血清胆酸评价肝动脉化疗栓塞术后疗效

血清胆酸评价肝动脉化疗栓塞术后疗效任安，姜卫剑，张雪哲肝动脉化疗栓塞（ＴＡＥ）术后疗效评价对预测病情转归、指导治疗有重要意义。笔者着重讨论ＴＡＥ后血清胆酸改变和ＣＴ所见的相关关系，探讨其在疗效评价中的作用。资料和方法１９８８年４月～１９９２年１０月行...

Computed tomography perfusion in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma

AIM： To prospectively assess the changes in parameters of computed tomography （CT） perfusion pre- and post-transarterial chemoembolization （TACE） of hepatocellular carcinoma （HCC） in different treatment response groups, and to correlate the changes with various responses of HCC to TACE. METHODS： Thirty-nine HCC patients underwent CT perfusion examinations pre-（1 d before TACE） and post-treatment （4 wk after TACE）. The response evaluation criteria for solid tumors （RECIST） were referred to when treatment responses were distributed. Wilcoxon-signed ranks test was used to compare the differences in CT perfusion parameters pre- and post- TACE for different response groups. RESULTS： Only one case had treatment response to CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signals. In the PR treatment response group, hepatic artery perfusion （HAP）, hepatic arterial fracture （HAF） and hepatic blood volume （HBV） of viable tumors post-TACE were reduced compared with pre-TACE （P = 0.001, 0.030 and 0.001, respectively）. In the SD group, all CT perfusion parameters were not significantly different pre- and post-TACE. In the PD group, HAP, HAl=, portal vein perfusion （PVP） and hepatic blood flow （HBF） of viable tumors post-TACE were significantly increased compared with pre-TACE （P = 0.005, 0.012, 0.035 and 0.005, respectively）. CONCLUSION： Changes in CT perfusion parameters of viable tumors are correlated with different responses of HCC to TACE. Therefore, CT perfusion imaging is a feasible technique for monitoring response of HCC to TACE.

Late hepatic artery pseudoaneurysm:A rare complication after resection of hilar cholangiocarcinoma

We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type 11 hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography （MDCTA） showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization （TAE） of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and welltolerated with normal liver function tests and without signs of liver infarction.

Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolizationof the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.

Portal vein thrombosis and arterioportal shunts:Effects on tumor response after chemoembolization of hepatocellular carcinoma

AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

A large congenital and solitary intrahepatic arterioportal fistula in an old woman

Arterioportal fistula(APF)is a rare cause of portal hypertension and may lead to death.APF can be congenital,post-traumatic,iatrogenic(transhepatic intervention or biopsy)or related to ruptured hepatic artery aneurysms.Congenital APF is a rare condition even in children.In this case report,we describe a 73-year-old woman diagnosed as APF by ultrasonography,computed tomography,and hepatic artery selective arteriography.The fistula was embolized twice but failed,and she still suffered from alimentary tract hemorrhage.Then,selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized.During the 2-year follow-up,the patient remained asymptomatic.We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.

Studies of Selective Arterial Perfusion plus Chemoembolization on Hepatic Metastasis from Rectal Cancer

OBJECTIVE To develop an effectual method for treating hepatic metas-tasis from rectal cancer. METHODS A randomized control study of celiac artery perfusion plus transcatheter hepatic arterial chemoembolization (TACE) (observation group) and intravenous chemotherapy (control group) for 99 cases with hepatic me-tastasis from rectal cancer was performed. The perfusion was repeated once at 4 weeks after the first treatment of 52 cases in the observation group, and it was subsequently repeated at an interval of 2 or 3 months. Using intrave-nous administration, the perfusion was repeated once every 3 weeks with 47 cases in the control group. RESULTS Three months after treatment, the patients in the observation group who showed a relief or elimination of a former superior abdominal pain amounted to 70.6%, and those with a diminution of their intrahepatic mass reached 55.8%. In the control group, the patients with a relief or disappear-ance of hepatalgia reached 20%, and those with a diminution of their intrahe-patic mass reached 10.6%. The 1, 2 and 3-year survival rates were 80.8%, 46.2% and 25.0% in the cases of the observation group and 61.7%, 19.1% and 4.3% in the control group, respectively. CONCLUSION For the patients who failed to receive a surgical opera-tion on their hepatic metastasis from rectal cancer, celiac artery perfusion plus TACE is a more effective regimen for improvement of the clinical symp-toms and extension of the survival time, compared to intravenous chemo-therapy, and is a better choice for palliative therapy.

Non-selective pulmonary angiography for venous thromboembolism diagnosis, a better choice?

Objective: To evaluate the efficiency of non-selective pulmonary angiography for pulmonary embolism diagnosis. Methods: 105 consecutive subjects diagnosed with limb deep venous thrombosis (DVT) by lower limb phlebography underwent non-selective pulmonary angiography. Results: 52.38% patients were diagnosed with pulmonary embolism, 21.9% with inferior vena cava thromboembolism, and 9.52% with pulmonary embolism combined with inferior vena cava thrombosis. Images obtained by non-selective pulmonary angiography had a good correlation with selective pulmonary angiography. Conclusion: The non-selective pulmonary angiography was a simplified, efficient and safe method for pulmonary embolism diagnosis. Large clinical trials are still needed to further evaluate the accuracy and safety of the non-selective method.

Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.

Establishment of animal models for chronic pulmonary embolism

Objective： To establish the animal model for the chronic pulmonary embolism and do some research on it. Methods： Pulmonary arteriography by DSA were performed in 6 goats and the stent was released in the infer-pulmonary arterary. Arterial blood gas analysis and right heart catheterization were done. After 3 days of embolism, pulmonary arteriography were performed again. After the animal was sacrificed, the right and left infer-pulmonary tissues were prepared and pathologically studied. Results： Stents were smoothly released in 6 animals. Compared with that before embolism, the arterial blood gas showed no difference 10 minutes later and 3 days later of the stent released. The pulmonary angiography showed that the right infra pulmonary artery was partly blocked and the blood could still pass by. 3 d of the embolism later, the stent was placed well and the right pulmonary artery was completely blocked. Compared with that before embolism,the right atrial pressure, ventricular pressure and the pulmonary pressure in 10 rain after embolism did not change much （ P 〉 0.05 ）, while 3 d after embolism, the pressures were obviously changed（P 〈 0.05 ）. There was no atelectasis ,pleural effusion in the right infra lobe in the experimental group. The wall of blood capillary among the alve- olar wall were significantly dilated. Hyperemia and edema were also observed. Lots of monocyte infiltrated. Localized exudates appeared in alveolar. Conclusion： By releasing stent in the pulmonary, the chronic pulmonary embolism model could be established in the animal experiment, and it should have great potential value in the following study.

Diagnosis and treatment of traumatic carotid cavernous fistula

To discuss the diagnosis and manage ment of traumatic carotid cavernous fistula (TCCF).Methods: In all 15 patients with TCCF confirmed by angiography, 8 patients got early diagnosis and cure. With Seldinger technique adpoted in th e puncture of femoral artery, Magic 3 F 1.8 F BD catheters combining with b alloon were used to embolize the fistula or the internal carotid artery. Results: Early diagnosis and cure were achieved in 8 patients w ithin one week and no sequelae occurred. Seven patients with delayed diagnosis who were cured beyond one week had some sequelae such as hypopsia in 5 cases, incomplete oculomotor paralyses in 3 and incomplete abducent paralyses in 2. Am ong all the 15 cases, the internal carotid artery was preserved in 12 cases acou nting for 80%. Occluding the fistula with sacrifice of the internal carotid arte ry was performed in 3 cases and no repatency of the fistula occurred by followin g up beyond three months. Conclusions: The preferred therapy for TCCF is to occlude the f istula using detachable balloon. The diagnosis and treatment for TCCF can signif icantly reduce occurrence rate of the complications and sequelae.

Emergency intervention therapy for renal vascular injury

Objective： To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury. Methods： A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles （PVA） in 9, and gelfoam particles in 6 cases. Results： Renal angiogram revealed arterlovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months （mean, 48 months）. Six patients died of primary diseases （5 cases of renal failure and multiple organ failure and l case of malignant tumor）. Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range. Conclusion： Transcatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.