ABSTRACT
Objective To explore the causes, diagnosis and treatment of biliary tract hemorrhage after hepatic cancer thermal ablation. Methods The clinical data of 6 patients with biliary tract hemorrhage developed after hepatic cancer thermal ablation in our hospital from May 2013 to May 2018 were retrospectively analyzed. Endoscopic or digital subtraction angiography (DSA) was used to determine the bleeding points. After a definite diagnosis of biliary tract hemorrhage, selective hepatic artery embolization was performed. Hemoglobin, hepatic function and other indicators were detected after surgery to evaluate the treatment effect. Results Preoperative imaging diagnosis showed that 3 patients had mild dilatation of the intrahepatic bile duct. Endoscopy examination showed that there was persistent bleeding in the duodenal papilla with blood clot formation in all 6 patients. DSA examination showed that there were clear bleeding points in 4 patients, and no bleeding points in 2 patients. After embolization, the patients complained of biliary colic disappearance. Within 24 h after embolization, the patients still had hematochezia but the hemoglobin levels were stable. After 24 h operation, the hematochezia gradually disappeared. After selective hepatic artery embolization treatment, 6 patients obtained good hemostatic effects with the effective rate being 100%. All patients were discharged. No biliary bleeding reoccured in the 6-month follow-up. Conclusion Local expansion of intrahepatic bile duct is one of the main risk factors of biliary tract hemorrhage after hepatic cancer ablation. Triad of biliary bleeding is a typical symptom. Endoscopic detection rate is high. DSA examination diagnosis still need to be supported by clinical symptoms. Selective hepatic artery embolization is an effective treatment method. Selective hepatic artery embolization is also satisfactory in diagnostic treatment of patients without bleeding points on DSA examination.
ABSTRACT
Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR)=2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.
ABSTRACT
Vasoactive intestinal polypeptide-secreting tumors (VIPomas) cause VIPoma syndrome, which is characterized by watery diarrhea, hypokalemia, and achlorhydria. The treatment options for metastatic VIPomas include somatostatin analogs, cytoreductive surgery, and chemotherapy. We report the case of a 54-year-old male who presented with a peripancreatic mass with multiple hepatic metastases on computed tomography. After resection, the peripancreatic mass was demonstrated pathologically to be a neuroendocrine tumor. Although the patient received systemic chemotherapy and somatostatin analogs for the hepatic metastatic masses, the tumor increased in size. The patient then experienced severe diarrhea, despite treatment with the somatostatin analogs. Elevated serum VIP levels (3,260 pg/mL) and typical symptoms confirmed the diagnosis of VIPoma. We performed hepatic artery embolization (HAE) to reduce the tumor volume and control his symptoms, which led to a very rapid symptomatic response. The patient has remained symptom-free for 18 months with repeated HAE.
Subject(s)
Humans , Male , Middle Aged , Achlorhydria , Diagnosis , Diarrhea , Drug Therapy , Hepatic Artery , Hypokalemia , Liver , Neoplasm Metastasis , Neuroendocrine Tumors , Somatostatin , Tumor Burden , VipomaABSTRACT
Hemangioma of the liver is usually asymptomatic and incidentally discovered. However, giant hemangioma of the liver may be symptomatic, which is an indication for treatment. A 31-year-old female was admitted with a fever and 1-month history of a nonproductive cough. Her blood test results revealed thrombocytopenia, anemia, and mild coagulopathy. A giant hemangioma of the liver was the cause of her symptoms and signs, and was too large for surgical treatment. Therefore, we performed two sessions of transcatheter hepatic arterial embolization (TAE). The patient has been doing well without fever for 1 year following the second TAE procedure. Surgical resection and enucleation are the traditional treatments of choice for symptomatic giant hemangioma of the liver. However, the signs and symptoms of giant hemangioma of the liver improved by TAE in the present case. We herein report a case of complicated giant hemangioma of the liver that was partially treated by TAE and conservative management.
Subject(s)
Adult , Female , Humans , Anemia , Cough , Fever , Hemangioma , Hematologic Tests , Liver , ThrombocytopeniaABSTRACT
Objective Compared with surgical operation,to investigate the clinical efficacy and advantages of interventional treatment in blunt liver traum.Methods 32 patients from July 2010 to October 2012,who were diagnosed as blunt liver trauma,received super selective hepatic artery embolization in Chinese People's Liberation Army in 98th Hospital.Another 27 ones received operation at the same time in Peolies's Liberation Army 98th (AAST grade Ⅱ to Ⅳ).Retrospective analysis of related cases was presented.The results were analyzed by t test.Results All of 32 patients that received super selective hepatic artery embolization were stanched bleeding successfully.All patients were followed up for 3 to 18 months,the mean follow-up time was 10 months,with no severe complications occurred or no lost cases.Conclusions Compared with surgical operation,interventional treatment had advantage that included eliable hemostasis,less operation time,minimally invasive and less hospitalization time.Interventional treatment had good effects on blunt liver trauma which were AAST grade Ⅱ to Ⅲ.
ABSTRACT
Objective To evaluate the effect of transcatheter hepatic artery embolization with lipiodol on perfused radiofrequency ablation (PRFA) on mini-porcine.Methods Ten Chinese mini-porcine were randomly divided into embolization group and control group (each n=5) .A standard PRFA with infusing cooling procedure was done in control group,while transcatheter hepatic artery embolization with lipiodol was done before PRFA in embolization group.CT and MR scan were performed after PRFA.Then a comparative analysis of the shape and volume of the lesions in the liver were performed.Resuits In both two groups,distinct spherical margin of the PRFA lesions was obtained.The minimal diameter was (31.76±3.43) mm in embolization group and (27.23±3.49) mm in control group (t=2.675,P＜0.05) .The average volume of the embolization group was (54.47±9.98) cm~3,while in the control group was (20.90±5.68) cm~3 (t=10.424,P＜0.05) .Conclusion Transcatheter hepatic artery embolization with lipiodol before PRFA can enlarge the ablation size of mini-porcine's liver.
ABSTRACT
Objective To evaluate the indications,method and prognosis of emergent hepateetomy and tran-scatheter arterial embolization(TAE) for spontaneous rupture of primary liver carcinoma(PLC). Methods Clinical data of 85 cases with PLC were analyzed. Patients were divided into four groups: the group of delayed hepatectomy (group A,n=30);the group of emergent transcatheter arterial embolization (group B,n=22);the group of emer-gent hepatectomy (group C, n=18) and the group of medical treatment (group D, n=15). The hemostasis achieve-ment ratio, operative complications, perioperative morbidity, 1-year and 3-year survival rates among the four groups were compared. Results In group A and B, celiac urteriogram in 52 cases showed that extravasation of contrast media happened in 14 cases (26.9%). The hemostasis achievement ratio was 100% (30/30, 22/22, 18/18) in group A,B and C,respectively,which was remarkably higher than that in group D(40%,6/15) (P<0.05);The in-hospital fatality was 0% (0/30),3.8% (2/52) and 16.7% (3/18),which was lower than that of group D(80.0%, 12/15) (P<0.01). The 1-year survival rate was 76.7% and 3-year survival rate of group A was 53.3%, which was higher than that of group B (45.5 % and 31.8 %) and group C (44.4% and 33.3 %) (P<0.05). The cases in group D did not survive one year(P<0.01). Conclusions Emergent hepatectomy and transcatheter arterial emboli-zation are safe and feasible for spontaneous rupture of primary hepatocellular carcinoma. For those with resectable ca-ses,surgical resection is the first choice after transcatheter arterial embolization.
ABSTRACT
Objective:To evaluate the different effect of TACE and TACE combined with PEI and RF in treating liver metastasis.Methods:67 patients with liver metastasis were classified as group TACE(46 cases)and combined group including TACE+PEI(7 cases) and group TACE+RF(14 cases).All patients were analyzed after treatment by follow-up、CT and their blood biochemical tests.Results:The rate of tumor shrinkage and necrosis was 46.8% and 20.7%,while the contrast group was 78.9%,49.2% respectively(P
ABSTRACT
Objective To discuss the value of TAI, TAE and PEI treatments for intermediate and advanced stages of hepatic cancers.Methods Conventional TAE, TAI, PEI perfusion chemotherapy and mulitiple percutaneous transhepatic injection of pure alcohol under guidance of fluoroscopy and CT were used for different cases. Results Follow up 1-3 year. 1,2,3 year survival rates were 60.3%, 28.6%, 17.3% respectively.Conclusions Combination interventional treatment in intermediate and advanced stages of hepatic is very important outcoming with high efficacy.
ABSTRACT
Objective To observe the effect of iodized oil on radiofrequency thermal ablation (RFA) of hepatic neoplasms by using a cluster array of ten separate electrodes. Methods The patients were divided into 2 groups, group A with transcatheter hepatic artery embolization, group B without transcatheter hepatic artery embolization. All patients were undergone radiofrequency ablation of hepatic neoplasms. Results The time of RFA for group A was (9?2.1) minutes, showing the diameter of necrosis of (5.3?1.4)cm. The time of RFA for group B was (1.6?4.6) minutes demonstrating the diameter of necrosis of (3.5?1.8)cm (P