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Objective:To evaluate the safety and efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) combined with interventional therapy for primary hepatic carcinoma complicated with portal hypertension.Methods:From October 2013 to December 2017, medical records of 141 patients with primary hepatic carcinoma complicated with portal hypertension hospitalized and treated in Anhui Provincial Cancer Hospital were collected. According to the inclusion and exclusion criteria, 32 cases were in the TIPS combined with interventional treatment group and 29 cases were included in the intervention-only group after age, gender, mean tumor diameter and Child-Pugh classification matched with TIPS combined with intervention treatment group. The efficacy of TIPS was obsented, and the related complications and prognosis of the two groups at six, 12 and 24 months after treatment were compared. Independent sample t test, Mann-Whitney U test and Chi-square test were used for statistical analysis, and Kaplan-Merier method was used for survival analysis. Results:There were no statistically significant differences between TIPS combined with intervention group and intervention-only group in age, gender, mean tumor diameter, Child-Pugh classification, Child-Turcotte-Pugh (CTP) score, Barcelona staging, interventional treatment, causes of liver cirrhosis, portal hypertension related symptoms , portal vein tumor thrombus, alanine aminotransferase (ALT), and total bilirubin (TBil) (all P>0.05). The success rate of TIPS of patients in TIPS combined with intervention group was 100% (32/32). All the portal hypertension related symptoms after TIPS were relieved, and the remission rate was 100% (32/32). Compared with that before TIPS, after TIPS, the portal vein pressure decreased ((36.5±6.9) cmH 2O vs. (25.5±5.6) cmH 2O (1 cmH 2O=0.098 kPa)), the diameter of portal vein decreased ((15.9±3.5) mm vs. (13.7±2.7) mm), and ascites volume decreased (abdominal circumference ((105.6±13.9) cm vs. (88.0±9.8) cm), red blood cell count ((2.6±0.8)×10 12/L vs. (3.3±1.3)×10 12 /L) and hemoglobin level ((78.9±15.5) g/L vs. (108.4±14.6) g/L) both increased, and the differences were statistically significant ( t=2.866, 3.105, 10.769, -3.548 and -3.869, all P<0.01). The stent patency rate six months after TIPS was 100% (32/32), the 12-month patency rate was 94% (30/32), and the 24-month patency rate was 84% (27/32). Six months, 12 months and 24 months after treatment, the incidence of ascites of patients in the TIPS combined with interventional treatment group was 0, 3.1% (1/32) and 9.4% (3/32), respectively, and the incidence of bleeding was 3.1% (1/32), 9.4% (3/32) and 15. 6% (5/32), respectively, which were all lower than those of the intervention-only group (13.8%, 4/29; 27.6%, 8/29; 65.5%, 19/29; 20.7%, 6/29; 34.5%, 10/29 and 62.1%, 18/29), and the differences were statistically significant ( χ2=4.72, 7.24, 20.80; and 4.62, 5.72, 13.97; all P<0.05). There were no statistically significant differences in the incidence rates of hepatic encephalopathy 6 and 12 months after treatment between the two groups (both P>0.05). The incidence of hepatic encephalopathy of intervention-only group (48.3%, 14/29) 24 months after treatment was higher than that of TIPS combined with intervention group (21.9%, 7/32), and the difference was statistically significant ( χ2=4.70, P=0.030). The results of Kaplan-Merier analysis indicated that 12 and 24 months after treatment the cumulative survival rates of TIPS combined with intervention group (84.4%, 27/32 and 53.1%, 17/32) were both higher than those of the intervention-only group (41.4%, 12/29 and 13.8%, 4/29), and the differences were statistically significant ( χ2=12.20 and 5.06, both P<0.05). The median survival time of TIPS combined with intervention group was 25 months, which was longer than that of the intervention-only group (12 months), and the difference was statistically significant ( Z=3.341, P=0.001). Conclusions:TIPS combined with interventional therapy is safe and effective in the treatment of primary hepatic carcinoma complicated with portal hypertension, which can improve the quality of life and increase the survival rate.
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Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS)in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS).Methods From April 2015 to August 2018,at The First Affiliated Hospital of University of Science and Technology of China,21 patients with gynura segetum caused HSOS were selected.All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks.After operation patients were followed up with liver and portal vein Doppler ultrasonography examination,liver and kidney function tests,and survival observation.T test,logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis.Results Among the 21 patients with gynura segetum-related HSOS,18 patients were in the subacute phase and three patients in the chronic phase.All of them were moderate or severe patients and all successfully underwent TIPS.The postoperative portal vein pressure was (16.71 ± 4.68) cmH2O (1 cmH2O =0.098 kPa),which was lower than that before operation ((41.52 ±6.27) cmH2O),and the difference was statistically significant (t =16.936,P ＜ 0.01).The postoperation portal vein blood flow velocity was (41.52 ±7.70) cm/s,which was higher than before operation ((11.19 ± 3.29) cm/s),and the difference was statistically significant (t =-15.191,P ＜0.01).At one month after operation,15 of 21 patients were clinically cured;among the remaining six patients,four patients were improved and two patients were ineffective (including one patient died).At four months after operation,two patients died,and the remaining 19 patients were clinically cured.At one month after operation,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and serum creatinine were (23.7 ± 16.8) U/L,(33.9 ±7.4) U/L,(52.7 ± 38.2) μmol/L and (62.7 ± 12.6) μmol/L,respectively,which were lower than those before operation ((60.5 ± 42.4) U/L,(78.4 ± 42.4) U/L,(74.9 ± 38.2) μmol/L and (82.4 ± 19.6) μmol/L,respectively),and the differences were statistically significant (t =3.193,3.493,2.378 and 4.519;all P ＜ 0.05).The level of albumin was (39.0 ±3.1) g/L,which was higher than that before operation ((30.9 ± 3.8) g/L),and the difference was statistically significant (t =-10.283,P ＜ 0.01).Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P ＜0.05).The one-year cumulative survival rate of patients was 90.5％.Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P ＜ 0.05).Conclusion TIPS is a safe,reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy,which can improve the prognosis and survival rate of the patients.
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Objective To explore the incidence and risk factors of acute kidney injury (AKI) following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma(HCC),Child class A. Methods Retrospective analysis was performed on patients with HCC,Child Class A who were admitted from January 2008 to October 2016.The inclusion criteria:(1) patients were diagnosed with pathologically confirmed hepatocellular carcinoma based on the standards of primary liver cancer diagnosis and treatment (2011 edition);(2) patients have complete laboratory parameters and imaging data within the 7 days before the TACE treatment;(3) the Child-pugh score was 5 to 6;(4) patients have no acute or chronic renalfailure before the treatment of TACE.The morbidity of AKI after TACE was investigated.Twenty-six factors such as age,sexy,contrast dose,hemoglobin were included as independent variable, so as to investigate the risk factors for postoperative AKI. Results A total of 818 patients were included in the study, including 38 experiencing postoperative AKI(4.64%).Multivariate logistic regression analysis identified elevated preoperative uric acid as the independent risk factor for postoperative AKI(OR=1.005,95% CI 1.000 to 1.009,P=0.037), and elevated preoperative hemoglobin as the protective factor for postoperative AKI(OR=0.974,95% CI 0.952 to 0.997,P=0.028).Conclusions AKI is not uncommon following hepatic arterial chemoembolization inpatients with HCC,Child Class A,and is correlated with elevated uric acid and anemia.Preoperative risk assessment and anemia correction might be effective for reducing the incidence of AKI following hepatic arterial chemoembolization.
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Objective To investigate the application of ultrasonic examination for patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) in the stents in artificial channel (SIAC) and portal vein (PV).Methods The clinical data of 28 patients who were admitted into our hospital from January 2013 to February 2017 and received TIPS were analyzed.Scanned the stents in artificial channel and portal vein and their inner diameter through transabdominal probe,and then measured the blood flow velocity by doppler.ResultsAfter TIPS,the SIAC of cirrhosis patients showed parallel tubular high echo,smooth wall and clear vessel lumen.And the inner diameter of SIAC was (5.93±0.76)mm,the blood flow velocity was (97.14±28.46)cm/s,and the 95% reference value was 4.45 mm~7.41 mm and 41.36~152.92 cm/s respectively.And the inner diameter of PV was (12.40 mm±2.90)mm,the blood flow velocity was (38.33 cm±16.01)cm/s,and the 95% reference value was 6.72~18.08 mm and 22.32~49.34 cm/s respectively.Conclusion Ultrasonography can give objective evaluation of whether SIAC and PV is unobstructed after TIPS,and it can get their parameters of inner diameter and velocity.As a result, ultrasonography can be regard as a perfect means for follow-up checkup.
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Objective To evaluate the success rate,vascular patency time and their influencing factors of percutaneous transluminal angioplasty (PTA) in treating swollen hand syndrome in hemodialysis patients.Methods The clinical data of 16 hemodialysis patients with swollen hand syndrome,who were admitted to authors' hospital during the period from May 2015 to March 2017 to receive PTA,were retrospectively analyzed.The technical success rate,the follow-up primary vascular patency time and primary patency rate were calculated,and the factors influencing technical success rate and vascular patency time were analyzed.Results Venography with DSA revealed that a total of 16 segments of venous stenosis or occlusion were found in 16 patients,including 6 stenotic lesions and 10 occlusive lesions.Successful PTA was obtained in 14 patients,including one patient whose angiography performed immediately after PTA with balloon dilatation showed that the stenosis was still over 50％,and stent implantation had to be carried out.The technical success rate was 87.5％,in 2 patients PTA failed as the guide wire could not pass through the long segment of vascular occlusion.The 14 patients were followed up for 3-24 months,and the median patency time was 10.5 months.The 3-,6-and 12-month primary patency rates were 71.4％ (10/14),57.1％ (8/14) and 42.9％ (6/14) respectively.Univariate analysis indicated that the length of occlusive segment and the balloon pressure required for angioplasty were the potential factors that affected the postoperative vascular patency time.Conclusion For the treatment of swollen hand syndrome in hemodialysis patients,PTA is safe and effective,although long-term vascular patency rate needs to be further improved.
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Objective To retrospectively analyze the effect of interventional embolization for hepatocelluar carcinoma (HCC) associated with arteriovenous shunting (AVS), and to discuss the factors influencing the therapeutic results. Methods The clinical data of 62 cases with HCC associated with AVS , who were treated with interventional chemoembolization , were retrospectively analyzed. Based on the type and extent of AVS identified by angiographic manifestations, appropriate obstruction of the shunt and Lipiodol chemoembolization of HCC were conducted. The curative effect of the shunt embolization was assessed by DSA at one or two months after the treatment. The relevant factors influencing the prognosis of embolization were analyzed by using univariate and multivariate Cox regression analysis methods. Results Of the 62 patients, arterioportal shunting (APS) was detected in 44, hepatic arterio-venous shunting (HAVS) in 11, APS together with HAVS in 4, and hepatic artery-pulmonary artery shunting (HAPAS) in 3. Re-examination with DSA was carried out in 53 patients at 1 - 2 months after the treatment , which showed that the shunting disappeared in 18 cases, obvious reduction of the shunt flow was seen in 19 cases, the lesion remained stable in 9 cases and the disease became worse in 7 cases. Univariate analysis indicated that the kind of embolic material and the presence of tumor thrombus could affect the obstructive result of the shunt , while multivariate Cox regression analysis showed that portal tumoral thrombus was an independent risk factor. The embolization effect of polyvinyl alcohol (PVA) particles and Lipiodol-ethanol mixture, used as the embolic agents, was better than that of gelatin sponge particles. Conclusion To ensure a successful interventional chemoembolization for HCC combined with AVS the procedure should be individualized according to the type and extent of the arteriovenous shunting. The type of embolic materials used for embolization can affect the results to a certain degree.
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ObjectiveTo evaluate the technical feasibility of animal model of avascular necrosis of femoral head (ANFH)with transcatheter arterial embolization (TAE).MethodsTwenty experimental pigs were randomly divided into experimental group and control group (each n= 10).Experimental group:A 5F Cobra catheter was inserted into left femoral artery,and the feeding arteries of femoral head were superselectively inserted.The feeding arteries were embolismed through transcatheter arterial injecting the segments of silk measuring about 500μm.Control group:The arterial embolization was not performed,and the other treatment was identical to experimental group.The articulation of hip in all pigs underwent plain X-ray examination,CT and MR scanning 2 weeks and 4 weeks after treatment,respectively.Histological examination was made in 4 weeks to evaluate volume of bone trabecula (TBV) and percentage of bone lacuna (PBL) at unit area under microscope.The data were compared between the two groups.Results In experimental group,CT and MRI showed swolling in hip soft tissue and high T1 in hip joint cavity,while no obvious abnormalities were found in plain X-ray film 2 weeks after feeding arteries were embolized.Four weeks after feeding arteries embolization,plain X-ray film,CT and MR showed typical necrosis of femoral head in the experimental group,while no obvious abnormalities were found in control group.The histology examination revealed there were obvious karyopyknosis and anachromasis in the bone cells.The quantity of bone cells decreased obviously or disappeared.PBL increased and TBV decreased significantly compared with those of control group (P＜0.05).ConclusionThe animal model of ANFH in pigs can be induced by TAE.It can preferably mimic the pathological situation of ANFH.
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[Objective]This study was designed to evaluate the effects of percutaneously puncturing vertebrate adjacent to cartilage endplate and injecting pingyangmycin on lumbar intervertebral disc and cartilage endplate in New Zealand Rabbits.[Methods]Thirty-six New Zealand white rabbits were enrolled in this study.The fifth lumbar vertebmte(L_5)was injected with pingyangrnycin as experimental group,and the fourth lumbar vertebmte(L_4)injected normal sodium as control group.Six rabbits were selected randomly,then MRI and histological observation was performed in the first,second,third,fourth,Fifth week and third month after operation respectively.Moreover,the correlation analysis was performed between MRI and histological measurements for areas of the lesion in L_5.[Results]There was no obvious changes on MRI and histological examination in control group.For experimental group,there were also no obvious changes in the first two weeks after bperation.However,in the third week,it demonstrated slightly hyperintense signal on T_2WI and fat-suppression T_2WI(FS T_2WI),while FS T_1WI was hypointense signal.The signal changed more obviously in the fourth week.Histologically,the structure of vertibrates arranged disordedy,chondrocyte of endplate decreased and architecture became disorder.Anulus fibrosus and nucleus pulposus did not change.The cartilage endplate and intervertebral disc degenerated in the fifth week.Both of them degenerated more obviously in third month.There was a strong correlation between MRI and histological measurements for areas of the lesion in the fourth week(r=0.965,P＜ 0.001).[Conclusion]Degeneration of lumbar intervertebral disc and cartilage endplate in New Zealand Rabbits can be induced by percutaneously puncturing vertebrate adjacent to cartilage endplate and injecting pingyangmycin.
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BACKGROUND: Currently, the widely used intervertebral disc degeneration models are induced by altering intervertebral disc biomechanics, damaging intervertebral disc structure or changing hereditary features with genetic technique. All these methods are vades from natural duration of intervertebral disc degeneration. OBJECTIVE: To evaluate the feasibility of the establishment of rabbit model of ischemic lumbar vertebrae adjacent to endplate by percutaneous puncture followed by pingyangmycin injection. METHODS: A total of 46 New Zealand white rabbits were selected and two vertebraes were divided as experimental group (L_5) and control group (L_4) in every rabbit. Vertebrae adjacent to endplate was punctured. Pingyangmycin (2 g/L) 1 mL was injected into rabbits in the experimental group. And 1 mL normal sodium was injected into the control group. Lumbar artery angiography was performed in 4 rabbits before operation. Six rabbits were randomly performed MRI and then were executed for vertebral histology at weeks 1,2, 3, 4, 5 and months 2, 3 after operation. Ischemic areas of L_5 were measured by the MRI and histological section at week 4 after operation. RESULTS AND CONCLUSION: MRI and histology of control group had not specific changes. MRI had not significant signal intensity changes in the first 2 weeks in the experimental group. At week 3 after operation, it demonstrated slightly hyperintense signal on T_2-weighted image (T_2WI) and fat-suppression T_2-weighted image (FS T_2WI), while fat-suppression T_1-weighted image (FS T_1WI) was hypointense signal. The signal changed more obviously at week 4. Histology of experimental group had not specific changes in the first 2 weeks. From weeks 3-4, bone trabecula arranged confusedly and disorderly, with gradually decreased osteocyte and marrow haemocytes, while adipocytes increased and coalesced. Cartilage corpuscle of endplate decreased and architecture became disorder. But the anulus fibrosus and nucleus pulposus had no obviously changes. The intervertebral disk of the experimental group degenerated at week 5, and the ischemia of lumbar vertebrae still existed and intervertebral disk degenerated more obviously at months 2-3 after operation. There was significant positive correlation of ischemic areas of experimental group between MRI and histology at week 4 (t-=0.965, P < 0.001). The rabbit model of ischemic lumbar vertebrae adjacent to endplate can be established successfully by peroutaneous puncture vertebrae adjacent to endplate followed by pingyangmycin injection. The operation is minimally invasive, simple and reproducible, with high success rate. This is a fairly ideal animal model to study the degeneration of the lumbar spine and intervertebral disc.
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BACKGROUND: The uterine arterial embolization which is a major method to treat hysteromyoma has bean widely used in clinic and achieved a satisfactory therapeutic efficacy. The study addressing the effect of trisacryl gelatin microspheres on uterine arterial embolization in a hysteromyoma guinea pig model has less bean reported yet. OBJECTIVE: To vedfy the feesibility of trisacryl gelatin microspheres to uterine arterial embolization in hysteromyoma guinea pig models. METHODS: A total of 30 adult female guinea pigs were randomly divided into two groups: pelvic cavity artery moulding group (n=10) was performed pelvic vascular casting mould to demonstrate the anatomical characteristics, such as source, running shape, length, diameter and branches; arterial embolization group (n=20) was induced hysteromyoma model using astrogen-progestogen replacement therapy and performed technical research and pathological analysis by bilateral uterine arterial embolization. RESULTS AND CONCLUSION: The trunks of uterine arteries were erupted from internal iliac arteries. The diameter of the trunks and its arcuate branches were (0.350±0.022) mm and (0.160±0.012) mm, respectively. The 20 guinea pigs of the arterial embolization group were succeeded in operating bilateral arterial embolization. The dosage of 40-120 pm and 100-300 μm trisacryl gelatin microspheras were (0.040t±0.005) mL and (0.017±0.002) mL respectively during the operation. The achievement ratio of establishing model was 75% in the arterial embolization group. On the pathological section, the microspheres could be found in the uterine arterial arcuate branches and second branches within the subsercsa and third branches. The myometrium Was thickening. The cells of the leiomyoma nodules arranged in palisade or weaving shapes. Ischemia and necrosis were evidently present in leiomyomas of guinea pigs after embolization, but the myometria and endometria had no pathological change of ischemia and necrosis. It is feasible to use trisacryl gelatin microspheres to operate uterine arterial embolization for hysteromyoma of guinea pigs and the embolization effects are satisfactory.
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Objective To evaluate the therapeutic effects and experience of the tracheal stent implantation for the management of severe tracheal stenosis.Materials Thirteen patients with severe tracheal stenosis of various causes underwent high kilovoltage radiography and computed tomography for evaluating the site,form and extent of the stenosis including 10 at the trachea,1 at the right main bronchus and 2 at left main bronchus.The C2 catheter assisted with ultra-slipping guide wire was inserted into the trachea under fluoroscopy and then a replaced high shoring guide wire was pushed through the stenotic segment and retained the stent. Results All stents were implanted successfully with successful rate 100% together with dyspneic improvements.The mean survival time was 6.2 months for patients with malignant neoplasm.One patient with benign tracheal stenosis has been followed-up for 5 years without restenosis. Conclusions The tracheal stent implantation is an effective means for severe tracheal stenosis.