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The vast majority of patients with hepatocellular carcinoma (HCC) in China originate from hepatitis B cirrhosis, while 90% of cirrhotic patients may develop portal hypertension, and the HCC patients with portal hypertension account for 15%-30%. Portal hypertension is a group of clinical syndromes characterized by elevated portal venous pressure and formation of portal-systemic collateral circulation, and it is one of the most important complications of liver cirrhosis. HCC and portal hypertension affect each other, and portal hypertension seriously affects the prognosis of HCC patients. The development of systemic treatment regimens for HCC provides more treatment options for patients with advanced HCC, including molecular-targeted drug therapy, immunotherapy, and chemotherapy. Different systemic therapeutic drugs for HCC have different impacts on portal hypertension, and this article reviews the effect of commonly used systemic therapeutic drugs for HCC on portal hypertension.
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"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
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Objective:To evaluate the diagnostic and therapeutic effect of percutaneous intranodal lymphography in patient with chylous leakage.Methods:The clinical data of percutaneous intranodal lymphography in patients with chylous leakage from January 2019 to November 2019 in Cancer Hospital Chinese Academy of Medical Sciences were retrospectively analyzed. A total of 8 patients (5 males and 3 females, median age 64 years old) were enrolled. Four patients were iatrogenic chylothorax, 3 patients iatrogenic chyloperitoneum, and 1 patient chyloperitoneum with unknown cause. All 8 patients were received inguinal lymph nodes puncture under ultrasound guidance, and contrast agent iodinated oil was injected for lymphography. The procedure complications were recorded and the follow-up data were collected for efficacy assessment.Results:The percutaneous intranodal lymphography was successfully performed in all patients (8/8). The median amount of iodinated oil used was 17.5 ml; the median operation time was 88 min, without complications found during the procedure. The results of percutaneous intranodal lymphography was positive in 5/8 cases, of which chylothorax and chyloperitoneum was 4/4 and 1/4, respectively. Four cases with chylothorax showed contrast extravasation at different level of thoracic duct, and 1 case after pancreatic cancer resection showed contrast extravasation at L3-4 level. The chylous leakage was treated in 5 patients (5/8) during and resolved after percutaneous intranodal lymphography, with 3 chylothorax and 2 chyloperitoneum cases, respectively.Conclusion:Percutaneous intranodal lymphography is a safe and effective lymphography method for the diagnosis of chylous leakage, and also has application values in the treatment of chylous leakage.
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Objective Toexploretheeffectivenessandsafetyofballoonocclusionofthelowerabdominalaortaincesareansection forpatientswithperniciousplacentaprevia.Methods Theclinicaldataof59patientswithperniciousplacentapreviawhounderwent cesareansectionwereevaluatedretrospectively.35casesweretreatedwithcesareansectionassistedwiththelowerabdominalaorta balloonocclusion (studygroup),24casesweretreatedwithcesareansectiontoterminatethepregnancy(controlgroup).Theoperation time,intraoperativebloodloss,intraoperativebloodtransfusion,bloodlosswithinpostoperative24h,hysterectomyrate,hospitalstay aftercesareansection,Apgarscoreandbirthweightofthetwogroupswerecompared.Results Theintraoperativebloodloss(778.5± 566.3)mL,intraoperativebloodtransfusion(288.5±392.2)mLandhysterectomyratewerelowerinthestudygroupthanthosein thecontrolgroup,withstatisticalsignificance(P＜0.05).Therewasnosignificantdifferencebetweentwogroupsinoperationtime, bloodlosswithinpostoperative24h,hospitalstayaftercesareansection,Apgarscoreandbirthweight(P＞0.05).Conclusion Incesarean sectionassistedwithballoonocclusionoflowerabdominalaortaforpatientswithperniciousplacentapreviaisasafeandeffective technique,whichcanreduceintraoperativebloodlossandbloodtransfusiontodecreasetheriskofhysterectomy.
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Objective To discuss the effect of body posture change on the catheter tip position of totally implantable venous access port (TIVAP).Methods Under ultrasound guidance,implantation of TIVAP was carried out through bedside puncturing of internal jugular vein or subclavian vein.After the implantation of TIVAP,X-ray chest films of both erect position and supine position were taken to check the catheter tip position.The distance from the upper edge of the first thoracic vertebra to the catheter tip was separately measured on the erect position and supine position chest films.The shift of the catheter tip position was judged by the difference in the distance measured on chest films as well as by the comparison with the bony anatomic marks.Results Successful implantation of TIVAP was accomplished in 86 patients.When the patients changed from erect position to supine position,the catheter tip of TIVAP moved caudally in 71 patients,with the mean displace distance being (12.29±7.48) mm;the catheter tip of TIVAP moved cephalad in 31 patients,with the mean displace distance being (5.00±3.79) mm;and the catheter tip of TIVAP remained in the same position in 2 patients.When the patients changed from erect position to supine position,the catheter tip of TIVAP had a tendency to move toward the foot side,the average displace distance was (-9.32±9.36) mm,the difference in catheter tip location between two photographic positions was statistically significant (P＜0.000 1).No statistically significant correlation existed between the changes of catheter tip position and the sex,age,height,weight as well as body mass index (P＞0.05).Conclusion After the implantation of TIVAP,the position of catheter tip will change with patient's body posture.When patient's posture changes from erect position to supine position the tip of the catheter tends to shift towards the atrium.
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Objective To compare the curative effect of transarterial chemoembolization (TACE)plus microwave ablation (MWA) with that of pure TACE in treating hepatocellular carcinoma (HCC) larger than 5 cm in diameter.Methods The clinical data of 208 patients with HCC,who were admitted to authors' hospital to receive treatment during the period from June 2014 to December 2015,were retrospectively analyzed.The patients were divided into combination group (n=40,treated with TACE+MWA) and TACE group (n=168,treated with TACE only).By using 1 ∶ 1 pairing,the curative results of the two groups were analyzed.The survival of patient was taken as the primary observation index,and both the one-month solidtumor response value determined with modified Response Evaluation Criteria in Solid Tumors (mRECIST)and the reduction in AFP level were the secondary observation indexes.Results A total of 31 pairings were accomplished.The baseline data of the paired groups were comparable.The results indicated that half-,one-,1.5-,2-and 2.5-year survival rates in the combination group were 96.8％,90.3％,86.8％,82.5％ and 70.7％ respectively,which were significantly better than those of 77.4％,61.3％,53.6％,48.2％ and 24.1％ respectively in the TACE group (P=0.011).The one-month tumor-control rate and the reduction degree in AFP level of the combination group were better than those of the TACE group.No severe complications occurred in both groups.Conclusion For the treatment of HCC that is larger than 5 cm in diameter,TACE combined with MWA is superior to pure TACE in increasing survival rate as well as in improving tumor-control rate.
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Objective To make an interpretation for the time-related evolving process of magnetic resonance imaging (MRI) signal of hepatic tumors after microwave ablation (MWA) treatment.Methods A total of 56 patients with malignant hepatic tumors (56 lesions in total) were enrolled in this study.Upper abdominal MRI plain scan and enhanced scan were performed in all patients at the second day,one month and 6 months after MWA treatment.The MRI signal features of ablation zones at different time points on T1WI,T2WI,DWI as well as on contrast-enhanced T1WI were documented,and the judgment of whether there was tumor recurrence was made.Results Two days after MWA,the ablation zone was manifested as target-like structure on T1WI and T2WI,which was characterized by central high signal ablation zone with low signal band around on T1WI and low signal ablation zone surrounded by high signal band on T2WI.One and 6 months after MWA,the volume of ablation area was atrophied,the target-like structure could still be observed on T1WI and T2WI,and the signal of ablation zone became intensified.Contrast-enhanced MRI revealed that abnormal high perfusion sign could be observed around the ablation zone,and on MRI scans performed at two days,one and 6 months after MWA,the ablation zone showed no enhancement.DWI indicated that two days after MWA the signal around the ablation zone was heightened,which decreased gradually in one and 6 months after MWA.Conclusion The signal of the ablation zone of hepatic tumor after MWA is evolving over time.Correct interpretation of MRI signal of ablation zone is helpful for the judgment of curative effect and for the making of therapeutic plan.
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Objective To establish the rabbit model of main portal vein VX2 tumor thrombus by using orthotopic implantation and to observe its radiological and pathological features.Methods 24 New Zealand white rabbits were randomly divided into study group (n=16) and control group (n=8).In study group,VX2 tumor tissue fragments were fixed on the inner wall of the main portal vein by using a surgical approach.In control group, autologous muscle fragments were fixed on the inner wall of the main portal vein in the same way.CT examinations were performed in both group on 7 days, 14 days, 21 days and 28 days after the procedure.At each observation point,3 rabbits of the study group were inspected by using digital subtraction angiography (DSA),and then sacrificed for histologic examination.Meanwhile,1 rabbit of the control group was sacrificed for histologic examination after CT scanning.The survival time of the remaining rabbits were recorded.Results Among 16 rabbits of the study group, successful implantations were achieved in 15 rabbits (93.8%).Tumor thrombus formed in the main portal vein successfully for all these 15 rabbits.The mean survival time of the remaining 3 rabbits in the study group was (39.3±2.1) days.The imaging characteristic of tumor thrombus could be demonstrated by CT and DSA examinations.Tumor thrombus and the inner neovascularization were confirmed by histological examination.Conclusion It is feasible to establish an animal model of main portal vein tumor thrombus by orthotopic implantation.The radiological and pathological features of animal model are similar to hepatocellular carcinoma patients with portal vein tumor thrombus.
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Objective To evaluate the clinical effect and safety of oxycodone in the anesthesia for percutaneous microwave ablation (PMWA) in liver cancer when the scope of ablation involving liver capsule.Methods Thirty-eight patients scheduled for percutaneous microwave ablation of liver cancer abutting capsule, including 32 males and 6 females, aged 41-75 years, with ASA grade Ⅰ or Ⅱ.Patients were randomly divided into 2 groups:oxycodone group (group O,n=20) and fentanyl group (group F, n=18).Before the puncture, a loading dose of oxycodone 0.1 mg/kg was given intravenously in group O, a loading dose of fentanyl 1 μg/kg was given intravenously in group F.After successful puncture, both groups were induced by Propofol 1.5 mg/kg, followed by Propofol infusion at 4-7 mg·kg-1·h-1 in two groups.The changes of MAP, HR, SpO2 and RR before, during and after operation were recorded.Body movement and respiratory depression were recorded.The total amount of propofol,the postoperative recovery time, postoperative nausea and vomiting, and postoperative 4 h VAS scores were recorded.Results There was no significant difference in general condition and intraoperative condition of ablation operation between the two groups.The incidences of respiratory depression and body movement in group F were significantly higher than those in group O.There was no significant difference in the incidences of postoperative nausea and vomiting between the two groups.VAS score 4 h after operation in group F [(3.9±2.0) score] was significantly higher than that in group O [(1.7±0.9) score] (P＜0.01).There was no significant difference in HR between the two groups at each point.Compared with before surgery, the MAP during surgery in group F was significantly increased (P＜0.05),the RR during surgery in groups F and O were significantly lower (P＜0.01 or P＜0.05).The RR during surgery in group F was significantly lower than that in group O(P＜0.05),but there was no significant difference at the other points between the two groups.Conclusion Oxycodone can be used safely and effectively for percutaneous microwave ablation of liver cancer when the scope of ablation involving liver capsule.It has lower incidence of respiratory depression, effectively alleviates intraoperative pain and reduces postoperative pain.
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Objective To compare the curative effect of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) with that of simple TACE in treating large liver cancers.Methods A computer-based search assisted by manual searching for TACE+MWA vs simple TACE clinical control trials for large liver cancers was conducted.The patient survival,tumor response and complications were enrolled in the scope of analysis.Results A total of 16 papers met the inclusion criteria,which included 1199 patients in total.Meta-analysis indicated that one-,2-and 3-year survival rates of TACE+MWA group were better than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The complete response (CR) rate and partial response (PR) rate of TACE+MWA group were higher than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The stable disease (SD) rate and progressive disease (PD) rate of TACE+MWA group were lower than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).Conclusion For the treatment of large liver cancers,TACE +MWA is superior to simple TACE.(J Intervent Radiol,2017,26:225-231)
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Objective To investigate the feasibility, safety and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate(NBCA) in rabbit VX2 liver tumor models. MethodsTwenty-four rabbits were implanted with VX2 hepatic tumors into the left hepatic lobes, and were scanned with CT to measure the volume of the tumor after 14 days. They were randomly divided into three groups with 8 rabbits assigned to each group. Transarterial embolization was conducted with physiological saline in control group A, with pure Lipiodol in group B, with 2.5% NBCA in group C. Hepatic toxicity was evaluated by blood biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). One week later, the volumes of the tumors were measured by CT again. Tumor growth rate was the ratio of tumor's volume at 7th day after embolization to the tumors' volume before embolization. The survival periods of the rabbits of the three groups after treatment were also recorded. The data of ALT and AST mean values from each group were analyzed with repeated measurement analysis of variance (ANOVA). Tumor growth rates and survival periods were analyzed by using one-way ANOVA. Results All animal models were successfully established and underwent interventional catheterization. Both ALT and AST mean values of the rabbits in group A, B and C at each time point before and after embolization were significantly different (ALT F=10.508, 16.443, 19.828, respectively; AST F=23.696, 23.334, 15.594, respectively)(P＜0.05). ALT in group A, B, C were (49.4±13.5), (115.2±48.8), (124.7±49.4)U/L, while AST in group A, B, C were (52.3±12.0), (128.3±50.1), (137.0±66.9)U/L 4 days after embolization. The ALT and AST mean values were significantly elevated 4 days after embolization in group B and group C compared with those before embolization and those of group A 4 days after treatment(P＜0.05). However, the ALT and AST mean values showed no statistically significant difference in all the groups before embolization and 7 days after embolization. On the other hand, the growth rates of the tumors differed significantly among the three groups(F=110.865, P=0.000). The group C showed significantly lower tumor growth rate (0.839±0.144)% than the group A(2.978±0.547)%(P=0.000), but no significantly different tumor growth rate compared with group B(0.871±0.0725)%( P=0.845). Consequently, the survival period of the animals in group C(38.9±4.0) days was significantly longer than that in group A(32.1±3.1)days (P=0.006), while it was not significantly different from that in group B(36.9±4.8)days(P=0.366). ConclusionsTransarterial embolization with low concentration of NBCA was feasible and safe. It could be a new option of treatment for HCC and might have potential further clinical value.
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Objective Acute massive pulmonary embolism(PE)is a clinical emergency requiring rapid and supportive measures.With the development of interventional technology and devices,percutaneous mechanical thrombectomy(PMT)is considered to be an alternative for the treatment of PE,though there is still relative lack of clinical experience.The purpose of this study is to evaluate the clinical efficacy and safety of PMT in the management of acute massive PE.Methods The clinical data of massive PE patients treated with interventional methods were collected and analyzed in a retrospective way.From Jan.2003 to Jan.2008,6 patients(5 males and one female,with a mean age of 62 years)with acute massive PE,which was initially diagnosed by computed tomography and finally confirmed by pulmonary angiography,were treated with percutaneous catheter fragmentation and/or Straub Rotarex thrombectomy device.Results The improvement of clinical status and restoration of blood flow in the main branches of pulmonary artery were obtained in all patients.Oxygen saturation(SaO2)increased from preoperative(79.5±5.3)%to postoporative (92.8±3.4)%,with P＜0.01.Partial arterial oxygen pressure(PaO2)increased from preoperative(58.0±9.8)mmHg to postoperative(88.7±4.1)mmHg(P＜0.01).After PMT treatment,the mean pulmonary artery pressure(PAP)decreased from preoperative(40.8±7.8)mmHg to postoperative(29.8±8.0)mmHg (P＜0.01).Miller index decreased from preoperative 0.54±0.03 to postoperative 0.18±0.07(P＜0.01).During a clinical follow-up period ranged from 1 to 5 years,four patients showed no recurrence of PE,the other two patients lost touch with the authors.Conclusion The preliminary experience in onr series suggests that PMT is an easy,effective and safe therapy in the clinical management of acute massive PE,especially when thrombolysis is contraindicated.
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Objective To evaluate the clinical application of embolization therapy using N-butyl 2-cyanoacrylate(NBCA)for hepatocellular carcinoma(HCC)complicated with arterio-portal fistula(APF).Methods Eighty patients with HCC and APF underwent embolothempy with NBCA(NBCA group,26 patients)or absolute alcohol(alcohol group,54 patients).The APF wag first treated with liquid embolic agent during the TACE procedure.We used NBCA-Lipiodol mixtures in concentration of 20%-50% according to tlle different circulation times of these APF in NBCA group,Absolute alcohol plus gelfoam or other materisis were used for embolization of APF in alcohol group.The pain reaction during the procedure,influence for liver function(X2 test).occlusive suceessfxil rate after single embolization(Fisher's exact test)and the survival rate of 1 year(log-rank analysis)between two groups were compared after the embolotherapy.Results Four patients in NBCA group and 52 patients in alcohol group felt painful during the pmcedures.There wag statistically significant difference between two groups(x2=58.86,P＜0.001).The APF disappeared after only sin~e embolization in 24(92.3%,24/26)cages of NBCA group and in 37(68.5%,37/54)patients of alcohol group.There wag also significant difference between two groups (P=0.024).There were no statistical ditierence in the post.embolization liver function change and 1 year survival rate between two groups.Conclusions The embolization therapy using NBCA for HCC complicated with APF is safe.effective and more accurate.It can be used as a new technique for these patients.
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Objective To discuss the technique of Neuroform stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms and to evaluate its clinical efficacy and complications.Methods Neuroform stent-assisted technique was used for coil embolization treatment in 31 patients with intracranial wide-necked aneurysms, all aneurysms were ruptured and the patients suffered from subarachnoid hemorrhage (SAH). Of the total 43 aneurysms, 39 were wide-necked and 4 were narrow-necked. Results Thirty-five stents were inserted in 31 patients. The stents were implanted in both internal carotid arteries in 3 patients and in both middle cerebral arteries in one patient, Intra-arterial embolization with coils was successfully performed in 41 of 43 aneurysms. Intraoperative hemorrhage occurred in 2 patients, which probably resulted from the rupture of middle cerebral artery branch due to microwire damage. The cerebral isehemic symptom happened in 1 patient with posterior communicating artery aneurysm due to the shifting of the coil from the original site to M2 segment of middle cerebral artery. During a follow-up period of 24.7 months in average, neither death nor recurrent hemorrhage occurred in 29 cases. Twenty-eight patients were in good living condition and the remaining one patient showed obvious disturbance of neural function.Conclusion For the treatment of intracranial wide-necked aneurysms, intra-arterial coil embolization with Neuroform stent-assisted technique is a safe and effective clinical therapy. It can effectively broaden the extent of indications in treating intracranial aneurysms by using interventional technique.
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When reading or writing a medical paper involving clinical practice or fundamental research, it is necessary to read or review other correlative ones published in specially journals. Medical papers are always the fastest and most authorized way of reporting the latest achievements ,innovation and discoveries in medicine. However, viewpoints expressed by different authors and different periodicals varied considerably, sometimes were similar, sometimes were contradicted and even poles apart in one subject. It is worthwhile to think about facing with different conclusions, as how to make one’s papers choice. In this article, we took the example for analysis of medical papers about "The complication of post hepatic transplantation: splenic artery steals syndrome" written by different authors and talking about how to treat medical papers properly.
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Objective To assess the role of helical CT in the long-term follow-up of patients with malignant hepatic tumors treated with RFA. Methods CT findings of patients with liver malignant tumors (29 hepatocellular carcinomas and 7 metastases) were reviewed retrospectively, who underwent percutaneous ultrasound-guided radiofrequency ablation (RFA). CT images consisted of nonenhanced and dual-phase contrast-enhanced helical CT scan, the effect of ablation therapy and tumor recurrence were detected. Results The major patterns of tumor residual or local recurrence were the lesions with thick rim or nodular peripheral enhancement in arterial phase or the lesions with gross enlargement on follow-up CT images. The complete necrosis lesions in 28 cases (77.8%) were seen on the initial postablation CT scans after a single session RFA. On the subsequent follow-up CT examination, the local intra-hepatic tumor recurrences were seen in 2 cases (5.6%) as well as the remote intra-hepatic tumor recurrences were seen in 4 cases (11.1%).Conclusion For certain patients with hepatic malignant tumors, RFA is an effective therapeutic method, and dual-phase contrast enhanced helical CT scans play a important role in long-term assessment and follow-up of patients.
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Biliary tract complications occurred after liver transplantation have been the well-known causes of the substantial morbidity and mortality. It has been widely accepted that biliary drainage, balloon dilation and stent placement are useful interventional techniques for the treatment of biliary tract complications. Biliary tract complications are more likely to be complex and to have multiple causes. For the interventional radiologists, a further understanding of the mechanism, pathology, classification and diagnosis of the biliary complications is very helpful in reasonably working out the appropriate therapeutic strategy in order to improve the clinical success rate of liver transplantation.