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Objective To study the treatment outcomes using transcatheter arterial chemoemboliza tion (TACE) followed by hepatic resection (HR) in patients with BCLC stage B hepatocellular carcinoma (HCC).Methods The clinical data of 46 patients with intermediate stage HCC in the Third Affiliated Hospital of Sun Yat-sen University from Jan.2004 to Jul.2013 were analyzed retrospectively.The baseline characteristics of these 46 patients were recorded.The levels of serum aspartate transaminase (AST),ala nine aminotransferase (ALT),total bilirubin (TBil),and albumin (Alb),and the prothrombin time (PT) at 1 week and 1 month after HR were compared with those at the baseline.The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan-Meier method.The effect on PFS by the changes in the alpha-fetal protein level and the modified Response Evaluation Criteria In Solid Tumors (mRECIST) after TACE were analyzed using the log-rank test.Results The number of cycles of TACE given before HR was 1.7 ± 1.1.The mean time interval between TACE and HR was 3.0 ± 3.2 months.The levels of serum AST,ALT,TBil,Alb and PT at 1 week after HR were significantly different from the baseline levels (P ＜ 0.05),while those levels at 1 months after HR showed no significant difference from the baseline levels (P＞0.05).The mean OS was 72.1 ±6.0 (95％ CI 60.36 ～83.86) months.The median PFS was 46.0 (95％ CI:42.60～49.40) months.Using the log-rank test,the decrease in AFP (P ＜ 0.001) and the improvement in mRECIST (CR + PR) (P ＜ 0.001) after TACE were significantly associated with better PFS.Conclusions HR after TACE was safe for patients with BCLC stage B HCC and might prolong the PFS and OS.Decreases in AFP level and improvement in mRECIST (CR + PR) after TACE were factors they could be used to predict the survival outcomes of HR.
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Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt(PTIPS)for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension.Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016,were analyzed retrospectively.The differences of the portosystemic pressure gradient(PPG)measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed.Results The PTIPS procedure was technically successful in 36 patients.The other two patients with unsuccessful PTIPS underwent medical treatment,and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS.And the mean PPG was decreased from(25.2±2.9)to(13.2± 1.3) mmHg (1 mmHg=0.133 kPa) before and after PTIPS respectively and the difference was statistically significant(P<0.05).During the procedure,arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage (PTBD)was then performed.The mean follow-up period of the 36 patients was(26.7±10.4)months(range from 3.0 to 74.0 months).Hepatic encephalopathy appeared in 4 cases,among which,3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent.Shunt dysfunction occurred in 10 cases,of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure(n=4), hepatic cellular carcinoma(n=1), recurrent varicose vein bleeding(n=1), and renal failure(n=1). The other patients remained asymptomatic and shunt patency. Conclusions PTIPS is both safe and effective for the treatment of symptomatic portal hypertension caused by chronic portal vein occlusion and cavernous transformation.The technical success rate is high,and the short-term curative effect is satisfied.
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Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.
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Hepatic venous outflow obstruction is a severe complication after liver transplantation, often occurs after living donor liver transplantation (LDLT). In this article, the clinical and imaging data of two patients with hepatic venous outflow obstruction after LDLT were analyzed retrospectively, and the related literatures were reviewed to explore the diagnosis and the interventional therapy of this complication. Hepatic venous outflow obstruction can be confirmed with percutaneous transhepatic venography. Percutaneous interventional managements, including balloon angioplasty and stent implantation are safe, easy and effective for the treatment of hepatic venous outflow obstruction after adult-to-adult living donor liver transplantation (A-A LDLT).
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Objective To evaluate multisliee CT in the diagnosis of biliary complications after liver transplantation. Methods Eighty-three consecutive patients who had undergone orthotopic liver transplantation (OLT) presented with clinical or biochemical signs of biliary complications and underwent contrast-enhancement CT examination. Three experienced radiologists, who were blinded to patient's clinical data, assessed CT images for the detection of biliary complications in consensus. Diagnostic confirmation of biliary complications was obtained with direct cholangiography in 69 patients, histologie study in 11 patients and hepatieojejunostomy in 3 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for the detection of biliary complications were calculated. In addition, CT features of anastomotie biliary stricture (ABS) were compared with those of non-anastomotie biliary stricture (NABS) using x2 test. Results A total of 62 biliary complications (74. 7% ) was eventually confirmed in the 83 patients, including ABS in 32 patients, NABS in 21 patients, biliary duct stones in 16 patients (of which 12 patients with biliary stricture), anastomotie bile leakage in 5 patients, biloma in 4 patients with biliary stricture, and biliogenic abscess in 2 patients with biliary stricture. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for the detection of biliary stricture were 90. 6%、86. 7%、89. 2%、92. 3% and 83.9% , respectively. Other biliary complications, including biliary duct stones ( 16 cases) , anastomotic bile leak (5 cases) , biloma (4 cases), and biliogenic abscess (2 cases), were correctly diagnosed by CT; there was no false-positive or false-negative result. The incidence of irregular dilatation of bile duct was 71.4% ( 15/21 ), which was significantly higher in NABS cases than in ABS of 25.0% (8/32,P <0. 01 ) ; whereas the incidence of extrahepatie biliary dilatation was 33.3% (7/21) and regular dilatation was 14. 3% (3/21), which was significantly lower in NABS cases than in ABS of 84. 4% ( 27/32 ) and 68. 8% ( 22/32 ), respectively ( P < 0. 01 ). Of 21 patients with NABS, 66. 7% (14/21)complicated with hepatic artery stenosis or thrombosis, which was markedly more than that of NABS cases (15. 6%, 5/32,P <0. 01 ). Conclusions Multislice CT is a useful imaging procedure in the detection of biliary complications after liver transplantation, and biliary stricture can be primitively classified into ABS and NABS by CT. Hepatic artery ischemia is an important factor that causes NABS.
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Objective To study the safety and effect of interventional treatment for arteriesclerotic obliterations of iliaco-fermoral artery via radial artery retrospectively.Methods Sixteen cages were treated with interventional procedare via radial artery.The duration of disease was from 3 days to 2 years.All cases presented with rest pain and intermittent claudicating(with distance less than 500 m).Unilateral lesions were found in 9 cases.and bilateral lesions in 7 cases.Iliaco-femoral arteries were obliterated completely in 6 cases.while the other ten cases had arterial stenesis more than 75%.After visualization of obliterative artery.urokinase was administrated consecutively from catheter indweUed in or above thrombus.Transcatheter thrombolysis would be cancelled if the therapeutic effect wag negligible after using umkinase for 72 hours.After thrombolysis.the balloon angioplasty and the stent implantation were performed in the cases with residual stenesis more than 50%. In all of 16 cases,5 caseg underwent continuous intraarterial thrombolysis only.11 cases received balloon angioplasty and/or stent implantation additionally.The ankle/braehial index(ABI)post-treatment and pre-treatment was analyzed.Results The duration of transcatheter thrombolysis was 3.0-15.0 days,averaged(8.4±2.9)days.The obliterative arteries were recanalized in 15 cases.The symptoms of rest pain disappeared in all cases.while intermittent claudicating was still present in 4 cases,but the claudicating distance increased significantly(92.50±60.21 and 625.00±84.26 m for pre-and post-operation respectively).The ABl was 0.63-1.10(0.91±0.12)for post-treatment and 0-4).57(0.32±0.14)for pre-treatment respectively(t=21.73,P＜0.01).During 6-24 months' follow-up,restenosis occurred in 1 case,which was treated successfully once again after halloon angioplasty.There was no serious complication related to the procedure.Conclusion It is safe and effective to apply continuous thrombolysis combined with balloon angioplasty and stent implantation to treat iliacofemoral artery obliteration interventionally via radial arterv.
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Objective To discuss the technical skills and the contraindication of transjugular intrahepatic portosystemic shunt stent (TIPSS) in portal vein cancercous thrombosis (PVCT) complicated with portal hypertension. Methods There were 16 cases of PVCT with portal hypertension, and average age of 53.6 yr. There were 9 cases with complete occlusion of portal vein trunk and 7 cases with incomplete thrombosis. There were 5 cases with cavernous transformation of the portal vein(CTPV). 1 case of simple upper gastro intestinal tract (GIT) massive bleeding, 4 with refractory ascites and 11 with upper GIT massive bleeding and refractory ascites. Results The procedure of TIPS was successful in 11 cases, the successful rate reached about 68.8%. The mean portal vein pressure was reduced from 4.9kPa to 2.4kPa with average 2.5kPa reduction. Ascites decreased, bleeding stopped and the clinical symptoms disappeared. The average survival period was 136 days. The procedure failed in 5 cases. Conclusions TIPSS is an effective method to control the bleeding and ascites caused by PVCT. The PV cavernous transformation was the contraindication of TIPSS.