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Objective:To investigate the clinical value of drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) in preoperative liver transplantation application of hepatocellular carcinoma beyond Milan standard.Methods:A total of 100 patients with hepatocellular carcinoma who were underwent liver transplantation exceeding Milan criteria were retrospectively analyzed from April 2013 to March 2019 at the Tianjin First Central Hospital. Of 72 males and 28 females were included, aged (50.3±7.8) years. Fifty patients who received preoperative DEB-TACE treatment were included in the DEB-TACE group. According to the tumor necrosis rate after liver transplantation, they were further divided into group A (complete tumor necrosis), group B (50%≤ tumor necrosis rate <100%) and group C (tumor necrosis rate <50%). Fifty patients with hepatocellular carcinoma who did not receive any preoperative treatment were included in the control group. DEB-TACE complications were analyzed. Their survival and recurrence were followed up. Survival analysis was performed by Kaplan-Meier method and survival rates were compared by log-rank test.Results:In the DEB-TACE group, the technical success rate of interventions was 100%(50/50) and 1 to 4(1.8±1.2) interventions were received. Post-DEB-TACE complications, included post-embolization syndrome in 18 cases (36.0%). Cumulative survival rates at 1, 2 and 3 years after liver transplantation in the DEB-TACE group were 96.0%, 90.0%, and 76.0%, respectively, which were better than the control group with 94.0%, 78.0%, and 54.0%. The differences were statistically significant (χ 2=6.62, P=0.015). The cumulative survival rates at 1, 2 and 3 years after liver transplantation for patients in group A+ B ( n=30) were 100.0%, 96.7% and 93.3% respectively, which were better than 94.0%, 78.0% and 54.0% for the control group, with statistically significant differences (χ 2=6.99, P=0.012). The cumulative survival rates after liver transplantation for group C compared with the control group were not statistically significant (χ 2=0.56, P=0.130). The results of the comparison of cumulative recurrence-free survival rates were consistent with the comparison of cumulative survival rates. Conclusion:In patients with liver cancer exceeding Milan criteria, DEB-TACE before liver transplantation is beneficial in improving the prognosis of patients.
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Objective:To evaluate the safety and efficacy of irreversible electroporation ablation for liver cancer.Methods:A retrospective study was conducted on 21 patients who underwent irreversible electroporation ablation for liver cancer from September 2018 to August 2019. There were 17 males and 4 females, with a median age of 57.9 (48, 69) years old. Complications were graded according to the Clavien Dindo complication grading system. Tumor response was evaluated by the improved evaluation standard of solid tumor efficacy. Clinical data such as tumor size and operation time were recorded. Tumor recurrence and survival outcomes were followed-up until August 27, 2020.Results:All patients had well-compensated cirrhosis (Child-Pugh A 20 cases, Child-Pugh B 1 case). There was no persistent deterioration of liver function after ablation. The diameter of tumor ranged from 10 to 56 mm, with 7 patients having a tumor diameter over 3 cm. Each of the 21 patients received only once irreversible electroporation ablation and the technical success rate was 100%. The operation time was 2.3 (1.5, 3.5) h. All complications were Clavien Dindo grade Ⅰ, which included pain, fever and brachial plexus strain. Imaging examination 4 weeks after treatment showed a complete remission rate of 85.7% (18/21), a partial remission rate of 9.5% (2/21), a stable disease rate of 0(0/21), and a progressive disease rate of 4.8% (1/21). The objective remission rate was 95.2% (20/21). Overall recurrence rates were 9.5% (2/21) at 3 months and 23.8% (5/21) at 12 months. AFP at 3 and 12 months after treatment were (28.0±7.3) and (29.0±8.1) ng/ml, respectively, which were significantly lower than that before treatment (278.0±41.2) ng/ml ( t3m=-3.57, t12m=-4.12, P<0.05). Conclusion:Irreversible electroporation ablation was safe and effective in treating malignant liver tumors.
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Objective:To explore the clinical efficacy ofendoscopic retrograde cholangiopancreatography (ERCP) plus percutaneous transhepatic cholangiodrainage (PTCD) of biliary reunion in the treatment of biliary occlusion after liver transplantation.Methods:From May 2018 to August 2019, clinical data were retrospectively analyzed for 9 patients with biliary tract occlusion after an initial liver transplantation. All of them underwent biliary reunion. An endoscopist performed ERCP while an interventional physician completed PTCD with bilateral guide wire under the same anesthetic period so that bilateral guide wire completed a reunion at biliary occlusion for re-opening biliary tract or establishing a new bile duct outflow path. Postoperative follow-ups were performed for observing the treatment outcomes and various factors of biliary stricture factors analyzed.Results:All of them received PTCD or T-tube sinus angiography and interventional treatment. The diagnosis of complete biliary occlusion was definite. After treatment, 7 cases of biliary tract reunion were successful. During operation, three reunion types of guide wire biliary, intestinal cavity and intra-abdominal cavity were employed. Two failed cases received continuous PTCD drainage after operation. The influencing factors of biliary tract stenosis were retrospectively analyzed after operation. Among them, there were non-anastomotic stenosis ( n=2), biliary leakage ( n=2) and anastomotic stenosis and long tortuous biliary tract ( n=5). Conclusions:Rapid, mini-invasive and safe, ERCP plus PTCD biliary tract reunion may be employed as a first choice for biliary occlusion after liver transplantation.
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The aims of bridging treatments before liver transplantation is to prevent the tumor from progressing to exceed the liver transplantation standards during the waiting period of patients with hepatocellular carcinoma (HCC), and to downgrade the HCC to meet the liver transplantation standards so as to reduce the postoperative tumor recurrence rate. Conventional transcatheter arterial chemoembolization (cTACE) has the disadvantages of large systemic adverse reactions and great influence on liver function. Drug-eluting beads (DEBs) are a new type of embolization material. Compared with cTACE, DEB-TACE can continuously and stably release chemotherapeutic drugs locally on the tumor for several weeks. Moreover, the concentration of the chemotherapeutic drug in the blood circulation is extremely low, which can effectively avoid systemic reactions caused by chemotherapy drugs, and is more effective in thebridging treatments of liver transplantation. In this paper, the current status and research progress of DEB-TACE treatment before liver transplantation for liver cancer were reviewed.
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Objective:To study the short-term safety and efficacy of small diameter drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) for patients with liver cancer before liver transplantation.Methods:From Mar 2018 to Dec 2019, 47 patients underwent small diameter DEB-TACE for liver cancer before liver transplantation. There were 39 males and 8 females, aged 24 to 70 years (median 51.5 years). Analysis of tumor size, tumor number and complications was conducted after DEB-TACE. After DEB-TACE, tumor response evaluation was done according to the modified response evaluation criteria in solid tumors criteria. Ananlyze the elimination rate and downstaged rate during liver transplantation waiting period. For patients who underwent liver transplantation, the pathological findings and the tumor recurrence of patients were analysed.Results:There were 46 patients Child-Pugh A, 1 patient Child-Pugh B. A solitary liver cancer was found in 17 patients, and multiple tumors in 30 patients. The lesion size was (30.8±17.7)mm. For the 47 patients who together underwent 50 times DEB-TACE. The technical success rate was 100.0%, the complete response rate 27.7%(13/47), partial response rate 51.1%(24/47), stable disease rate 17.0%(8/47), and progressive disease rate 4.2%(2/47). For the 22 patients who met the Milan cirteria and were awaiting for transplantation, the elimination from transplantation rate was 0. For the 25 patients who are beyond the cirteria and who underwent DEB-TACE, 84.0% (21/25) of patients were downstaged to within the University of California, San Francisco cirteria and 56.0% (14/25) to within the Milan cirteria. For the 35 patients who underwent liver transplantation, pathology showed that complete necrosis rate was 39.4%(13/33), and more than 50 % necrosis was achieved in 26 of 33 patients(78.8%). No significant treatment related complications were observed. Only 3.0%(1/33) of patients suffered from tumor recurrence.Conclusion:Small diameter DEB-TACE for liver cancer was an effective procedure with a favorable safety profile and promising results in tumor necrosis rates.
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Objective To evaluate the value of DEB-TACE before liver transplantation for hepatocellular carcinoma patients.Methods From Jan.2016 to Jan.2018,23 patients received DEB-TACE before liver transplantation for hepatocellular carcinoma were induced.Complications evaluation was followed up after interventional therapy.4 weeks after the intervention,the imaging examination was performed to examine the tumor response rate depond on mRECIST,the pathological conditions and tumor free survival were studied in the patients who received liver transplantation.Results The achievement ration of operation was 100％ in 23 patients.23 patients received 24 times successfully,1 patient received DEB-TACE twice,and the remaining 22 patients received DEB-TACE once.No serious complications occurred.Eighteen patients (78.3％,18/23) had postembolic syndrome after interventional therapy,mainly fever and pain.Four weeks after DEB-TACE,the complete response rate was 47.8％ (11/23),partial response rate was 30.4％ (7/23),disease stability rate was 21.7％ (5/23).All the 23 patients were included in the waiting list for transplantation.Among them,15 cases received liver transplantation.Pathological results showed that the total necrosis rate was 53.3％ (8/15),and the tumour necrosis rate in 4 of them was less than 50％.The average tumour necrosis rate of the neoplasm was 75.0％.The 15 patients who received liver transplantation were alive with no tumor recurrence.Conclusion DEB-TACE is a safe and effective treatment for patients suffered from hepatocellular carcinoma in waiting for liver transplantation.However,due to the short time of DEBs in China,further research is needed.
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Objective To observe among stroke survivors the timing of muscle activation at the stance phase during walking using the surface electromyography ( sEMG) combined with 3D gait analysis. Methods Twenty stroke survivors assessed as at Brunnstrom stages Ⅲ, Ⅳ and Ⅴ were assigned to groups designated Ⅲ, Ⅳ and V. sEMG and 3D gait analysis were used to assess the activation timing of the bilateral rectus femoris ( RF) and biceps femoris ( BF) , the tibialis anterior ( TA) and the gastrocnemius medialis ( GM) . The activation timing and the dura-tion of activation of the muscles were compared among the 3 groups, as well as with those of healthy muscles. Results The onset time of the RF on the affected side was significantly later than on the healthy side, while that of the GM was significant earlier. The durations of BF and GM activation on the affected side were significantly shorter than on the unaffected side in group III. The onset times of the TA and GM on the affected side were significantly ear-lier than on the healthy side in group IV, as was the onset time of the TA of the affected side in group V. The average RF and BF onset times on the affected side in group Ⅳ were significantly earlier than in group Ⅲ. The onset time of the TA on the unaffected side and the average BF onset time on the affected side in group Ⅴ were significantly later than in group IV. The onset time of the RF and TA on the unaffected side in group Ⅳ and the onset time of the GM on the affected side were significantly later than in group III, while the onset time of the BF and TA on the affected side was significantly earlier. The average duration of BF activation on the unaffected side in group Ⅳ was significant-ly shorter than that of group Ⅲ. The average duration of TA activation on the unaffected side in group Ⅴ was signifi-cantly shorter than that of group IV. The duration of RF activation on the affected side in group Ⅴ was significantly shorter than that in group Ⅲ, and the same was true of the RF, BF, TA and GM activation times on the healthy side. Conclusions There are significant differences in the onset and duration of muscle activation when stroke survivors at different stages of recovery walk. Some muscles are activated too early and others are over-activated. These abnormali-ties gradually disappear with the recovery of motor function.
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Objective To evaluate the drug-eluting-beads (DEB)-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.Methods Inclusion criteria:the hepatocellular carcinoma exceeding the standard of Milan criteria.From Jan 2016 to Jan 2018,30 patients received DEB-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.4 weeks after DEB-TACE,the imaging examination was performed.The patients who received the liver transplantation,the pathological conditions were recorded and the tumor free survival of the patients was followed up.Results 30 patients received 30 times DEB-TACE successfully.76.7％ (23/30) patients was down-staged to meet UCSF criteria,53.3％ (16/30) patients was down-staged to meet Milan criteria.13 patients had being given liver transplantation,pathology showed that DEB-TACE achieved complete necrosis in 30.8 ％ (4/13)cases.No significant treatment related complications were observed.After liver transplantation 12 patients are alive with no tumor recurrence.The tumor recurrence rate after liver transplantation was 7.7％.Conclusion DEB-TACE is safe and effective as down-stage therapy for hepatocellular carcinoma before liver transplantation.
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Objective To study the use of contrast-enhanced ultrasound in diagnosing splenic arterial steal syndrome (SASS) after liver transplantation,and to compare the curative effect,safety and follow-up results of the different embolization methods in the treatment of SASS after liver transplantation.Methods From January 2005 to December 2017,41 patients after liver transplantation in our hospital developed splenic artery steal syndrome and were treated with splenic arterial embolization.All these patients underwent ultrasound,and in 19 patients contrast-enhanced ultrasonography was also done to detect the presence of splenic artery steal.The findings were confirmed by angiography.These patients then underwent splenic arterial embolization.In 32 patients coil embolization was done (group A) and in 9 patients embolization was assisted with Amplatzer occluders (group B).Results In all the 41 patients with SASS,angiography after splenic artery embolization showed the second and third order arterial branches in the liver increased in number and in diameter with good blood flow compared with those before treatment.The postoperative blood flow and pattern on ultrasound returned to normal.In group A,12 patients (12/32,37.5％) developed splenic infarction,including 11 patients with partial splenic infarction,and 1 patient developed a splenic abscess after complete splenic infarction.In group B,two patients developed partial splenic infarction (2/9,22.2％).All the patients with splenic infarct had no clinical symptoms.No treatment was required except for the patient who developed splenic abscess after complete splenic infarction.The patient recovered well after treatment with antibiotics and splenic abscess drainage.There was no other complications.Conclusions Contrast-enhanced ultrasound provided early diagnosis of splenic artery steal after liver transplantation.Interventional splenic artery embolization was safe and effective to treat splenic arterial steal syndrome after liver transplantation.Coil embolization assisted with Amplatzer occluders was better than the traditional coil embolization with more accurate embolization site and fewer complications.
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Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.
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This article presented our experience on transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) before hepatic resection for huge hepatocellular carcinoma with cirrhosis.The preoperative future liver remnant/total estimated liver Volume (FLR/TELV) ratios of 5 patients were less than 40％,and preoperative TACE was implemented 3 weeks after PVE.In all these patients,right hepatectomy was successfully implemented.Preoperative TACE and PVE expanded the indication of hepatectomy,increased the safety of surgery and improved the curative rate.
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<p><b>OBJECTIVE</b>To discuss the risk factors of splenic arterial steal syndrome (SASS) after orthotopic liver transplantation.</p><p><b>METHODS</b>Twenty-four cases who confirmed SASS after liver transplantation in Tianjin First Central Hospital between June 2005 and June 2013 were analyzed retrospectively. Another 96 cases were selected randomly from those patients of the same time with no complication of SASS patients postoperatively as control group. Clinical data of two groups including diameter of splenic artery and hepatic artery preoperatively, weight of graft, weight of recipients, cold/warm ischemia time, an hepatic period and operation time and so on were collected. Others including hepatic artery peak systolic velocity (PSV), end diastolic velocity (EDV), blood flow resistance index and portal vein average velocity (PVF) on the first day after liver transplantation, the day before diagnosis, the day when diagnosed, the 1, 3, 7 days after treatment in SASS group and on 1, 3, 7, 9, 11, 14 days after liver transplantation in control group. Statistical analysis were made between two groups.</p><p><b>RESULTS</b>The splenic artery/hepatic artery ratio preoperatively and weight of donor liver,and the GRWR in SASS group and control group were 1.26 and 1.00, 1 032 g and 1 075 g, (1.40±0.30)% and (1.82±0.21)% respectively, with significantly statistical differences (Z=-6.40, Z=-2.22, t=-6.50; all P<0.05). The warm ischemia time, the cold ischemia time, the anhepatic period and operation time in SASS group and control group were 3.5 minutes and 4.0 minutes, 10.25 hours and 10.10 hours, 43 minutes and 45 minutes, 8.7 hours and 8.7 hours, with no significantly statistical differences (all P>0.05). RI of hepatic went up gradually in the early time after transplantation while dropped obviously when spleen artery spring coils embolization was received (P<0.01) and trended to stable two weeks later.</p><p><b>CONCLUSIONS</b>Splenic artery/hepatic artery ratio and GRWR are the positive and negative risk factors respectively for SASS. The gradual rising of hepatic RI in the early time after transplantation may be the warning signal SASS and spleen artery spring coils embolization is the effective strategy for SASS after liver transplantation.</p>
Subject(s)
Humans , Cold Ischemia , Embolization, Therapeutic , Hepatic Artery , Pathology , Liver , General Surgery , Liver Transplantation , Retrospective Studies , Risk Factors , Spleen , Splenic Artery , Pathology , Vascular Diseases , Epidemiology , Warm IschemiaABSTRACT
Objective To study the role of cover-stent and embolization in the treatment of hepatic artery pseudoaneurysm following liver transplantation.Methods 5 patients with hepatic artery pseudoaneurysm after liver transplantation were treated with cover-stent and embolization between May 2010 and July 2013.The clinical features,imaging findings and complications were reviewed.Results All the 5 patients with hepatic artery pseudoaneurysm were successfully treated.2 patients with intrahepatic pseudoaneurysm received embolization.Of the 3 patients with extrahepatic pseudoaneurysm,2 received cover-stent treatment,and 1 patient received embolization.No complications related to the interventional treatment were encountered.2 patients died from multi-organ failure one month after the interventional treatment.Conclusion Cover-stent and embolization were effective and safe to treat patients with hepatic artery pseudoneurysm following liver transplantations.
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Objective To evaluate the medium and long-term therapeutic results of percutaneous transhepatic angioplasty for portal vein stenosis (PSV) following pediatric liver transplantation.Methods From Jan.2008 to Dec.2012,5 cases with PVS after pediatric liver transplantation received percutaneous transhepatic angioplasty.There were 3 male and 2 female cases ranging from 7 months to 8 year-old with the median age of 2 years and 10 months.The protopathy included 1 Carolis disease and 4 congenital biliary atresia.The therapeutic results were monitored by clinical follow-up and imaging examination.The clinical data,imaging examination and therapeutic results were analyzed.Results All interventions were performed successfully,and the treatment efficacy was 100％.One patient was diagnosed with earl-onset PVS at 0.5 month after liver transplantation.Four patients were diagnosed with late-onset PVS at 3-30 months after liver transplantation.The prestenotic portal venous average diameter was (2.3 ± 0.6) mm (1.2-3.0 mm),the degrees of stenosis were 70％-95％.The poststenotic portal venous average diameter was (9 ± 1) mm (8-10 mm) (t =32.560,P ＜ 0.05).The prestenotic portal venous average pressure gradient was (11.0 ± 3.2) mmHg (8-16 mmHg),and the poststenotic portal venous pressure gradient was(2.2 ± 1.5) mmHg(0-4.0 mmHg) (t =8.242,P ＜ 0.05).Postoperative follow-up was 10-66 months,the portal veins of all cases were patent,and patency rate was 100％.Conclusions Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of PVS following liver transplantation.Its medium and long-term patency rates are high.
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Objective To evaluate the therapeutic effectiveness of percutaneous endovascular treatment of hepatic venous outflow obstruction (HVOO)after pediatric liver transplantation(LT).Methods From January 2008 to January 2013,10 children with obstruction of hepatic vein (HV) or inferior vena cava (IVC) anastomosis underwent percutaneous transluminal angioplasty (PTA) with balloon dilation or stent placement.The hepatic venous outflow obstruction occurred 10-455 days (median,125 days) after pediatric liver transplantation.According to the time of obstruction,the obstruction was divide into early onset (＜1 month) and late onset(＞1 month).The effectiveness of PTA was analyzed.Results Twenty-one procedures were performed.One treatment was ineffective,and technical and initial clinical success ratio was 95.2％ (20/21) and 70.0％ (7/10),respectively.In 3 cases with early onset after LT,operation was performed after unsuccessful PTA in 1 case.One patient who developed recurrent stenosis was treated with PTAS.The other patient died of acute rejection.Late onset after LT was found in 7 cases,who were treated with PTA or stent successfully.Conclusions In cases of venous outflow obstruction resulting from HV and/or IVC lesions after pediatric liver transplantation,percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment that results in midterm and long-term patency.Early-onset or hepatic veins combined with superior vena cava obstruction should be implanted with stents as early as possible.Late-onset or hepatic veins obstruction alone can be get better results with Balloon Dilatation.
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Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty in patients with portal vein stenosis following liver transplantation.Methods From 2005 to 2013,38 patients developed portal vein stenosis following liver transplantation.Percutaneous transhepatic angioplasty of the portal vein stenosis was performed on these patients.The results were monitored by clinical follow-up and imaging studies.Results Percutaneous transhepatic angioplasty was successful in these patients.Self-expanding metallic stents (n=7),balloon-expandable coronary stent (n=29),and membranous stent (n=1) were used.The follow-up period ranged from 3 to 90 months.Portal venous patency was maintained in 34 patients (one patient died due to multi organ failure,1 patient accepted a third liver transplantation because of biliary tract complication,and 1 patient received a repeat placement of a membranous tent because the portal vein stent was blocked by a tumor thrombus,and 1 patient developed stent restenosis).There was 1 patient who developed hemorrhage in the early postoperative period (2.63％).A diagnosis of hepatic artery hemorrhage was made by hepatic artery angiography and the patient was treated by interventional embolization.Conclusion Percutaneous transhepatic stent angioplasty is an efficacious and safe method to treat portal vein stenosis following liver transplantation.
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Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty for portal vein stenosis following liver transplant.Methods From 2005 to 2007,7 patients developed portal vein stenosis following liver transplant.Percutaneous transhepatic stent angioplasty of the portal vein was performed in all patients.The therapeutic results were monitored by clinical follow-up and imaging examination.Results In seven patients,the percutaneous transhepatic stents were placed successfully.The follow up period ranged from 3 months to 34 months.Portal venous patency Was maintained in six patients(one patient died due to hepatic arterial thrombosis and ischemic insult to bile duct at three months following the stent placement).No complications due to stent angioplasty occurred.Conclusion Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of portal vein stenosis following liver transplant.
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Aiming at the shortcomings of the "National Information Management System for Employment of College Graduates Version 1.1",which is used by some colleges and univer-sities at present,this paper seeks to introduce a web-based system.The purpose of this system is to improve the efficiency of the management of graduate employment,and build a multi-net-work platform for better communication among the graduates,their departments and the school career management department.Moreover the design and development process of this web-based system will also be briefly introduced in this paper.