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Objective:To evaluate the safety and efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) combined with interventional therapy for primary hepatic carcinoma complicated with portal hypertension.Methods:From October 2013 to December 2017, medical records of 141 patients with primary hepatic carcinoma complicated with portal hypertension hospitalized and treated in Anhui Provincial Cancer Hospital were collected. According to the inclusion and exclusion criteria, 32 cases were in the TIPS combined with interventional treatment group and 29 cases were included in the intervention-only group after age, gender, mean tumor diameter and Child-Pugh classification matched with TIPS combined with intervention treatment group. The efficacy of TIPS was obsented, and the related complications and prognosis of the two groups at six, 12 and 24 months after treatment were compared. Independent sample t test, Mann-Whitney U test and Chi-square test were used for statistical analysis, and Kaplan-Merier method was used for survival analysis. Results:There were no statistically significant differences between TIPS combined with intervention group and intervention-only group in age, gender, mean tumor diameter, Child-Pugh classification, Child-Turcotte-Pugh (CTP) score, Barcelona staging, interventional treatment, causes of liver cirrhosis, portal hypertension related symptoms , portal vein tumor thrombus, alanine aminotransferase (ALT), and total bilirubin (TBil) (all P>0.05). The success rate of TIPS of patients in TIPS combined with intervention group was 100% (32/32). All the portal hypertension related symptoms after TIPS were relieved, and the remission rate was 100% (32/32). Compared with that before TIPS, after TIPS, the portal vein pressure decreased ((36.5±6.9) cmH 2O vs. (25.5±5.6) cmH 2O (1 cmH 2O=0.098 kPa)), the diameter of portal vein decreased ((15.9±3.5) mm vs. (13.7±2.7) mm), and ascites volume decreased (abdominal circumference ((105.6±13.9) cm vs. (88.0±9.8) cm), red blood cell count ((2.6±0.8)×10 12/L vs. (3.3±1.3)×10 12 /L) and hemoglobin level ((78.9±15.5) g/L vs. (108.4±14.6) g/L) both increased, and the differences were statistically significant ( t=2.866, 3.105, 10.769, -3.548 and -3.869, all P<0.01). The stent patency rate six months after TIPS was 100% (32/32), the 12-month patency rate was 94% (30/32), and the 24-month patency rate was 84% (27/32). Six months, 12 months and 24 months after treatment, the incidence of ascites of patients in the TIPS combined with interventional treatment group was 0, 3.1% (1/32) and 9.4% (3/32), respectively, and the incidence of bleeding was 3.1% (1/32), 9.4% (3/32) and 15. 6% (5/32), respectively, which were all lower than those of the intervention-only group (13.8%, 4/29; 27.6%, 8/29; 65.5%, 19/29; 20.7%, 6/29; 34.5%, 10/29 and 62.1%, 18/29), and the differences were statistically significant ( χ2=4.72, 7.24, 20.80; and 4.62, 5.72, 13.97; all P<0.05). There were no statistically significant differences in the incidence rates of hepatic encephalopathy 6 and 12 months after treatment between the two groups (both P>0.05). The incidence of hepatic encephalopathy of intervention-only group (48.3%, 14/29) 24 months after treatment was higher than that of TIPS combined with intervention group (21.9%, 7/32), and the difference was statistically significant ( χ2=4.70, P=0.030). The results of Kaplan-Merier analysis indicated that 12 and 24 months after treatment the cumulative survival rates of TIPS combined with intervention group (84.4%, 27/32 and 53.1%, 17/32) were both higher than those of the intervention-only group (41.4%, 12/29 and 13.8%, 4/29), and the differences were statistically significant ( χ2=12.20 and 5.06, both P<0.05). The median survival time of TIPS combined with intervention group was 25 months, which was longer than that of the intervention-only group (12 months), and the difference was statistically significant ( Z=3.341, P=0.001). Conclusions:TIPS combined with interventional therapy is safe and effective in the treatment of primary hepatic carcinoma complicated with portal hypertension, which can improve the quality of life and increase the survival rate.
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Objective To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS)in the treatment of patients with hepatic sinusoidal obstruction syndrome (HSOS).Methods From April 2015 to August 2018,at The First Affiliated Hospital of University of Science and Technology of China,21 patients with gynura segetum caused HSOS were selected.All the patients received TIPS treatment because of unresponsiveness to anticoagulant therapy for at least two weeks.After operation patients were followed up with liver and portal vein Doppler ultrasonography examination,liver and kidney function tests,and survival observation.T test,logistic univariate regression analysis and Cox regression analysis were performed for statistical analysis.Results Among the 21 patients with gynura segetum-related HSOS,18 patients were in the subacute phase and three patients in the chronic phase.All of them were moderate or severe patients and all successfully underwent TIPS.The postoperative portal vein pressure was (16.71 ± 4.68) cmH2O (1 cmH2O =0.098 kPa),which was lower than that before operation ((41.52 ±6.27) cmH2O),and the difference was statistically significant (t =16.936,P ＜ 0.01).The postoperation portal vein blood flow velocity was (41.52 ±7.70) cm/s,which was higher than before operation ((11.19 ± 3.29) cm/s),and the difference was statistically significant (t =-15.191,P ＜0.01).At one month after operation,15 of 21 patients were clinically cured;among the remaining six patients,four patients were improved and two patients were ineffective (including one patient died).At four months after operation,two patients died,and the remaining 19 patients were clinically cured.At one month after operation,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and serum creatinine were (23.7 ± 16.8) U/L,(33.9 ±7.4) U/L,(52.7 ± 38.2) μmol/L and (62.7 ± 12.6) μmol/L,respectively,which were lower than those before operation ((60.5 ± 42.4) U/L,(78.4 ± 42.4) U/L,(74.9 ± 38.2) μmol/L and (82.4 ± 19.6) μmol/L,respectively),and the differences were statistically significant (t =3.193,3.493,2.378 and 4.519;all P ＜ 0.05).The level of albumin was (39.0 ±3.1) g/L,which was higher than that before operation ((30.9 ± 3.8) g/L),and the difference was statistically significant (t =-10.283,P ＜ 0.01).Portal vein thrombosis and preoperative TBil level had predictive value for therapeutic efficacy (both P ＜0.05).The one-year cumulative survival rate of patients was 90.5％.Preoperative TBil level and hepatic encephalopathy had effects on the prognosis of patients (both P ＜ 0.05).Conclusion TIPS is a safe,reliable and effective treatment for patients with subacute and chronic gynura segetum-related HSOS who are not responding to ineffective anticoagulant therapy,which can improve the prognosis and survival rate of the patients.
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Objective To explore the clinical distribution and significant of 23 kinds of human papillomavir-us(HPV)genetypes in normal cells and atypical squamous cells(ASC-US),meanwhile analysis result of cervi-cal histological pathology diagnosis in cases of ASC-US.Methods A total of 1 000 women with normal cells specimens were recruited into control group,and 236 women with ASC-US were selected into the ASC-US group.Polymerase chain reaction(PCR)and gene-chips technology were utilized for the detection of 23 kinds of HPV genetypes,all cases of ASC-US diagnosis of cervical pathological histology.Results A total of 106 ca-ses of HPV infection were detected in the control group,as the total HPV infection rate was 10.6%,in which the single genotypes infection rate was 9.3% and the multiple genotypes infection rate was 1.3%.A total of 139 cases of HPV infection were detected in ASC-US group,as the total HPV infection rate was 58.9%,in which the single genotypes infection rate was 38.1%,and the multiple genotypes infection rate was 20.8%. There were significant differences on the total HPV infection rate,the infection rates of type 1 and multiple geontypes between the control group and ASC-US group(P<0.05).The top six of constituent ratio in the control group were type 43,16,58,33,52,18,42,those in the ASC-US group were type 16,18,52,58,33,51,66.Conclusion PCR combined with the gene-chip technology could be used in the HPV genotypes detection in cervical cells,which has important clinical significance on the further distribution management of ASC-US,and should be draw great attention.
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Objective To discuss the technical method,safety and clinical efficacy of CT-guided 125I radioactive seed implantation for the treatment of mediastinal lymph node metastases.Methods CT-guided 125I radioactive seed implantation was carried out in 11 patients with mediastinal lymph node metastases.Before 125I seed implantation,the interstitial brachytherapy treatment planning system (TPS) was employed to formulate a treatment plan.The particles with radioactivity of (1.11-2.96) × 107Bq (0.3-0.8 mCi) were used for the implantation.Postoperative complications were recorded.The local lesion control rate and the effective rate of pain relief were evaluated at one,3,6 and 12 months after 125I seed implantation.Results After 125I seed implantation,pneumothorax occurred in 3 patients,tracheal fistula in one patient,and pulmonary infection in one patient.The local lesion control rates at one,3,6 and 12 months were 81.8％,90.9％,72.7％ and 72.7％ respectively;the effective rate of pain relief at one week,one,3,6 and 12 months were 100％,90.9％,90.9％,81.8％ and 72.7％ respectively.Conclusion For the treatment of mediastinal lymph node metastases,CT-guided radioactive 125I seed implantation is less-invasive with less complications,and it carries reliable local lesion control rate.Therefore,this technique is a safe therapeutic means.
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Objective To explore the expression of vascular endothelial growth factor (VEGF) and apoptosis of the tumor cells in the different regions of rabbit liver VX2 tumor after radiofrequency ablation (RFA).Methods Forty-eight experimental rabbits were implanted with VX2 tumor.After successfully established the model,the rabbits were randomly divided into control group (n=6) and RFA group (n=42).In the RFA group,7 rabbits at each time point were killed at immediately,1 day,2 days,1 week,2 weeks,3 weeks after RFA,and the tumor specimens were retained and performed with HE staining,VEGF,Annexin V-FITC/PI labeling,flow cytometry analysis.The changes of VEGF and apoptosis of the cells in different periods and different zones after RFA were observed.Results After the operation,the difference of the VEGF value of the needle zone,coagulation necrotic zone and junction zone had statistically significant (all P＜0.05).The difference of the VEGF value in each zone between immediately and the other time points after operation by pairwise comparisons were significantly different (all P＜0.05).The VEGF value of the needle zone and coagulation necrotic zone reached the peak after operation immediately,which declined from 1 day to 3 weeks after operative.And VEGF of the junction zone increased from immediately to 1 week after operation,and declined 2 weeks after operation.There were significant differences in the apoptosis rate of the three zones after RFA compared with control group (all P＜0.05).The apoptosis rate in all zones were at the peak on the 1 day after operation,and then showed a downward trend.Conclusion The reduction of VEGF and apoptosis of tumor cells in the needle zone and coagulation necrotic zone are significant,but tumor remnant remains visible in the junction zone.In the third week after RFA,the proliferation of the remaining tumor cells can be recurrent to preoperative levels,which suggests that the further treatment should be performed at this period.
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Objective To explore the mechanism of 125I seed interstitial implantation-induced apoptosis of liver VX2 tumor cells in experimental rabbits, and to compare the effects of different radioactivity 125I seeds on the apoptosis and on the proliferation of tumor cells. Methods A total of 24 rabbit models with VX2 liver cancer were randomly and equally divided into 3 groups, and 125I seeds with different initial radioactivity were separately implanted into the rabbits of the three groups. 125I seeds of 0 mCi radioactivity were used in the control group (n=8), 125I seeds of 0.7 mCi radioactivity were used in the 0.7 mCi group (n=8) and 125I seeds of 1.0 mCi radioactivity were used in the 1.0 mCi group (n=8). The experimental rabbits were sacrificed at 5 weeks after the implantation; the tumor lesions were removed, and the effects of 125I seeds on the apoptosis and proliferation of tumor cells were determined. The tumor cell apoptosis rate, tumor growth-related factors, tumor growth factor expression protein and the influence of caspase-3 activity were evaluated. Results Regardless of their initial radioactivity, all the 125I seeds could make the tumor cell apoptosis rate increased, make Bcl-2 and VEGF expression level decreased, and make Bax expression increased, which were more obvious in 1.0 mCi group (P0.05). Conclusion The implanted 125I seeds can not only inhibit tumor’s growth through inducing apoptosis of tumor cells, but also inhibit tumor’s angiogenesis through influencing the expression of apoptosis-related gene and coding protein.
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Purpose To investigate the clinicopathological features, histogenesis, morphological characteristics, immunophenotypes and differential diagnosis of primary extragonadal yolk sac tumor ( eYST) . Methods Clinicopathological data, morphological charac-teristics and immunophenotypes results of 40 cases of eYST were retrospectively studied and the relevant literatures were reviewed. Re-sults All 40 patients, which included 24 male and 16 female, aged from 6 months to 42 years with a 12 years average age and 17 (42.5%) cases were over 12 years old. Mediastinum, sacrococcygeal, retroperitoneal, pineal gland and vagina were involved in 16 (40.0%), 12(30.0%), 5(12.5%), 4(10.0%) and 3(7.5%), respectively. All 40 cases included 32(80.0%) cases pure YSTs, while other 8(20.0%) cases contained other one or two types of germ cell tumor (GCT) components. Conclusions Primary eYST is rare, mediastinum and sacrococcygeal are the most common anatomic sites for eYST, and these mediastinal tumor patients are overwhelmingly confined to adult males, whose average age are significantly older than that in sacrococcygeal, retroperitoneal, pineal gland and vaginal tumor patients (P<0.05), while other sites eYST are restricted to prepubertal children. Adult eYST contain other types of GCT components in some cases, and children's counterparts are always pure YST. Extragonadal eYST manifestate pleomorphic histological features, which combine with immunohistochemical markers is definite value for diagnosis, differential diagnosis.