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Objective To investigate the characteristics of hepatitis virus B ( HBV) reactivation af-ter combined percutaneous microwave ablation ( PMWA ) and transcatheter arterial chemoembolization ( TACE) in patients with hepatocellular carcinoma ( HCC) and to study the therapeutic role of preoperative antiviral therapy .Methods The data on 180 HCC patients who were treated with the combined therapy were analyzed .The antivirus group ( n=90 ) received antiviral therapy , while the control group ( n=90 ) did not.HBV-DNA was used to study the reactivation status of HBV after the combined therapy and the role of antiviral therapy .Results The incidence of HBV reactivation was significantly lower in the antivirus group (8.2%, 7/90) than the control group (20.0%, 18/90, P<0.05).A preoperative HBV-DNA level above 104 copies/ml was the only independent risk factor of HBV reactivation (P<0.05).Conclusions The HBV reactivation rate was relatively high in patients with HBV-related HCC after combined PMWA and TACE.Preoperative antiviral therapy significantly reduced HBV reactivation and thus it should be adminis -trated especially to HCC patients with a preoperative HBV-DNA level above 104 copies/ml.
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Objective To investigate the effects of transarterial chemoembolization (TACE)treatment interval on the prognosis of patients with advanced hepatocellular caisinoma(HCC).Methods We retrospectively collected clinical data of 123 advanced HCC patients treated with repeated TACE.The patients were divided into two groups (group A with fixed repeated treatment interval and group B with that according to the clinical needs).Cox regression,survival curve and log-rank test were used to assess the effects of the treat-ment intervals on prognosis.Results The treatment intervals of the group A and group B were (1.1±0.3)months and (3.0±1.5) months,respectively (P <0.001).Multivariate Cox analysis showed the efficacy (P =0.024)and repetition periods (P <0.001 ) were independent prognostic factors.Conclusion TACE interval is independent risk factor for the prognosis of patients with ad-vanced HCC.Repeated TACE treatment according to clinical needs may be more favorable for prognosis of the patients.
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Objective To investigate the safety and clinical effect of endovascular radiofrequency ablation (RFA) catheter, the HabibTM VesOpen, in treating portal vein tumor thrombus. Methods Fifteen patients of hepatocellular carcinoma associated with portal vein thrombus causing obstruction of blood flow were enrolled in this study. Guided by ultrasound percutaneous portal catheter implantation was performed, then, under DSA guidance RFA catheter was placed at portal vein tumor thrombus. RF generator (RITA) was connected to the electrodes, the power was set at 10 W for 2 - 10 minutes. The technical success rate, the postoperative complications, the hepatic and renal functions as well as routine blood tests, portal vein blood flow and the ablation extent of portal vein tumor thrombus were evaluated, and the results were analyzed. Results The procedure was successfully accomplished in all patients. No technique-related complications, such as hemorrhage, vessel perforation, bile leak complicated by infection, liver abscess, abdominal bleeding occurred. Direct portography performed immediately after RFA showed that the portal vein was re-opened. Laboratory examinations performed 4 weeks after RFA showed that no obvious changes in hepatic functions and routine blood tests were observed. Doppler ultrasound examinations revealed that flowing blood was obviously displayed within previously obstructed portal vein. CT scanning was carried out in some patients with portal vein thrombus, and it indicated that the portal vein tumor thrombus was reduced in size or even disappeared. Conclusion For the treatment of portal vein tumor thrombus in patients with hepatocellular carcinoma, endovascular radiofrequency ablation is technically feasible, and the initial results indicate that this technique is an effective treatment.
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Objective To evaluate CT findings, diagnosis and management of intrahepatic biliary injuries after transcatheter arterial chemoembolization (TACE) for liver malignancies. Methods A total of 1302 patients with hepatic malignant tumors received TACE between Sep 2007 and Mar 2009. None of these patients were found to have any radiographic evidence of biliary abnormalities before TACE. A retrospective review of imaging studies and clinical outcomes was carried out to evaluate the changes of intrahepatic biliary injuries after TACE. Results Six patients developed intrahepatic biliary injuries during 1 and 3-month follow-up. Two cases with jaundice and high fever, underwent percutaneous transhepatic cholangiography and drainage and eventually recovered. The other 4 patients were asymptomatic with only radiographic changes and were managed observationally. Conclusions Intrahepatic biliary injury is a rare complicating TACE procedures. It will be identified by clinical outcomes and radiographic imaging findings. Percutaneous transhepatic cholangiography and drainage (PTCD) is the therapy of choice for intrahepatic biliary injuries with jaundice or high fever.
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Objective:To observe the level of endogenous cortisol in patients with advanced gastrointestinal cancer, and to evaluate the effect of exogenous glucocorticoids treatment on patient's malignant symptoms and serum cortisol level. Methods:Thirty-one patients with advanced gastrointestinal cancer who were given 40 mg/d methylprednisolone for continuous 5 days. The patients included 8 patients with esophageal and cardial cancer, 12 patients with gastric cancer, and 11 patients with colorectal cancer. At the same time, 30 healthy adults were selected as control group. The cortisol radioactive immunoassay kit was used to determine the level of serum cortisol in the gastrointestinal cancer patients and controls. The life quality changes of gastrointestinal cancer patients were evaluated. Results:The serum cortisol level of 31 advanced gastrointestinal cancer patients was higher than that of healthy volunteers [(312.39±57.64)vs(144.64±52.20) μg/L,P0.05). Conclusion:Endogenous serum cortisol levels of gastrointestinal cancer patients were significantly higher than those of healthy adults. Short-term treatment with medium dosage of exogenous glucocorticoids had little effect on the endogenous serum cortisol level.
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Objective The aim of this study was to analyze the causes of misdiagnosing xanthogranulomatous cholecystitis (XGC) as carcinoma of gallbladder.Methods Clinical data of 33 XGC patients admitted from 1996 to 2005 were retrospectively analyzed, among them 10 patients were misdiagnosed as carcinoma of the gallbladder preoperatively and intraoperatively. Results All these 10 patients underwent preoperative ultrasound and computed tomography (CT). Both ultrasound and CT were suggestive of carcinoma of the gallbladder in 5 cases, and chronic cholecystitis in one case. The ultrasound was suggestive of carcinoma while CT diagnosed as chronic cholecystitis in 2 cases. CT suggested a carcinoma while ultrasound was suggestive of cholecystitis in other 2 cases. Thickened gallbladder wall and dense carcinoma-like adhesions was unanimous phenomena. Cholecystectomy and partial hepatic wedge resection was performed in 3 cases; Six cases underwent cholecystectomy and partial hepatic wedge resection plus regional lymphadenectomy. One case received partial cholecystectomy, cholecystoenterostomy, and partial transverse colectomy. XGC was definitely diagnosed by postoperative pathological examination in all of patients. Conclusions XGC mimics the imaging features (CT, ultrasonography) and gross findings of gallbladder carcinoma making a misdiagnosis. Definite diagnosis of XGC is dependent on postoperative pathology.