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Objective To evaluate the technical success rate,effectiveness and safety of transcatheter arterial chemoembolization (TACE)via the omental branch in the treatment of hepatocellular carcinoma (HCC)with blood supply from the omental branch. Methods 45 patients with HCC fed by the omental branch who had undergone TACE were evaluated retrospectively.Results All patients had undergone several therapeutic procedures including TACE before the revelation of the blood supply from the omental branch,8 patients had a history of surgery of hepatic resection for HCC.45 patients had 48 tumors total,52 omental branches were observed angiographically,48 omental branches (9 2%)were successfully embolized.Stenosis or occlusion of the hepatic artery was observed in 37 patients(82%).The alpha fetoprotein (AFP)levels were reduced from 5.05－4 246.89 ng/mL(mean,1 748.52 ng/mL)before treatment to 3.78－1 048.32 ng/mL(mean,287.46 ng/mL)after TACE 4－6 weeks later.The tumors diminished in size in 32 patients,stabilized in 13 patients(29%),however,recurred 2－6 months (mean,3 months)after TACE.28 patients died after 6－18 months (mean,10 months),17 patients were alive for 3－32 months (mean,14 months),but tumor recurred in 8 patients.Severe complications were not observed in any patient.Conclusion TACE via the omental branch is safe,effective and had high technical success rate,it is important to embolize all the feeding arteries at the same time for reducing the recurrence rate.
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Objective To evaluate the cause and the treatment of the vagus nerve reflex in patients with hemoptysis during bron-chial artery embolization (BAE).Methods 1 12 patients with much hemoptysis were enrolled,9 of whom represented vagus nerve reflex in the process of interventional embolization.Results In 9 patients with mixed vagal reflex,5 occurred in the process of bron-chial artery embolization,1 in removing of sheath,1 in hemostasis by compression and 2 in returning to the ward.The intraoperative vagus reflex during BAE was related to over tension and unnormolized operation,and it improved by block of vagus nerve,raising blood pressure and fluid expansion without serious complications.Conclusion Vagus nerve reflex during BAE should be noticed, and early detection and timely intervention may improve its prognosis.
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Objective To discuss the value of combining superselective mesenteric angiography (SSMA)with methylene blue in-jection for localization of the Obscure Gastrointestinal Bleeding (OGIB).Methods 12 patients presenting with OGIB had preopera-tive localization of the bleeding site by SSMA.The microcatheter was remained inside the bleeding artery branch after angiography. Then the methylene blue was injected via the microcatheter for localization during exploratory laparotomy and the dyed intestine was then removed.Results The detected rate of bleeding sites by using preoperative SSMA was 100%.The lesions in total 12 patients were found quickly during the exploratory laparotomy.The length of the removed intestine was 9 -12 cm (median,10 cm).After followed up for 10-24 months (median,18 months),all patients with OGIB had no recurrence.Conclusion The method of SSMA combined with the use of methylene blue injection is a safe and effective procedure for the localization of OGIB and could be beneficial for increasing the surgical success rate of hemostasis.