficacy and decrease its adverse effects, especially bleeding. Sequential TACE and cryosurgery may be the better procedure for unresectable HCC, especially for large HCC.

Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization

Most patients with hepatocellular carcinoma （HCC） are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis. In case of non resectable HCC it is now widely accepted that transarterial chemoembolization （TACE） leads to a better survival when compared to conservative treatment. Thus, the question remains whether combined portal vein embolization （PVE） may enhance the proven efficiency of TACE in patients with unresectable HCC. We herein report the case of a 56-year-old cirrhotic woman with a voluminous HCC unsuitable for surgical resection. Yet, complete turnout necrosis and prolonged survival could be achieved a^er a combined porto-arterial embolization. This case emphasizes the potential synergistic effect of a combined arterio-portal embolization and the hypothetical survival benefit of such a procedure, in selected patients, with HCC not suitable for surgery or local ablative therapy.

Evaluation of transarterial chemoembolization combined with percutaneous ethanol ablation for large hepatocellular carcinoma

AIM： To assess the effects of combined transcatheter arterial chemoembolization （TACE） and percutaneous ethanol ablation （PEA） in patients with large hepatocellular carcinoma （HCC）.METHODS： A total of 63 patients with unresectable large HCC were treated with TACE followed by PEA. The largest dimension of the tumors ranged from 5.3 cm to 17.8 cm. The survival rates, acute effects, toxicity and prognostic factors were analyzed.RESULTS： The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively （a median survival of 27.7 too）. Tumor area was reduced by more than 50% in 30 （47.6%） cases. In 56 cases with increased α-fetoprotein （AFP） values, AFP level was declined by more than 75%. The combined thera- py was generally well tolerated. Only two patients died from variceal bleeding associated with the therapy. The Cox proportional hazards model showed that the num- ber of tumors, the tumor margin and the ethanol dose were independent prognostic factors. CONCLUSION： The combined TACE and PEA therapy is a promising approach for unresectable large HCC.

Transarterial injection of H101 in combination with chemoembolization overcomes recurrent hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has become the standard treatment modality for unresectable hepatocellular carcinoma (HCC). Nonetheless, the clinical outcomes in patients with unresectable HCC are often unsatisfactory, especially in those with recurrent HCC. H101, an E1B gene deleted adenovirus, is known to have a significant antitumor activity. In addition, local injection of H101 can enhance the effect of antitumor therapies (chemotherapy and radiotherapy). Transarterial H101 gene injection in combination with TACE may help to control refractory and recurrent HCC. In this study, we report a 55-year-old patient with recurrent HCC which was treated with transarterial injection of H101 in combination with TACE, leading to a good clinical prognosis of the patient.

Primary choriocarcinoma of uterine cervix treated by uterine artery drug pouring and embolism: one case report

Primary choriocarcinoma of the uterine cervix (PCC) is an extremely rare disease. The conventional treatment of PCC is a combination of hysterectomy and chemotherapy. We present one rare case proved by cervical biopsy. The patient was an 36-year-old Chinese woman with irregular vaginal bleeding for 60 days. A cervical tumoral mass was seen in the pelvic examination and biopsy revealed active hyperplasia of trophoblastic cell. Because of massive vaginal haemorrhage, the patient accepted uterine artery drug pouring and embolism emergently. This management had gained a satisfactory effect. Thus, Uterine artery drug pouring and embolism is one new and effective weapon for PCC, which can preserve the patient’s productive ability.

Jinlong capsule decreases adverse reactions after transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma

Objective The aim of this study was to analyze whether Jinlong capsule could decrease adverse reactions after transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma. Methods Eighty-two patients with hepatocellular carcinoma were randomly divided into the control group and experimental group. On the first day after TACE, the experimental group started receiving four Jinlong capsules orally three times daily, whereas the control group did not receive the treatment.Results The incidences of erythropenia and thrombocytopenia in the experimental group was lower than those in the control group(P = 0.040 and 0.033, respectively). The differences in serum levels of aminotransferase, albumin, potassium, and sodium between the two groups were significant(P = 0.034, 0.034, 0.013, and 0.044, respectively). The mean durations of stomachache and abdominal distension in the experimental group was significantly shorter than those in the control group(P = 0.004 and 0.021, respectively). However, there were no significant differences in the incidences of nausea, fever, and vomiting between the two groups(P = 0.490, 0.495, and 0.585, respectively). Conclusion The reduction in the incidence rate and duration of partial adverse reactions after TACE was observed in hepatocellular carcinoma patients treated with Jinlong capsule compared to untreated patients, suggesting possible beneficial effects exerted by Jinlong capsule on the reduction of TACE-induced liver damage, thereby improving liver function and, consequently, the quality of life.

Study of hepatic arterial infusion of Endostar combined with TACE on advanced hepatocellular carcinoma

Objective:To study the efficacy and safety of hepatic arterial infusion of Endostatin(YH-16,Endostar),combined with transcatheter arterial chemoembolization(TACE) on advanced hepatocellular carcinoma.Methods:Thirty patients with advanced hepatocellular carcinoma were enrolled in the study.The patients received hepatic arterial infusion of Endostar combined with TACE.The efficacy was evaluated strictly after 1-2 cycles according to RECIST criteria and the value of AFP;quality of life(QOL) was evaluated according to Karnofsky scores.Adverse effects were evaluated too.Results:29 cases' efficacy was evaluated among the total 30 cases.The KPS were significantly increased after the treatment(80.39 ± 8.37 vs 73.93 ± 9.22,P = 0.002).Compared with control group,the objective response rate(CR and PR) and the rate of AFP negative changed were significantly higher(P = 0.021,P = 0.046).The adverse effects were not obvious.Conclusion:The QOL and preliminary efficiency of patients of advanced hepatocellular carcinoma may be improved by hepatic arterial infusion of Endostar combined with TACE,the rate of AFP negative changed were significantly higher too,and there are little of adverse effects.It is worthy to clinical generalization and further clinical observation.

Pulmonary embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma:a retrospective analysis on 10 years' experience

To study the clinical characteristics and treatment of pulmonary embolism （PE） after transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods： The clinical records of 13 512 patients diagnosed with HCC and received TACE from January 2000 to December 2009 were reviewed. Among these patients, 5 031 were allocated into group A who had one or more disorders like diabetes, hypertension, coronary heart disease, obesity or varicose vein of lower limb, while the other 8 481 patients who did not have such disorders were in group B. Results： A total of 39 185 TACE procedures were performed for the 13 512 patients. Five （0.01%） patients in group A developed PE after TACE, of whom two recovered 4 and 5 d later with early anticoagulant therapy while the hypertension, coronary heart disease, obesity or varicose vein of lower limb are possibly more likely to develop PE other 3 died of respiratory failure within 5 h. The mortality of PE was 60% （3/5）. Conelusion： HCC patients with diabetes, after TACE than those without such disorders. Patients who have such disorders should be more carefully observed after TACE and early treatment with heparin should be applied once PE develops.

Treatment of primary hepatic carcinoma by transcatheter arterial perfusion of batroxobin combined with TACE:a preliminary clinical study

Objective:The aim of the study was to explore the therapeutic efficacy and safety of batroxobin in patients with primary hepatic carcinoma(PHC) and the advantages of transcatheter arterial perfusion of batroxobin combined with transcatheter arterial chemoembolization(TACE).Methods:Forty patients with PHC were randomized into experimental group(transcatheter arterial perfusion of batroxobin combined with TACE treatment,20 patients) and control group(TACE alone group,20 patients).The patients were followed up and the data were recorded,compared and analyzed.Results:(1) Compared with the control group,the FIB level in the experimental group was significantly decreased at the first month after treatment(P < 0.05).(2) The baseline of the tumor was shortened in both groups after the treatment.There was a significant difference between the two groups at different time intervals(P < 0.05).(3) After the treatment,there was a significant difference of progression-free survival(PFS) levels between the two groups(t =2.877,P < 0.05).(4) The incidence of metastasis were 5.0%(1/20) in both groups at 6 months after treatment,and that after one year was 10.0%(2/20) in the experimental group and 25.0%(5/20) in the control group.However,the difference was not significant(χ2 = 0.693,P > 0.05).Conclusion:Batroxobin can rapidly and effectively decrease the FIB level of the PHC cases.Therefore it may be used as an effective and safe adjuvant drug for the treatment of primary hepatic carcinomas.Transcatheter arterial perfusion of batroxobin combined with TACE therapy has advantages in comparison with TACE alone therapy.It could be taken as a new therapeutic regimen in the PHC treatment.