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Objective To compare the recmrence and survival rate between small hepatocellular carcinoma (HCC)patients with and without folfox4 adjuvant chemotherapy after radical resection.Methods From April 2006 to October 2012 46 HCC eases after curative resection received folfox4 adjuvant chemotherapy, 51 cases served as control.Results The clinical and pathological data of the two groups were not significantly different.The 1, 2, 3, 4, 5-year disease-free survival of the group with folfox4 adjuvant chemotherapy was 89％ , 70％ , 59％ , 48％ , 35％ ,and that was 78％ , 65％ , 53％ , 37％ , 27％in control group, the difference was not statistically significant (P =0.459).The 1, 2, 3,4, 5-year overall survival rate of the group with folfox4 adjuvant chemotherapy was 96％ , 76％ , 63％ , 57％ , 52％ , that in control group was 96％ , 73％ , 59％ , 51％ , 47％ , the difference was not statistically significant (P =0.459).COX-hazards regression showed folfox4 adjuvant chemotherapy was not independent factors of recurrence and prognosis (P =0.467, P =0.834).Conclusions For patients with hepatocellular carcinoma smaller than 5 cm in diameter,folfox4 adjuvant chemotherapy after radical resection did not reduce the recurrence rate and did not improve survival.
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Objective To explore the correlation between coagulation and coagulation suppresion system disorders of portal vein thrombosis in patients of portal hypertension undergoing splenectomy.Methods Clinical data of 33 patients with postoperative portal vein thrombosis were enrolled.The clotting and coagulation inhibitor in portal vein blood and peripheral blood was detected and analyzed.Results The Hb,APTT,FIB,factor Ⅶ,protein C,AT-Ⅲ,CD62P of portal vein blood and peripheral blood before the surgery and on postoperative day 1,day 7,day 14 were no significant difference (P ＞ 0.05).The WBC,PLT,PT,D-Dimer of in portal vein blood before surgery were (2.9 ± 1.4) × 109/L,(37.5 ± 20.7) × 109/L,(16.1 ± 2.9) seconds,(0.7 ± 0.3) μg/ml,which were significantly different from those on postop day 1 (13.7 ±4.4) × 109/L,(86.3 ±34.6) × 109/L,(6.9 ±5.7) seconds,(16.1 ±2.9) μg/ml; day 7 (10.7 ±4.3) × 109/L,(312.4 ±137.2) × 109/L,(14.4 ±2.9) seconds,(7.6 ±4.4) μg/ml and day 14 (7.7 ± 3.3) × 109/L,(486.3 ± 216.7) × 109/L,(14.4 ± 2.9) seconds,(5.5 ± 4.4) μg/ml (P ＜ 0.05).WBC,PLT,PT,D-Dimer in preop peripheral blood were (2.4 ±0.8) × 109/L,(44.4 ± 25.8) × 109/L,(16.3 ± 3.0) seconds,(0.6 ± 0.4) μg/ml,which were significantly different from those on postop day 1 (13.7 ± 5.7) × 109/L,(75.1 ± 29.3) × 109/L,(13.7 ± 2.6) seconds,(6.8 ± 5.3) μg/ml; day 7 (10.6 ± 4.8) × 109/L,(337.9 ± 141.3) × 109/L,(14.0 ± 2.1) seconds,(7.6 ± 5.5) μg/ml and day 14 (7.8 ±3.9) × 109/L,(504.9 ±237.4) × 109/L,(14.0 ±2.1) seconds,(5.4 ±4.9) μg/ml postoperative (P ＜ 0.05).Conclusions The cause of postsplenectomy portal vein thrombosis is multifactorial.The dysfunction of coagulation-coagulation suppression system was just one of the conditions conducive to portal vein thrombosis after splenectomy.
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Objective To investigate the relationship between the changes of portal pressure gradient after selective devascularization with postoperative complications and recurrent bleeding of gastroesophageal varix in patients of portal hypertension. Methods The clinical data of 135 cases of portal hypertension undergoing selective devascularization was collected. Portal pressure gradient was measured before splenectomy and after selective devascularization, and was analyzed against postoperative complications and recurrent bleeding. Results In this study, 135 patients of portal hypertension underwent selective devascularization, two cases died during perioperative period ( 1.5% ). Postoperatively patients were divided into three groups based on PPG ＜ 12 mm Hg after selective devascularization (62 cases), HVPG ≥ 12 mm Hg but a more than 20% of decrease off the pre-splenectomy baseline (41 cases) and HVPG ≥12 mm Hg with less than 20% of decrease from the baseline (32 cases). The postoperative complications between the three groups were of no significant difference ( P ＞ 0. 05 ). The 1,2,3 year cumulative rate of no variceal rebleeding of the three groups were 100% vs. 100% vs. 95%; 100%vs. 97% vs. 90%; and 100% vs. 93% vs. 87% (x2 =6. 859, P = 0. 032). COX regression analysis indicated portal vein pressure gradient was an independent prognostic factor of variceal bleeding recurrence (P=0.002). 1,2,3 year cumulative survival rates of the three groups were 100% vs. 100% vs. 94%; 98% vs. 95% vs. 92%; 97% vs. 93% vs. 88%, there were no significant difference among the three groups ( x2 = 2. 917, P = 0. 233 ). Conclusions The decrease in the PPG after selective devascularization is a predictor for the risk of rebleeding but not for survival after selective devascularization.
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Objective To explore the therapeutic effect of dual perfusion embolization and chemotherapy via hepatic artery and portal vein(combmation treatment) in the treatment of unresectable PHC.Methods Eighty-one cases of unresectable PHC were randomly divided into two gronps: (1) Combination treatment group.Forty-one cases,These cases received embolization and chemotherapy via hepatic artery and portal vein through a drug delivery system intraoperatively,and then embolization and chemotherapy via the drug pump were given periodically. (2) TACE group.Forty cases.These cases were treated with Seldinger's technique, the dosage of drugs were the same as used in the former group during laparotomy. After 3 times of treatment, AFP, the size of tumor, liver function, body weight, abdominal perimeter, survival time of the two groups were compared.Results The weight, AFP, decrease of tumour size in combination group were much better than those in TACE group( P 0.05). The median survival time in the two groups were 18.0 months and 11.1 months ( P =0.0001). The accumulating survival rate of 6, 9, 12, 24 months were 87.8%, 78.0% , 68.2%,31.7% in combination group, and 70.0%, 52.5%, 30.0%, 5.0% in TACE group, respectively . The factors affecting survival were therapeutic method, liver function, size of tumour.Conclusions Combination treatment is simple, convenient with less complications, and the effect is better than TACE. So it is an effective method for the unresectable hepatic carcinoma.