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Objective :To explore the clinical value of emergent interventional embolization in treatment of concealed hemorrhage of small artery injury in patients with pelvic fracture. Methods Clinical data of 14 patients with concealed hemorrhage of small artery injury caused by pelvic fracture were retrospectively analyzed. All patients underwent emergent interventional embolization with gelatin sponge particles and micro-coils. Results There was no obvious contrast staining or accumulation in 14 patients. In the delayed phase, a total of 34 small arteries with slight staining were found. Obvious contrast media spillover signs were found with superselective catheterization. The hemostasis was successful after interventional embolization. Two patients died of hemorrhagic shock, severe acidosis and multiple organ failure after treatment. Conclusion: Superselective interventional embolization is an effective hemostatic measure for concealed hemorrhage of small artery injury in patients with pelvic fracture. Delayed phase angiography can improve the detection rate of small artery injury.
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Objective To observe the efficacy and safety of transcatheter arterial chemoembolization combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma. Methods Eighty-six patients with unresectable large hepatocellular carcinoma treated in the Second Affiliated Hospital of Hainan Medical College from March 2013 to March 2015 were selected and were randomly divided into the experimental group ( 43 cases ) and the control group ( 43 cases ), and were treated with transcatheter arterial chemoembolization(TACE) combined with cryoablation therapy and TACE therapy alone. The clinical efficacy, complications related to treatment,1-year and 2-year survival rate,overall survival and progression free survival of the two groups were compared and analyzed. The COX regression analysis was used to observe the prognostic factors. Results The total effective rate in experimental group was higher than that in the control group (67. 44% (29/ 43) vs. (46. 51% (20/ 43),P = 0. 049). The 1-year survival rate,2-year survival rate and 1-year PFS rate of the experimental group were significantly higher than those in the control group (81. 40% (35/ 43) vs. 60. 47% (26/ 43),58. 14% (25/ 43) vs. 34. 88% (15/ 43),53. 49% (23/ 43) vs. 32. 56% (14/ 43),P= 0. 033,3. 031,0. 049) . There was no significant difference in the incidence of complications at grade 3 or above between the control group and experimental group ( (9. 30% (4/ 43) vs. 13. 95% (6/ 43),P = 0. 501) . COX regression analysis showed that male (OR = 1. 756,95%CI 1. 044-3. 563,P = 0. 041),hypoproteinemia (OR= 1. 523,95%CI 1. 067-2. 891,P = 0. 011) and ascites (OR = 1. 719,95%CI 1. 034-3. 108,P = 0. 031) were unfavorable to the prognosis of patients. TACE combined with cryoablation were more effective in improving the prognosis than TACE alone (OR= 0. 438,95%CI 0. 283-0. 712,P= 0. 001). Conclusion TACE combined with cryoablation is an effective and safe therapy, it also can obviously improve the survival expectancy for patients with unresectable large hepatocellular carcinoma.
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Objective To study the correlation between liver fibroindex and prognosis of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 77 patients with hepatocellular carcinoma who underwent hepatectomy at the 5th Hospital Affiliated to Sun Yat-sen University from 2009 October to 2014 December were analyzed retrospectively.Using data from preoperative Fibroindex,these patients were divided into 2 groups,Group 1:Fibroindex ≤5.4,and Group 2:Fibroindex ＞5.4.The clinical pathological parameters and postoperative disease free survival rates in these groups were analyzed.The Cox ratio risk pattern analysis was used for factors correlating recurrence.Results The parameters in the 2 groups which included sex (35/0 vs 29/13),type of cirrhosis (23/12 vs 14/28),numbers of tumor (35/0 vs 26/16),maximal diameter of tumor (31/4 vs 23/19),vascular invasion status (32/3 vs 26/16),resection margin status (35/0 vs 36/6),hepatic vein/portal vein tumor thrombus status (35/0 vs 29/13),perioperative change of HBV DNA levels (23/12 vs 15/27)were correlated with postoperative recurrence,and they all showed significant differences (P ＜ 0.05).Disease free survival rate in Group 2 was lower than Group 1 (71.4％,33.7％,22.4％ vs 94.3％,46.2％,46.2％,P ＜ 0.05).The Cox regression analysis showed Fibroindex ＞ 5.4,AFP-L3％ ≥ 10％,and number of tumor ＞ 3 to be independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative Fibroindex ＞ 5.4 was an independent adverse predictor of poor disease-free survival.It was valuable to predict postoperative recurrence in hepatocellular carcinoma patients.
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Objective To explore the value of preoperative spleen-liver volume ratio for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 75 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively.According to the preoperative spleen-liver volume ratio,these patients were divided into 2 groups:those with spleen-liver volume ratio ＜ 0.8,and spleen-liver volume ratio≥0.8.Patients were followed-up until March 2014.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results Univariate analysis showed that preoperative AFPL3％ ≥ 10％,the maximum diameter of the tumor ＞ 5 cm,the number of tumor ＞ 3,spleen-liver volume ratio ≥0.8,vascular invasion,positive resection margin and hepatic or portal vein tumor thrombus were all risk factors of poor disease-free survival (P ＜ 0.05).Cox regression analysis revealed that spleen-liver volume ratio ≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞5 cm and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma(P ＜ 0.05).Conclusions Preoperative spleen-liver volume ratio ≥0.8 was an independent adverse predictor of poor disease-free survival.
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Objective To study the predictive value of preoperative blood CD4 +/CD8 + ratio in postoperative recurrence after hepatectomy for patients with hepatocellular carcinoma.Methods The clinical data of 67 patients who underwent hepatectomy for hepatocellular carcinoma at The Fifth Hospital Affiliated to Sun Yat-sen University were analyzed retrospectively.Using the preoperative blood CD4 +/CD8 + ratio,these patients were divided into 2 groups,the CD4 +/CD8 + ＜ 1 group and the CD4 +/CD8 + ≥ 1 group.These patients were followed up at the outpatient clinic and/or by telephone till June 2013.The Cox ratio risk pattern analysis was used to determine the significant risk factors of tumor recurrence.Results On univariate analysis,preoperative AFP ≥400 μg/L,maximum diameter of tumor ＞ 5 cm,number of tumor ＞ 3,CD4 +/CD8 + ＜ 1,vascular invasion,positive resection margin,and portal vein tumor thrombus were risk factors of poor disease-free survival (P ＜ 0.05).On multivariant analysis,CD4 +/CD8 + ＜ 1,number of tumor ＞ 3,and portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative CD4 +/CD8 + ＜ 1 was an independent adverse predictor of poor disease-free survival.It was valuable in predicting postoperative recurrence of hepatocellular carcinoma.
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Objective To discuss the feasibility of displaying the extrahepatic feeding arteries in hepatocellular carcinoma with the help of multi-slice spiral CT 3D reconstruction and to assess the clinical value of this technique. Methods Triple-phase enhanced CT scanning with a 64-slice spiral CT scanner was performed in 89 patients with advanced primary hepatocellular carcinoma (HCC). Three-dimensional reconstruction techniques,including maximum intensity projection (MIP) and volume rendering (VR),with arterial phase images,were used to display the origination and course of both the intrahepatic and extrahepatic supplying arteries of HCC. The results were compared with the angiographic findings. Results Of 59 cases with massive type HCC,extrahepatic supplying arteries were found in 33. In 21 cases of diffuse type HCC four showed extrahepatic supplying arteries,and in nine cases of nodular type HCC only one had extra-hepatic supplying arteries. The HCC could get their extrahepatic blood supply via eight pathways. A total of 44 extrahepatic supplying arteries were detected,and 19 anomalously originated hepatic arteries were found. Conclusion The extrahepatic supplying arteries in hepatocellular carcinoma are common findings and their supplying pattern are extremely varied,which may be associated with the type and location of the tumors. Three-dimensional reconstruction technique with the help of triple-phase enhanced CT scanning on a 64-slice spiral CT scanner can provide excellent images as vivid and ideal as angiography can afford. Therefore,the times of angiography examination,the use of contrast media as well as the dose of radiation to both the patients and the physicians can be reduced as far as possible. The detailed information about extrahepatic blood supply is very useful for improving the therapeutic result of HCC.
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Objective To discuss the clinical significance of anomalous origination of right gastric artery in interventional treatment for hepatocellular carcinoma(HCC).Methods The dynamic enhanced CT scanning of the liver with a 64-slice spiral CT unit was performed in 72 HCC patients.In arterial phase,maximum intensity projection(MIP) and volume reconstruction technique(VRT) were used to observe the origin of the right gastric artery and its relationship with the hepatic artery.The findings were compared with the angiographic results.Results Of the total 72 cases,the anomalous origin of the right gastric artery was found in 43(59.8%).The anomalous origins of the right gastric artery included proper hepatic artery(n=19),left hepatic artery(n=17),gastroduodenal artery(n=4),right hepatic artery(n=2) and common hepatic artery(n=1).The results obtained from three-dimensional reconstruction were in good accordance with angiographic findings.Conclusion The anomalously originated right gastric artery most commonly originates from the left hepatic artery.Three-dimensional reconstruction obtained from the 64-slice spiral CT scans can provide the clear and reliable images of the right gastric artery,which is very helpful for the interventional procedure.