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Objective:To study the risk factors of patients with hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization(TACE) refractoriness.Methods:The clinical data of 106 HCC patients who underwent TACE at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were retrospectively studied. There were 90 males and 16 females, with the age of (59.9±9.3) years. These patients were divided into the TACE-refractory group ( n=47) and the control group ( n=59) based on whether TACE refratoriness occurred after surgery. Serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVIKA-II), maximum diameter of tumor, number of tumor and tumor vascularization patterns between the two groups were compared. Multivariate logistic regression analysis was performed to analyse the risk factors of TACE refractoriness in patients with HCC after TACE. Results:The proportion of patients with AFP >400 μg/L, PIVIKA-II >40 AU/L, number of tumor and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement) were significantly higher in the TACE-refractory group than the control group (all P<0.05). The maximum diameter of tumor for patients in the TACE-refractory group was significantly larger than that in the control group ( Z=-2.41, P=0.016). Multivariate logistic regression analysis showed that patients with serum AFP >400 μg/L( OR=2.707, 95% CI: 1.008-7.271), multiple tumors ( OR=6.069, 95% CI: 2.115-17.415) and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement)( OR=7.813, 95% CI: 2.246-27.176) before the first TACE were at increased risks of TACE refractoriness (all P<0.05). Conclusion:Preoperative AFP >400 μg/L, multiple tumors and tumor vascularization patterns Ⅲ+ Ⅳ were independent risk factors for TACE refractoriness in patients with HCC.
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Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.
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Objective:To study the risk factors of Budd-Chiari syndrome (BCS) associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.Methods:The data of 340 patients with BCS who underwent endovascular recanalization at the Affiliated Hospital of Xuzhou Medical University between January 2015 and June 2021 were retrospectively collected. Using propensity score matching, a total of 57 patients (40 males and 17 females) were enrolled into this study, with the age of (50.4±8.7) years. Patients were divided into the hepatocellular carcinoma group ( n=19) and the control group ( n=38) according to whether occurrence of hepatocellular carcinoma after cardovascular recanalization. Preoperative indicators including gender, age, BCS type, and model for end-stage liver disease (MELD) score, and postoperative indicators including alpha fetoprotein, intrahepatic nodule formation, vascular restenosis, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between the two groups after propensity score matching. Multivariate logistic regression analysis was used to analyze the risk factors of BCS associated with after endovascular recanalization in these patients. Results:There were no significant differences in gender, age, BCS type, MELD score and other preoperative data between the two groups (all P>0.05). The proportions of patients with postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, ALT>50 U/L, intrahepatic nodules and vascular restenosis after endovascular treatment in the hepatocellular carcinoma group were significantly higher than those in the control group (all P<0.05). Multivariate analysis showed postoperative alpha fetoprotein >9.0 μg/L ( OR=46.778, 95% CI: 3.310-661.140), AST>40 U/L ( OR=36.307, 95% CI: 1.317-1 001.009), intrahepatic nodule formation ( OR=66.254, 95% CI: 4.225-1 038.974) and vascular restenosis ( OR=16.276, 95% CI: 1.712-154.773) to have an increased risk of being associated with hepatocellular carcinoma in these BCS patients (all P<0.05). Conclusion:Postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, intrahepatic nodule formation and vascular restenosis were independent risk factors of BCS associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.
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Objective:To study the use of three-dimensional (3D) visualization in diagnosis and interventional treatment of patients with Budd-Chiari syndrome (BCS) presenting with inferior vena cava obstruction and dangerous collateral branches.Methods:The data of 28 patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches treated at the Affiliated Hospital of Xuzhou Medical University from September 2018 to January 2021 were retrospectively analyzed. There were 11 males and 17 females with a mean age of 49.0 years. Enhanced MR images of these 28 patients were used to build 3D visualization of inferior vena cava. Anteroposterior and left lateral digital subtraction angiography (DSA) of inferior vena cava were performed. The inferior vena cava of these patients was recanalized under guidance of 3D visualization, and patency of inferior vena cava was determined on follow up.Results:3D visualization of inferior vena cava was successfully constructed in all the 28 patients, and 51 dangerous collateral branches were displayed. One, 2, 3 and 4 dangerous collateral branches were found in 13, 8, 6 and 1 patients, respectively. The average angle between the preoperative planning puncture route and the long axis of the proximal end of inferior vena cava was 22.2°. The orifices and courses of the dangerous collaterals and the shape of inferior vena cava could be clearly displayed on 3D visualization in all the 28 patients (100.0%), which were significantly better than the 6 patients (21.4%) using DSA obtained in the anteroposterior and left lateral positions (χ 2=20.045, P<0.05). The inferior vena cava was successfully recanalized in all the 28 patients without complications. On follow up of these patients for 2 to 30 months (mean 18.4 months), the inferior vena cava was patent in 25 patients. Three patients developed inferior vena cava re-obstruction at 3, 4 and 14 months after interventional treatment, respectively. Conclusion:3D visualization was useful in the diagnosis and interventional treatment of patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches.
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Objective:To investigate the changes of liver volume and liver function in patients with extensive hepatic vein occluded Budd-Chiari syndrome (BCS) treated with transjugular intrahepatic portosystem shunt (TIPS).Methods:The clinical data of 29 BCS patients from Affiliated Hospital of Xuzhou Medical University during March 2016 to June 2019 were retrospectively collected and analyzed. The BCS was caused by extensive hepatic vein occlusion and patients were treated with TIPS. Pre- and postoperative abdominal CT/MRI images were collected and analyzed, and hepatic volume was measured with 3D-reconstruction. The liver volume and liver function during before and post the surgery were also collected and analyzed with preoperative value.Results:Patients including 8 males and 21 females, aged (33.3±6.3) years, were enrolled in this study. TIPS was successfully performed in all patients, with a technical success rate 100%. No serious complications related to TIPS occurred. Patients were followed up for 12-33 months (median, 16 months). Compared with preoperative [(2 124.6±420.9) cm 3] , the hepatic volume of time points after operation [1 week: (1 926.3±372.3) cm 3; 3 months: (1 480.6±183.1) cm 3; 6 months: (1 461.9±153.0) cm 3; 12 months: (1 469.3±148.5) cm 3] were all significantly reduced, and the differences were statistically significant ( P<0.05). Compared with preoperative values, the hepatic function indexes at each time point after operation were significantly improved ( P<0.05). The complete remission rate of ascites was 96.4% (27/28), 100.0% (28/28) and 100.0% (28/28) at 3, 6 and 12 months, respectively. Conclusion:The extensive hepatic vein occlusive BCS patients were benefit from TIPS therapy. Six months after operation, the hepatic volume and the hepatic function returned to normal level.
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Objective@#To investigate the safety, feasibility, and preliminary clinical experience of ultrasonic guided percutaneous portal vein punctures combined bi-directional angiography in the treatment by transjugular intrahepatic portosystemic shunt(TIPS).@*Methods@#From January 2016 to June 2018, 15 patients with TIPS from our hospital who were treated by ultrasonic guided percutaneous portal vein punctures combined with bi-directional angiography were enrolled,and were recruited as experimental group. During the same period, 30 patients who were treated by TIPS combined with traditional methods were enrolled, and were recruited as control group. There was no statistical difference in baseline characteristics between the two groups (P > 0.05). The portal pressure difference in preoperative and postoperative, the fluoroscopy time, the number of puncture needles and complications were recorded. After treatment, the patients were followed up through outpatient service or telephone method.@*Results@#The technical success rate was 100% in experimental group, and 96.7% in control group. In the experimental group, number of percutaneous transhepatic portal vein puncture by needle was 1-3 (average, 2.13 ± 0.74), and the number of portal vein puncture needles in the control group were 1-11 (average, 4.16 ± 2.13). The number of puncture needles in the experimental group were significantly decreased than in the control group (P < 0.001). In the experimental group, the fluoroscopy time was 18 ~ 46 (average 29.64 ± 8.79) minutes. In the control group, the fluoroscopy time was 12 ~ 150 (average 44.57 ± 26.84) minutes.The fluoroscopy time was significantly reduced in the experimental group compared with the control group(P = 0.023).@*Conclusion@#Ultrasound-guided portal vein combined with bidirectional angiog-raphy is safe, feasible, and reliable in the treatment by TIPS. Compare with traditional TIPS, it can reduce the fluoroscopy time, the number of puncture needles and the liver injury.
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Objective To analyze the application of three-dimensional visualization in interventional treatment of Budd-Chiari syndrome (BCS) with the hepatic vein occlusion type.Methods A retrospective study was conducted on 15 patients with BCS of the hepatic vein occlusion type who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2018.The study included 8 males and 7 females with a mean age of (36.7±14.4) years.All patients were examined with MRI enhanced scanning and the original MRI data of the DICOM format were extracted.The digital data were then extracted and reconstructed by the Mimics software to obtain a three-dimensional visualization model.The hepatic vein was recanalized under the guidance of the three-dimensional visualization model.Results The three-dimensional visualization model was successfully constructed.Of all the 15 three-dimensional visualization models,right hepatic vein ostial stenosis occurred in 4 patients and occlusion in 11 patients.The middle hepatic vein and the left hepatic vein formed a common trunk in 15 patients,and ostial stenosis and occlusion of the common trunk occurred in 3 and 12 patients,respectively.Communicating branches between the right and middle hepatic veins occurred in 6 patients.Accessory hepatic veins occurred in 3 of 15 patients,and the accessory hepatic vein ostium was stenosed in 3 patients.Communicating branches between the accessory hepatic vein and the right hepatic vein occurred in 2 patients,and communicating branches between the accessory hepatic vein and the middle hepatic vein occurred in 1 patient.All patients were treated successfully with interventional treatment without any complications.One,2,and 3 hepatic veins were recanalized in 7,5 and 3 patients,respectively.Conclusion The three-dimensional visualization was valuable in displaying the location,pattern and collateral vessels of the hepatic veins in BCS patients with the hepatic vein occlusion type.It was helpful for accurate preoperative assessment and to make individualized interventional treatment plans.
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Objective To compare the clinical effect and safety of transcatheter arterial chemoembolization (TACE) combined with 125I seed implantation with those of pure TACE in treating primary liver cancer (PHC) complicated by portal vein tumor thrombus (PVTT) . Methods Computer and manual retrieval of PubMed, Cochrane Library, CBM, Wan Fang Database, China National Knowledge Internet and other databases was conducted to collect the retrospective cohort studies on the comparison of the clinical effect and safety of the combination use of TACE and 125I seed implantation with those of simple TACE in treating PHC complicated by PVTT, from which the relevant data were extracted. The quality of extracted documents was assessed according to the standard of Cochrane manual. Results A total of eight articles containing 822 patients were included in this study. Meta analysis indicated that both the effective rate and disease control rate for PHC complicated by PVTT in TACE plus 125I seed implantation group were significantly higher than those in pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . The half-year, one-year and 2-year survival rates of TACE plus 125I seed implantation group were better than those of pure TACE group, and the differences between the two groups were statistically significant (P<0.05) . No statistically significant differences in the incidence of severe complications existed between the two groups (P>0.05) . Conclusion In treating PHC complicated by PVTT, the curative effect of TACE plus 125I seed implantation is superior to pure TACE. No obvious difference in the incidence of severe complications exists between the two groups.
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Objective To study the intra-and extra-hepatic collateral pathways in various ChildPugh scores by using liver acceleration volume acquisition (LAVA) enhanced magnetic resonance imaging (MRI).Methods The clinical data and imaging findings of 146 patients with Budd-Chiari syndrome (BCS) were collected and analyzed.Intra-and extra-hepatic collateral pathways were evaluated by LAVA enhanced MRI.Intra-and extra-hepatic collateral pathways was analyzed using the Kappa identity test.Correlations of the intra-/extra-hepatic collateral pathways with Child-Pugh scores were analyzed using the Chi-square test.Correlation was calculated by the Cramer correction coefficient of contingency.Results Among 146 BCS patients there were 50 grade A patients,79 grade B patients and 17 grade C patients.Among MRI demonstrated 6 types dilated collateral shunts,only accessory hepatic veins (AHVs) and superficial epigastric veins (SEVs) as collateral pathways were associated with the Child-Pugh scores (x2 =20.324,P ＜ 0.05,x2 =11.855,P ＜ 0.05,respectively).AHVs as collateral pathways were associated with score A and score C (x2 =7.159,P ＜ 0.05,X2 =17.662,P ＜ 0.05,respectively),while SEVs were with score A and score B (x2 =7.244,P ＜ 0.05,x2 =11.855,P ＜ 0.05,respectively).Conclusion AHVs and SEVs as collateral pathways were associated with Child-Pugh scores in cases of Budd-Chiari syndrome.
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Objective To study the safety and efficacy of accessory hepatic vein (AHV) stenting to treat primary Budd-Chiari syndrome (BCS).Methods The clinical data of 20 BCS patients with AHV ostial stenosis or occlusion were retrospectively analyzed.These 20 patients underwent balloon dilation and AHV stenting.Thirteen patients underwent AHV stenting via the right jugular vein approach,5 patients via the right femoral vein approach,and 2 patients via the percutaneous transhepatic combined with the right femoral vein approach.On follow-up,patency of the AHV stent was evaluated by color Doppler ultrasound.The cumulative primary and secondary patency rates were assessed with the Kaplan-Meier curves.Results AHV stenting was successful in 20 patients.Angiography showed that the AHV was patent after stenting.The mean pressure gradient between the AHV and the inferior vena cava reduced from (19.2 ± 4.8) cmH2O (1 cmH2O =0.098 kPa) before treatment to (4.5 ± 1.9) cmH2O after treatment (t =7.119,P ＜ 0.01).During the procedure,rupture of the AHV caused by balloon dilation occurred in one patient.This was treated successfully by a covered stent placement.On follow-up from 1 to 80 months [(32.1 ±27.4) months]after treatment for the 20 patients,re-stenosis of the AHV were found in 5 patients.They were treated successfully with re-dilation.The cumulative 1-,3-,and 5-year primary patency rates were 100％,85.1％ and 74.5％,respectively.The cumulative 1-,3-,and 5-year secondary patency rates were 100％,90.9％ and 90.9％,respectively.One patient died of hepatic failure 3 years after the treatment.Conclusion AHV stenting was a safe and efficacious treatment for BCS and it provided good mid-and long-term results.
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Objective To explore the clinical application of 3D-printing model in guiding interventional management of Budd-Chiari syndrome (BCS) and in teaching practice.Methods A patient with typical BCS of inferior vena cava type was selected.By using MR enhanced scanning,the original MRA data of DICOM format were extracted,and then the digital data were extracted and reconstructed to obtain 3D BCS model by Simpleware software.The 3D BCS entity model,using 1 ∶ 1 ratio,was printed out by a 3D printer.An experienced chief physician made a simulated interventional manipulation on this 3D BCS entity model.Results The BCS 3D model was successfully printed.Simulated operation could be easily performed on the 3D-printing model,in this way the chief physician could make a demonstration of interventional procedure of BCS to the junior doctors and medical students.Interventional therapeutic manipulation for BCS could be well demonstrated on the 3D-printing model of BCS,which was very helpful in guiding teaching practice and in promoting the communication between doctors and patients.Conclusion The BCS 3D-printing model can truly reflect the spatial architecture features of the inferior vena cava and the hepatic veins,which are very valuable for the making of surgical plan,for the demonstration of simulation operation,and for teaching practice.Moreover,3D-printing model can stereoscopically display the location and morphology of the lesion,which can improve patient's understanding of the disease,thus,the communication between doctors and patients can be strengthened.
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Objective To explore the clinical efficacy of 1251 stent implantation in treatment of malignant tracheal stenosis with the help of ventilation catheter under local anesthesia.Methods Totally 180 consecutive patients with malignant tracheal stenosis underwent 125I airway stent implantation were analyzed retrospectively.The anhelation grade,oxygen saturation and respiratory rate before and after operation were recorded and analyzed,125I stent situation,clinical symptoms and survival situation were followed up after operation.Results The success rate of 125I stent placement was 100％ (180/180),and the stent type was tubular stent in 132 cases,Y-shaped stent in 34 cases,and L-shaped stent in 14 cases.Dyspnea was significantly relived in all patients.Oxygen saturation and respiratory rate improved from (80.60±3.87)％ and (29.36± 3.20)times/min before operation to (94.31±3.40)％ and (19.29±2.19)times/min after operation (t=-30.52,35.09,both P＜0.01).Patients were followed up 3-13 mouth after operation,and stent restenosis were occurred in 6 patients.The lifetime was 49-401 days and the average lifetime was (182±94) days.The 60-day survival rate was 0.99 and the 180-day survival rate was 0.65.Conclusion 125I stent implantation in treatment of malignant tracheal stenosis with the help of ventilation catheter under local anesthesia is a safe and effective method.
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Objective To evaluate the safety and efficacy of Viabahn covered stent in treatment of hepatic artery pseudoaneurysm (HAPA) caused by surgery.Methods Clinical data of 7 patients with postoperative massive intra-abdominal hemorrhage and diagnosed as HAPA with emergency angiography were collected from November 2015 to May 2016.All the patients underwent Viabahn covered stent implantation.Perioperative and postoperative clinical data of the patients were recorded,and with 1-month follow-up.Results All the 7 cases were diagnosed as extrahepatic HAPA and successfully completed Viabahn covered stent procedure,and curative rate was up to 100％.One case experienced transient vasospasm in the hepatic artery proximal to the stent.All the patients repeated hepatic artery CT angiography scans one week after surgery,with no evidence of bleeding.With 1-month follow-up,all the patients were in stable conditions.Conclusion Viabahn covered stent is minimally invasive,simple and effective interventional approach for HAPA.
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Objective To evaluate the clinical effect of reduced glutathione in protecting the liver function for patients with hepatocellular carcinoma (HCC) after receiving international therapy.Methods The clinical data of 110 HCC patients,who were admitted to authors' hospital during the period from January 2010 to June 2013,were retrospectively analyzed.According to the random number table method the patients were divided into the control group (n=50) and the treatment group (n=60),and transcatheter arterial chemoembolzation (TACE) and transcatheter arterial infusion (TAI) were carried out in all patients.After the treatment,intravenous infusion of 2.0 g vitamin C,0.2 g vitamin B6,2.0 g inosine,and 250 ml branched chain amino acid was employed per day for one week for the patients of both groups,and additional intravenous dripping of 1.8 g reduced glutathione (added in 250 ml of 5％ glucose solution) was adopted for the patients of the treatment group.Various liver function indexes were tested before and one week after the treatment,the results were compared between the two groups.Results Before the treatment,no obvious differences in the hepatic functions and in the clinical condition existed between the two groups.One week after the treatment,in both groups the aminotransferase (ALT and AST) and total bilirubin (TBIL) were significantly increased when compared with the preoperative data (P＜0.05),while the serum pre-albumin (PA) was remarkably decreased when compared with the preoperative data (P＜0.05);these changes of various indexes in the treatment group were apparently better than those in the control group (P＜0.05).Conclusion The use of reduced glutathione can effectively relieve the liver function damage caused by interventional therapy in HCC patients,therefore,reduced glutathione has a very good clinical application value.
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Objective To evaluate the safety and feasibility of 125I seeds stent implantation with assistance of airway tube under local anesthesia in treating malignant tracheobronchial stenosis.Methods The clinical data of 24 patients with malignant tracheal and bronchial stenosis,who underwent the treatment of 125I seed stent implantation at authors' institute during the period from March 2014 to January 2015,were retrospectively analyzed.The primary lesions included tracheal and bronchial cancer (n=6),esophageal carcinoma (n=8),pulmonary cancer associated with mediastinal lymph node metastasis (n=9),and malignant mediastinal tumor (n=l).All patients had different degrees of shortness of breath,cough and other symptoms due to airway constriction caused by malignant tumors.Grade Ⅱ of breath shortness was seen in 2 patients,grade Ⅲ in 16 patients,and grade Ⅳ in 6 patients.First,a 4F single-curve catheter was placed into one of the main bronchi,which was used as the ventilation catheter,then implantation of 125I seed stent in the diseased trachea and bronchus was carried out,finally,after the implantation of 125I seed stent was successfully accomplished the ventilation catheter was removed.The technical success rate of 125l seed stent implantation,the procedure-related complications and the intraoperative patient tolerance were calculated and the results were analyzed.Results Successful implantation of 125I seed stent with single procedure was accomplished in all 24 patients and no severe operation-related complications occurred.The technical success rate was 100％.Under the assistance of ventilation catheter,the oxygen saturation maintained at the level around 92.9％ when the stent release device was passing through the airway stenotic site.Neither intraoperative asphyxia nor severe decrease in blood oxygen saturation occurred in all patients.After the treatment,6 patients had bloody sputum,2 patients developed irritable cough,and one patient complained of mild chest pain,these symptoms were relieved after symptomatic treatment.During operation,no events that caused the patients unable to cooperate with the treatment,such as severe cough,dysphoria,dyspnea,etc.,occurred.Conclusion For the treatment of malignant airway stenosis,125I seed stent implantation with assistance of airway tube under local anesthesia is safe and feasible.
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Objective To explore the endovascular treatment of Budd-Chiari syndrome (BCS) in young child. Methods The clinical data of one young child diagnosed with BCS and treated with endovascular therapy were retrospectively analyzed. Results The 23-month-old female suffered from repeated abdominal distension for 3 months and was diagnosed with BCS by vascular ultrasound Doppler and magnetic resonance examination. After confirmation of the diagnosis, endovascular treatment was performed. Then the occluded blood vessels resumed blood stream, urine output increased, and abdominal distension was significant relieved. Conclusions In young children, BCS is rare, the condition is complex, and endovascular therapy is effective.
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Objective To establish a three-dimensional (3D) model of the diaphragm type of Budd-Chiari syndrome (BCS) with perforated membrane,to analyze changes of hemodynamic parameters pre and post percutaneous transluminal angioplasty (PTA) and to analyze any possibly related mechanical factors for postoperative recurrence in BCS.Methods The data on enhanced MRI from patients suffering from BCS with perforated diaphragm of inferior vena cava were reconstructed into a 3D model Computational fluid dynamics (CFD) were applied for numerical simulation based on the model,and the results were expressed as cloud images.Results The total number of model units of the finite element model for preoperative inferior vena cava stenosis was 16 422,and the total number of nodes was 48 170.The total number of model units for postoperative inferior vena cava was 16 539,and the total number of nodes was 51 339.Hemodynamic patterns of the lesion areas were effectively reflected in the 3D flow dynamic model for BCS.By comparing the hemodynamic parameters before and after interventional therapy,the data indicated that there was a gradual decline in wall pressure from the telecentric side.The largest blood flow velocity as well as wall shear stress were observed in the stenotic area of inferior vena cava.Both a large postoperative vascular central velocity and a low increase in local pressure predicted occurrence of vascular restenosis.Conclusions The establishment of a 3D fluid model of inferior vena cava revealed that there were mechanical changes in the location of the lesion.Variations in blood flow patterns exert a far-reaching influence on distribution of hemodynamic parameters,including local blood flow velocity,vascular wall pressure and shear stress.All these might be related to recurrence of BCS after interventional therapy.
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Objective To evaluate the value of removing intracranial lipiodol by fat emulsion injection.Methods Twelve rabbits were randomly divided into two groups,control group(n=6) and experimental group(n=6).All rabbits were injected lipiodolvia the internal carotid artery(0.06 ml/kg).When lipiodol was found intracranially by CT scan,the model was considered to be successful.The rabbits were then injected with fat emulsions intravenously immediatedly following the CT and at intervals of 24 hours,for a total of 6 times(20 ml/kg).Subsequently,the experimental group of rabbits underwent head CT scan at that time and 144 hours later.The control group without treatment underwent head CT scan at the same time interval.The highest density of 0.01 cm2 was selected as region of interest and the CT value was measured.Comparison between the two groups at different times used repeated measurements of ANOVA.Same time points between the two groups were compared using the two independent-samplesttest.Changes of clinical symptoms were observed in rabbits.Results At 24,48,72,96,120 hours,144 hours post-treatment,the CT values of the ROI in the control group and the experimentalgroupwere(103.8 ±7.1),(91.0±4.2),(79.5 ±5.5),(67.8±6.6),(53.9±5.1),(39.9±3.1)HU respectively and(90.7-±5.4),(74.1±4.6),(62.9±4.5),(48.1±3.1),(39.1±1.3),(38.8± 1.2)HU respectively.The results of the repeated measurementsof ANOVA showed that the CT values difference of the two groups at different time was statistically significant(F=201.30,P＜0.01).The results of the two independent-samples t test showed that the CT values difference of 24 to 120 hours posttreatment of the two groups also was statistically significant(t=3.60,6.64,5.72,6.62,6.89,P＜0.05).After the intra-arterial injection of lipiodol,all animals had different degrees of stroke symptoms.Clinical symptoms disappeared earlier in the experimental group than the control group by 24 hours.Conclusion Fat emulsions can accelerate the intracranial lipiodolclearence.This study provides some theoretical basis for clinical treatment of cerebrallipiodol embolism.
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Objective To investigate the value of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction.Methods A retrospective study was conducted on 25 patients with Budd-Chiari syndrome (BCS) with hepatic vein obstruction treated from May 2011 to August 2014.The technique of guide-wire loop was used in these patients.The pressure of the hepatic vein was measured before and after treatment.The difference in the pressure was analyzed by the t test.Results All the patients were treated successfully using guide-wire loop angioplasty.No complications of bleeding,pericardial tamponade and liver capsule hemorrhage were observed.After treatment,the pressure of the hepatic vein reduced from (48.3± 8.0) cmH2O to (20.9 ± 3.8) cmH2O (t =26.82,P ＜ 0.05);The symptoms and physical signs of the patients were relieved or disappeared.BCS-related symptoms reappeared on follow-up in 4 patients,2 were treated by balloon dilation successfully.1 patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) because of decompensated liver cirrhosis.1 patient with ankylosing spondylitis had treatment failure and the symptoms relapsed for the third time.Conclusion The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction is safe and effective,and it can improve the overall success rate of treatment.
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Objective To explore the effect of sequential therapy of transcatheter arterial chemoembolization (TACE) followed by percutaneous microwave coagulation therapy (PMCT) in treating early-stage primary hepatocellular carcinoma (PHC), and to analyze the factors that may affect the prognosis. Methods During the period from Jan. 2011 to Apr. 2014, a total of 66 patients with early-stage PHC were admitted to authors’ hospital. TACE was carried out in all patients, which was followed by PMCT in 5 -7 days. All patients were followed up regularly. CT, MR, ultrasonography, AFP, liver function and other related laboratory tests were performed. Kaplan-Meier estimation was used for the analysis of disease-free survival time. The high-risk factors were analyzed by Chi-square test. Multivariate analysis was conducted by using logistic analysis method. Results After TACE the serum levels of ALT, TBIL and DBIL were increased significantly when compared with preoperative ones (P< 0.01). After sequential PMCT the serum levels of AST, ALT and DBIL were increased significantly when compared with preoperative ones (P< 0.01). When compared with TACE, after sequential PMCT the serum level of AST was increased (P< 0.01), while serum levels of TBIL and DBIL were decreased (P< 0.01). Compared with TACE and preoperative data, the post-PMCT AFP level was decreased (P < 0.01). During the follow-up period one patient died. The 3-year cumulative survival rate was 98.5%. Recurrence was seen in 19 cases. The one-year, 2-year and 3-year disease-free cumulative survival rate was 70.3%, 50.8% and 41.6% respectively. Univariate and multivariate analysis indicated that the risk factors of recurrence in early-stage PHC included AFP ≥ 100 μg/L, viral load≥103 copies/ml and irregularity of tumor border (P<0.05). Conclusion Sequential therapy of TACE followed by PMCT is an ideal treatment for early-stage PHC, sequential PMCT after TACE does not affect liver recovery process. AFP ≥ 100 μg/L, viral load ≥ 103 copies/ml and irregularity of tumor border are the risk factors of recurrence.