Clinical study of 169 patients with hepatic angiomyolipoma / 中华外科杂志

<p><b>OBJECTIVE</b>To review and investigate the optimal preoperative diagnostic means and treatment principles of hepatic angiomyolipoma (HAML).</p><p><b>METHODS</b>The clinical features, treatment, prognostic and follow-up data of 169 HAML patients treated between January 1992 and May 2010 were retrospectively analyzed. The median age of the patients, including 46 male and 123 female (male/female, 1/2.7), was 45 years (range, 17 - 73 years). The mean case history was 0.54 year with a range of 2 d to 16 years.</p><p><b>RESULTS</b>Among the 169 patients, 149 patients (88.2%) had a solitary tumor and 96 patients (56.8%) were detected in the right lobe. The overall preoperative diagnostic rate was 13.6% and 119 patients (70.4%) were misdiagnosed as hepatocellular carcinoma or hepatic cavernous hemangioma. The diagnostic accuracy of MRI is higher than CT in distinguishing the nature of the tumor (χ² = 5.508, P = 0.019). One hundred and sixty-eight patients received surgical resection and one received percutaneous microwave coagulation therapy. One patient occurred postoperative hemorrhage and 3 patients developed hydrothorax. The postoperative mortality and recurrence for all the patients were 0. Postoperative pathology confirmed the diagnosis of hepatic angiomyolipoma. Follow-up study showed a benign course and no signs of recurrence.</p><p><b>CONCLUSIONS</b>MRI is the main diagnostic means of HAML. Treatment strategies of HAML depends largely on tumor size, location and growth rate. Surgical management is suggested to patients with the following criteria: (1) tumor size greater than 5 cm; (2) with clinical symptoms; (3) faster tumor growth; (4) the tumor located at 1, 4, 5, 8 segments of liver.</p>

Percutaneous laser ablation in the treatment of portal vein tumor thrombus in 93 hepatocellular carcinoma patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of percutaneous laser ablation (LA) in the treatment for portal vein tumor thrombus (PVTT) of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The PVTT of HCC patients were treated through percutaneous transhepatic laser ablation (PTLA). The survival rate, thrombus size, blood flow of embolized portal vein by thrombus, liver function, ascites and clinical presentation were observed.</p><p><b>RESULTS</b>The 6-month, 1-year and 2-year survival rate of these 93 patients were 82.8%, 53.0% and 34.1%, respectively. In 11 patients with partially occluded portal vein by PVTT, the cut-surface of the PVTT diminished significantly 6 months after LA. The color blood stream signal was seen again one day after LA in all of the other 82 patients with totally occluded portal vein by thrombus, and it could still be seen in 67 of those one month later, 57 (of 71) 3 months later, 40 (of 57) 6 months later, 27 (of 32) 1 year and 4 (of 6) 2 years later after LA. In the 38 patients who survived over 1 year, PVTT was gradually atrophied and disappeared eventually in 14, PVTT was atrophied and the portal vein changed into honeycomb-like appearance in 14. In the remaining 10 patients, PVTT continued to grow and made the portal vein enlarged. It was also observed that liver function, clinical symptom and ascites were improved in various degree after LA.</p><p><b>CONCLUSION</b>Percutaneous laser ablation might be an effective and safe treatment method for controlling portal vein tumor thrombus of hepatocellular carcinoma.</p>

Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce a newly developed procedure in the control of portal vein tumor thrombus (PVTT) of hepatocellular carcinoma (HCC), and evaluate the efficacy and indicate of this method.</p><p><b>METHODS</b>The PVTT of HCC patients were treated by percutaneous transhepatic laser ablation (LA). The blood flow of PVTT embolized portal vein, live function, ascites and clinical presentation was observed.</p><p><b>RESULTS</b>Twenty-four HCC patients, with a total of 30 PVTT portal vein and its main branch were treated with LA. There were no any blood flow signal in Doppler color Ultrasonography in these PVTT embolized portal vein before treatment. After treatment, blood flow was reappearance in all cases within one week. The continued patency blood flow was observed in 16 portal vein and continued but not patency blood flow in other 12 portal vein within 30 days. The continued patency blood flow was observed in 18 portal vein within 90 days. The improvement of liver function and clinical symptom. The reduction of ascites was observed in varying degrees.</p><p><b>CONCLUSION</b>LA treatment might be a effective and safe procedure in the control of portal vein tumor thrombus of HCC.</p>