Résumé
Objective To observe the efficacy and safety of transcatheter arterial chemoembolization combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma. Methods Eighty-six patients with unresectable large hepatocellular carcinoma treated in the Second Affiliated Hospital of Hainan Medical College from March 2013 to March 2015 were selected and were randomly divided into the experimental group ( 43 cases ) and the control group ( 43 cases ), and were treated with transcatheter arterial chemoembolization(TACE) combined with cryoablation therapy and TACE therapy alone. The clinical efficacy, complications related to treatment,1-year and 2-year survival rate,overall survival and progression free survival of the two groups were compared and analyzed. The COX regression analysis was used to observe the prognostic factors. Results The total effective rate in experimental group was higher than that in the control group (67. 44% (29/ 43) vs. (46. 51% (20/ 43),P = 0. 049). The 1-year survival rate,2-year survival rate and 1-year PFS rate of the experimental group were significantly higher than those in the control group (81. 40% (35/ 43) vs. 60. 47% (26/ 43),58. 14% (25/ 43) vs. 34. 88% (15/ 43),53. 49% (23/ 43) vs. 32. 56% (14/ 43),P= 0. 033,3. 031,0. 049) . There was no significant difference in the incidence of complications at grade 3 or above between the control group and experimental group ( (9. 30% (4/ 43) vs. 13. 95% (6/ 43),P = 0. 501) . COX regression analysis showed that male (OR = 1. 756,95%CI 1. 044-3. 563,P = 0. 041),hypoproteinemia (OR= 1. 523,95%CI 1. 067-2. 891,P = 0. 011) and ascites (OR = 1. 719,95%CI 1. 034-3. 108,P = 0. 031) were unfavorable to the prognosis of patients. TACE combined with cryoablation were more effective in improving the prognosis than TACE alone (OR= 0. 438,95%CI 0. 283-0. 712,P= 0. 001). Conclusion TACE combined with cryoablation is an effective and safe therapy, it also can obviously improve the survival expectancy for patients with unresectable large hepatocellular carcinoma.
Résumé
Objective To discuss the feasibility of displaying the extrahepatic feeding arteries in hepatocellular carcinoma with the help of multi-slice spiral CT 3D reconstruction and to assess the clinical value of this technique. Methods Triple-phase enhanced CT scanning with a 64-slice spiral CT scanner was performed in 89 patients with advanced primary hepatocellular carcinoma (HCC). Three-dimensional reconstruction techniques,including maximum intensity projection (MIP) and volume rendering (VR),with arterial phase images,were used to display the origination and course of both the intrahepatic and extrahepatic supplying arteries of HCC. The results were compared with the angiographic findings. Results Of 59 cases with massive type HCC,extrahepatic supplying arteries were found in 33. In 21 cases of diffuse type HCC four showed extrahepatic supplying arteries,and in nine cases of nodular type HCC only one had extra-hepatic supplying arteries. The HCC could get their extrahepatic blood supply via eight pathways. A total of 44 extrahepatic supplying arteries were detected,and 19 anomalously originated hepatic arteries were found. Conclusion The extrahepatic supplying arteries in hepatocellular carcinoma are common findings and their supplying pattern are extremely varied,which may be associated with the type and location of the tumors. Three-dimensional reconstruction technique with the help of triple-phase enhanced CT scanning on a 64-slice spiral CT scanner can provide excellent images as vivid and ideal as angiography can afford. Therefore,the times of angiography examination,the use of contrast media as well as the dose of radiation to both the patients and the physicians can be reduced as far as possible. The detailed information about extrahepatic blood supply is very useful for improving the therapeutic result of HCC.
Résumé
Objective To discuss the clinical significance of anomalous origination of right gastric artery in interventional treatment for hepatocellular carcinoma(HCC).Methods The dynamic enhanced CT scanning of the liver with a 64-slice spiral CT unit was performed in 72 HCC patients.In arterial phase,maximum intensity projection(MIP) and volume reconstruction technique(VRT) were used to observe the origin of the right gastric artery and its relationship with the hepatic artery.The findings were compared with the angiographic results.Results Of the total 72 cases,the anomalous origin of the right gastric artery was found in 43(59.8%).The anomalous origins of the right gastric artery included proper hepatic artery(n=19),left hepatic artery(n=17),gastroduodenal artery(n=4),right hepatic artery(n=2) and common hepatic artery(n=1).The results obtained from three-dimensional reconstruction were in good accordance with angiographic findings.Conclusion The anomalously originated right gastric artery most commonly originates from the left hepatic artery.Three-dimensional reconstruction obtained from the 64-slice spiral CT scans can provide the clear and reliable images of the right gastric artery,which is very helpful for the interventional procedure.