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Objective To explore the clinical efficiency and safety of radiofrequency ablation combined with Tegafur,Gimeracil and Oteracil Porassium Capsules( S-1 capsules) for hepatocellular carcinoma.Methods Sixty HCC patients included in this study were underwent initial radiofrequency ablation and then they were di-vided into RFA+S-1 group and RFA control group according to the metronomic chemotherapy either with S-1 or not.The local tumor control and disease free survival outcome between the two groups were compared.Results Follow-up observation showed that the total control rate after 9 months′treatment was 93.3%in RFA+S-1 group vs.73.4%in RFA control group(P=0.038).During the 18 months of follow up,the median time for dis-ease free survival was 16.25 months in RFA+S-1 group vs.12.25 months in RFA control group( P<0.001) . One-year progression free survival rate in RFA group was 53.3%,which was significantly lower than the RFA+S-1 group(83.3%)(P=0.012).The major complication rate was 13.3%.No procedu rerelated death or severe complications occurred.Conclusion Metronomic chemotherapy with S-1 following initial radiofrequency ablation delays tumor progression and prolongs overall survival of patients with HCC tumors.
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Objective To focus on the transitional nursing needs and its influencing factors of patients accepted transjugular intrahepatic portosystemic shunt (TIPS). Methods The study was conducted with a self-designed questionnaire involving 54 patients accepted TIPS. Also, in-depth semi-structured interviews were conducted among 10 patients. Results The total score of transitional nursing needs among patients accepted TIPS was (4.53 ± 0.48) points, which was in the relatively high lever. The multiple linear regression analysis showed that age, hepatic function and levels of venous ammonia were influence factors of transitional nursing needs among patients accepted TIPS (P<0.05). Conclusions The transitional nursing needs of patients accepted TIPS is urgent. Postoperative transitional nursing should be focused on younger, poor hepatic function and venous ammonia big change among patients accepted TIPS. Low-protein diet and the prevention of complications should be taken priority over all others.
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Objective To investigate the clinical effect and to summarize the experience of percutaneous radiofrequency ablation (RFA) of spleen together with splenic artery balloon block in treating hypersplenism due to cirrhosis and portal hypertension. Methods Under the situation of splenic artery occlusion with balloon, RFA of the spleen was performed in 15 patients with hypersplenism caused by cirrhosis and portal hypertension. The mean duration of RFA was (46.4±5.4) min. Routine blood tests were conducted at 3 days, one week, one, 3 and 6 months after the treatment, and abdominal CT angiography was performed one month after RFA. The results were analyzed. Results One patient developed massive bloody pleural effusion at left thorax three days after RFA, which was improved after hemostasis and thoracic drainage. No severe complications occurred in other patients. Abdominal CT angiography performed one month after RFA showed that the ablated extent by RFA was accounted for about 34.3%-71.8% proportion of the spleen, with a mean of (56.20 ±13.09)%. Preoperative blood tests indicated that the count of white blood cells, red blood corpuscles and blood platelets was (3.88±1.75)×109/L, (4.06±0.37) × 1012/L and (48.14± 11.33)×109/L, respectively. One month after RFA the count of white blood cells and blood platelets increased to (5.62±1.61) ×109/L and (132.29±33.20) ×109/L respectively. When compared with the preoperative data, the differences in the count of white blood cells and blood platelets were statistically significant (P<0.05). Conclusion For the treatment of hypersplenism due to cirrhosis and portal hypertension, percutaneous radiofrequency ablation of spleen together with splenic artery balloon block is quite safe and this technique has satisfactory short-term effect.
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Objective To investigate the changes in the serum level of vascular endothelial growth factor (VEGF) in experimental Wistar rats with hepatic alveolar echinococcosis (HAE) after hepatic arterial infusion (HAI) of bevacizumab treatment, and to discuss the efficacy of HAI of bevacizumab for hepatic alveolar echinococcosis. Methods Forty Wistar rats with successfully established HAE were randomly and equally divided into two groups with 20 rats in each group: the control group and the study group. Hepatic arterial infusion of saline was performed in the rats of the control group , while hepatic arterial infusion of bevacizumab was carried out in the rats of the study group. Before and 7, 14, 21 and 28 days after the treatment peripheral blood samples were collected from the tail vein, and the serum levels of VEGF, apartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined by the quantitative sandwich enzyme-linked immunosorbent assay (ELISA). All the rats were sacrificed 28 days after the treatment. HAE samples were examined to evaluate the effect of bevacizumab on HAE lesions. Results Seven days after hepatic arterial infusion of bevacizumab, serum VEGF expression level in the study group became gradually decreased, and the difference was statistically significant when compared with the preoperative level or with that in the control group (P = 0.019). Fourteen days after the treatment, the serum VEGF expression level kept going down to its lowest point, and the difference in serum VEGF expression level was statistically significant when compared with the preoperative level (P 0.05). Conclusion In treating hepatic alveolar echinococcosis, hepatic arterial infusion of bevacizumab has certain inhibitory effect on angiogenesis. This therapy is safe and effective.
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Objective To investigate the prognosis and survival rate of the patients with Barcelona clinic liver cancer stage B hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) treatment. Methods During the period from Feb. 2007 to Jan. 2013 at authors’ hospital, a total of 197 patients with Barcelona clinic liver cancer stage B HCC were treated with TACE. The clinical data were retrospectively analyzed. All patients were followed up from Feb. 2007 to July 2013 by admission to hospital of by phone. Based on the clinical materials the prognosis and survival rate were analyzed. Results The median follow-up time was 12 (6- 77) months and the median survival time was 24 (2 - 77) months. The survival rate of patients with liver function of Child-Pugh class A was significantly higher than that of patients with liver function of Child-Pugh class B (35 months vs. 15 months, P< 0.01). The survival rate of patients with Barcelona stage B1 was significantly better than those of patients with Barcelona stage B2, B3 and B4, and the median survival time of patients with Barcelona stage B1, B2, B3 and B4 was 35, 25, 9 and 7 months respectively (P < 0.01). No significant differences in survival rate existed between patients with different age, sex, nation, history of hepatitis and AFP levels. Conclusion TACE treatment can significantly increase the survival rate of patients with Barcelona stage B hepatocellular carcinoma. Barcelona staging and Child-Pugh classification can predict the prognosis and survival rate of patients with HCC after TACE.
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Objective To evaluate the diagnostic value of digital subtraction angiography (DSA) of intracranial meningioma.Methods DSA was performed in 115 cases with meningioma. The branches of the external carotid artery were embolized in 76 cases. Results The blood supply of the meningioma located at the relatively superficial cerebrum are mainly arising from the middle meningeal artery of the internal maxillary artery and those located at the skull base are mainly from the ophthalmic artery and the cerebral segment of the internal carotid artery. The possible dangerous anastomoses between the extermal and internal carotid arteries and the vertebrobasilar arteries may exist.Conclusions To have a good knowledge of the charactereristics of digital subtraction angiography of meningioma is crucial for endovascular embolization and operation of meningioma.
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Objective To analyse the DSA findings of hepatic alveolar echinococcus (HAE) and evaluate the feasibility of the interventional therapy.Methods Eight patients with HAE were all examined by DSA , CT and lab test . Three of them were performed the transcatheter arterial embolization by iodlized oil. All of them were confirmed by surgical operation and followed-up for three months. Results The DSA findings of HAE included hepatic arterial curling and enlargement with hypertrophied circled encircling as typical “handed ball”. Eight cases presented the ring stain during the capillary stage. After embolization, the retention of iodized oil were revealed by DSA in 3 cases. CT three months later showed fine iodized oil retention and the enlarged necrosis. Ischemic necrosis around the lesion and the cut margins were clearly seen in operation biopsy.Conclusions HAE possesses special DSA findings and interventional therapy in a new therapeutic method of choice.
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Objective To study the practical value of preoperative selective intra-arterial embolization in the surgical treatment of nasopharyngeal fibroangioma. Methods Digital subtraction angiogrophy(DSA) and selective arterial embolization were carried out in 15 cases of nasopharyngeal fibroangioma. The supplying arteries originated from the maxillary and the pharyngeal ascending branches arising from external carotid artery were embolized with gelatin sponge. Results 15 cases underwent operation after selective embolization of blood supplying arteries and the amount of bleeding in operation was thus reduced greatly in 13 cases, while the blood loss during the surgery of another 2 cases was still considerable because both external carotid artery and internal carotid artery supplied the tumor with only embolization of the external carotid artery. Optimum time for the operation was taken on 2-5 days after the embolization. Conclusions Preoperative intra-arteral embolization for nasopharyngeal fibroangioma is a valuable method of choice for the clinical treatment.
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This assay reviewed the feeding arteries of CHL and summarized the mechanism,technologic method and common embolization agent of interventional therapy,as well as its effect,indications,contraindications and complications.