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Objective:To investigate the feasibility of CT hepatic arteriography(CTHA) guided percutaneous radiofrequency ablation of hepatocellular carcinoma (HCC).Methods:Forty-four patients diagnosed with hepatocellular carcinomas were enrolled in this prospective study from September 2019 to May 2021 in Henan Cancer Hospital. Thirty-three out of the 44 patients were treatment naive, 8 cases recurred after radiofrequency ablation, and the other 3 patients recurred after surgery. The mean size of HCC nodules was 5-44(17±8)mm measured on enhanced MRI images. Each patient was implanted a 5-French Cobra catheter or a 5-French RH angiographic catheter, then was catheterized into common hepatic artery or proper hepatic artery, under DSA monitoring via right femoral artery. Then the patient was transferred to CT operation room. Percutaneous radiofrequency ablation was performed by CTHA guidance using contrast agent injected via the catheter indwelled in hepatic artery. The endpoint of a complete ablation was a non-enhancing ablation necrosis zone in the target tumor and the target tumor margin at least 5 mm on CTHA. At the end of the procedure, the probe was retracted using tract ablation, and the arterial catheter and sheath were removed. The number of HCC lesions showed on the enhanced MRI and CTHA imaging were compared using Wilcoxon rank-sum test. The technical success rate and volume of contrast agent used during the CTHA ablation procedures were summarized.Results:Additional tumors were founded in 13 out of the 44 patients during the CT hepatic arteriography compared with enhanced MRI. The tumors founded by enhanced MRI and CTHA were 64 and 91 respectively, with statistical significance ( Z=-3.24, P=0.001). One patient dropped out of the study after palliative ablation and was transferred to transaterial chemoembolization treatment because the number of lesions showed by CTHA scan was more than 5. The other 43 patients got complete ablation verified by immediate postoperative assessment using CTHA. The technical success rate was 100%. The average volume of contrast agent used in CTHA guided radiofrequency ablation was 30-80(42±14)ml. There was no complications occurred related to the CTHA guided percutaneous radiofrequency ablation procedures. Conclusions:CTHA can demonstrate additional lesions that can not be detected by the enhanced MRI images, which improves the lesion conspicuity and verifies the optimal position of radiofrequency probe. The complete tumor ablation can be verified by CTHA performed immediately after ablation.
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Objective To investigate the effect of embolization with ethanol-soaked gelatin sponge for the treatment of arterioportal shunting (APS) in patients with hepatocellular carcinoma (HCC). Methods From January 2016 to June 2017, a total of 78 patients with unresectable HCC were enrolled in this study. These patients were randomly divided into two groups by digital random method. The experimental group (n=39) received transarterial embolization of the shunt with ethanol-soaked gelatin sponge, while the control group (n=39) received only gelatin sponge shunt. Both of the two groups underwent transarterial chemoembolization if available. Changes in APS, tumor response (according to modified response evaluation criteria in solid tumor), changes in Eastern Cooperative Oncology Group (ECOG), and haemodynamics changes of the portal vein were analyzed. χ2 test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. The APS grades were compared between the two groups before treatment and 2 months after treatment using rank sum test. Results Six patients were lost during the 2-month follow-up, and 72 patients were followed up, which include 38 patients in the experimental group and 34 patients in the control group. Compared to (14/34), the experimental group (25/38) has higher The APS improvement rates of the experimental group and the control group were 65.8％(25/38) and 41.2％(14/34), and there was significant difference (χ2=4.379, P<0.05). Of the 72 patients, 66 cases were conform to modified response evaluation criteria in solid tumor, which include 35 patients in the experimental group and 31 patients in the control group. Tumor response at 2 months of the experimental group and the control group were 57.1％(20/35) and 32.3％(10/31), and there was significant difference (χ2=4.106, P<0.05). The ECOG score was significantly decreased from 2 points to ≤1 point in 19 cases in the experimental group, while 12 cases in the control group (χ2=6.894, P<0.05). Compared with the control group, the diameter of the portal vein dropped significantly (t=2.082, P<0.05), while the blood flow velocity of portal vein increased (t=2.219, P<0.05) obviously in the experimental group 1 month after treatment. Conclusion Tansarterial embolization with ethanol-soaked gelatin sponge can effectively improve APS improvement rate, and quality of life of patients with unresectable HCC accompanied with APS.
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Objective@#To study the application of intravoxel incoherent motion (IVIM) quantitative index combined with time-signal intensity curve (TIC) of dynamic contrast enhanced 3.0T magnetic resonance in the early precise diagnosis of residual lesions in non-small cell lung cancer (NSCLC) after argon-helium cryosurgery.@*Methods@#One hundred NSCLC patients who underwent argon-helium cryosurgery were collected and divided into the residual group (21 cases) and non-residual group (79 cases) according to the result of needle biopsy and follow-up. The apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (sADC), fast apparent diffusion coefficient (fADC), fraction of fast apparent diffusion coefficient (ffADC) and TIC type of IVIM quantitative index between the two groups were compared at 7 days and 1 month after argon-helium cryosurgery, respectively. The diagnosis performance of each quantitative index was analyzed by receiver operating characteristic (ROC) curve and the best cut-off value was computed. The specificity and sensitivity of TIC types were calculated as diagnostic criteria. The diagnosis performance of IVIM quantitative index combined with TIC type was evaluated and compared with the conventional MRI and DWI.@*Results@#The differences of ADC, sADC and ffADC at 7 days and 1 month after argon-helium cryosurgery between the residual group and non-residual group were statistically significant (all P<0.05), in which the diagnosis performance of sADC and ffADC were better. The AUC of sADC and ffADC at 7 days after argon-helium cryosurgery were 0.861 and 0.895, the sensitivity were 81.0% and 90.5%, and the specificity were 77.2% and 73.4%, respectively. The AUC of sADC and ffADC at 1 month after argon-helium cryosurgery were 0.836 and 0.883, the sensitivity were 100.0% and 76.2%, and the specificity were 58.2% and 89.9%, respectively. The diagnosis performance of TIC type Ⅱ&Ⅲ was best. The sensitivity and specificity were 80.9% and 58.2% at 7 days after treatment, 85.7% and 62.0% at 1 month after treatment, respectively. At 7 days after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 85.7%, while at 1 month after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 90.5%, respectively. The diagnosis performance of IVIM quantitative index combined with TIC type was better than conventional MRI and DWI.@*Conclusion@#The combination of IVIM quantitative index and TIC type can be used in the early diagnosis of residual lesions after argon-helium cryosurgery for NSCLC, whose effect is better than conventional MRI and DWI.
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Objective To evaluate the clinical value of CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy in treating refractory and recurrent pelvic malignant tumors.Methods A total of 35 patients with refractory and recurrent pelvic malignant tumor,who were admitted to authors' hospital during the period from January 2013 to January 2016 to receive CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy,were selected and used as the study group,while other 39 patients with refractory and recurrent pelvic malignant tumor received simple 125I particle implantation and were used as the control group.The short-term and long-term curative effect,as well as the improvement of clinical symptoms,were compared between the two groups.Results The objective effective rate and the benefit rate in the study group were 60.0％ (21/35) and 85.7％ (30/35) respectively,while those in the control group were 53.8％ (21/39) and 84.6％ (33/39) respectively,the differences between the two groups were not statistically significant (P=0.594 and P=0.894 respectively).In the study group the mean disease progressionfree period was 12.2 months,which was 3.6 months longer than that of 8.6 months in the control group,the difference between the two groups was statistically significant (P=0.002).The recurrence rates in the study group and the control group were 40.0％(12/30) and 57.6％ (19/33) respectively,the difference between the two groups was statistically significant (P=0.018).The mean preoperative and postoperative KPS values in the study group were 72.4 points and 82.7 points respectively,which in the control group were 68.9 points and 79.1 points respectively;in each group statistically significant difference existed between the preoperative KPS value and the postoperative one (P=0.043 and P=0.039 respectively),however,no statistically significant difference in postoperative KPS value existed between the study group and the control group (P=0.745).Conclusion For the treatment of refractory and recurrent pelvic malignant tumors,CT-guided 125I particle implantation is an effective therapy,however,combination use of iliac artery infusion chemotherapy can reduce the incidence of tumor recurrence and prolong the disease progression-free period.
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Objective To investigate the feasibility and safety of the double J tube removal from ureter under fluoroscopy observation. Methods The medical records of patients in our department from April 2013 to March 2015, who performed“double J tube removal and/or replacement”were retrospectively reviewed and analyzed. These data included gender and age of the patient, position of the double J tube end in the bladder, removal method, fluoroscopy time, postoperative complications and so on. The removal methods were divided into a direct method and an indirect method. The direct method means using the ring of a gooseneck snare to hitch directly the end of double J tube in the bladder, and pulling it to the urethral orifice. For the indirect method, a guide wire and a gooseneck snare first were sent into the bladder to clip the double J tube, then, the ring of the gooseneck snare was used to hitch the end of the guide wire to withdraw the gooseneck snare and the guide wire to the urethral orifice, and the double J tube was pulled to the urethral orifice. The double J tube end position in the bladder had direct relationship with the choice of removal method. The author divided the double J tube end position in the bladder into A type, B1 type, B2 type, and C type. The bladder was divided into four quarters equally. Direct method was suitable for all types, while indirect method was only suitable for B2 and C type. Between April 2013 and September 2014, all patients were treated by the direct method;between October 2014 and March 2015, all patients with B1 and A type were treated by the direct method, and all patients with B2 and C type were treated by the indirect method. According to the success rate of operation, fluoroscopy time, the incidence of different complications, the efficacy and safety were determined. Results This study recruited a total of 49 patients, including 6 males and 43 females, who underwent 114 times of“double J tube removal”. On average, double J tube was removed 2.3 times per case. The overall success rate was 96.5% (110/114). The application of direct method was 92 times, and the success rate was 95.7%(88/92). The application of indirect method was 22 times, and the success rate was 100%(22/22). In this study, there were 4 failures to remove the double J tube, all of which happened in the direct method for the C type of patients. In the successful 110 cases, the average fluoroscopy time was (11.3+9.5) min. The application of direct method was 88 times, and the average fluoroscopy time was (12.3 ± 10.3) min; the application of indirect method was 22 times, and the average fluoroscopy time was (7.6±3.8) min. There were 10 cases with pain in urethral orifice, in which 9 cases was treated with direct method and one with indirect method. There were 5 cases with gross hematuria complicated in direct method. The overall incidence rate of the complications was 13.2% (15/114). All of postoperative complications resolved spontaneously. Conclusion The direct way and the indirect way to remove ureteral double J tube fluoroscopically are feasible and safe .
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Objective To assess the therapeutic effect of combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I implantation in treating stage Ⅲ non-small cell lung cancer. Methods Sixty cases with stage Ⅲ non-small cell lung cancer were randomly divided into two groups with random number table. In group A (in interventional treatment group, n = 30),the gemcitabine 1000 mg/m2 and one third of the cisplatin 100 mg/m2 was given using seldinger technique for transcatheter bronchial arterial infusion chemotherapy on day 1. Two-thirds of the cisplatin 100 mg/m2 was infused in veins on day 2 and 3. The gemcitabine 1000 mg/m2 was infused in veins on day 8, 21 days for a period. In group B (interventional - 125I groups), the method of combination chemotherapy of gemcitabine and cisplatin was the same as in Group A. After ten days of arterial perfusion, 125I seeds were implantated, 21 days for a period. All patients received at least 2 cycles. The imaging evaluation of patients after treatment standards included complete remission (CR), partial remission (PR), stable (SD),progressive disease (PD), effective rate (CR + PR)/30 and clinical benefit rate (CR + PR + SD)/30.Non-parametric rank sum test was used to compare short-term effect of the two groups treatment of two cycles.x2 test was used to compare year survival, Kaplan-Meier method was used to calculate median survival,log-rank test method was used to difference between the groups. Results In group A, there were 17 PR,9SD and 4 PD. The overall response rate was 56. 7% (17/30) and clinical beneficial rate was 86. 7% (26/30). In Group B, there were 2 CR, 21 PR, 7 SD. The overall response rate was 76.7% (23/30) and clinical beneficial rate was 100% (30/30). There was significant difference between the two groups (P =0. 036). In group A, the 1 year survival rate was 46. 7% (14/30) and the 2 year survival rate was 36. 7%(11/30), median survival time (MST) was 10 months . In group B, the 1 year survival rate was 76. 7%(23/30) and the 2 year survival rate was 63. 3% (19/30) , median survival time (MST) was 27 months.There was a significant difference between two group in 1 year survival rate (P = 0. 017), 2 year survival rate (P = 0. 039) and median survival time (P = 0. 006). Conclusion The treatment effects of Ⅲ stage non-small cell lung cancer by gemcitabine and cisplatin combination chemotherapy with double way plus radioactive seed 125I implantation was better than gemcitabine and cisplatin combination chemotherapy with double way.
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Objective To assess the therapeutic outcomes of transcatheter arterial chemoembolization combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis for primary hepatic carcinoma accompanied by portal vein tumor thrombus. Methods Thirty patients with primary hepatic carcinoma accompanied by portal vein tumor thrombosis of type Ⅱ and type Ⅲ were randomly divided into two groups. The Child-Pugh ratings (class A and B) of group A and B were 9 vs 9 (class A) and 5 vs 7 (class B) respectively (χ~2 = 0.201, P > 0.05). The constitution of Type Ⅱ and type Ⅲ portal vein tumor thrombus in group A and B were 8 vs 9 and 6 vs 7 respectively (χ~2 =0.002, P>0.05). The median values of ALT, TBIL, ALB and AFP in group A and B were 58.7U/L vs 70.5 U/L (W=191.5, P>0.05), 21.4 μmol/L vs 21.7μmol/L (W=203, P>0.05), 35.3 g/L vs 37.5 g/L (W = 214, P > 0.05) and 680 μg/L vs 873 μg/L (W = 179. 00, P > 0.05) respectively. Group A was treated with transcatheter arterial chemoembolization (TACE) using emulsion made up of adriamycin, cisplatin, mitomycin and ultraliquidlipiodol plus percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis using emulsion consisted of cisplatin and ultraliquidlipiadol, while group B was treated with TACE only as a control group. Survival analyses were performed via the Kaplan-Meier test in SPSS11.5 with the log-rank tests with an threshold of 0.05. Results The 3, 6 and 12 months survival cases of group A and B were 11 vs 10, 10 vs 3, and 7 vs 0 respectively. The median survival time of group A and group B were 14.0 months and 4.0 months respectively. The difference of the two groups was significantly (χ~2 =11.728, P<0.01). There was no severe side-effect related to therapy in both groups. Conclusion Comparing with the control group, TACE combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma accompanied by type Ⅱ and type Ⅲ portal vein tumor thrombosis.