Factors influencing recurrence of hepatocellular carcinoma following combined transcatheter arterial chemoembolization and radiofrequency ablation / 中华肝胆外科杂志

Objective:To analyze the risk factors of short-term recurrence of hepatocellular carcinoma (HCC) treated by transcatheter arterial chemoembolization combined with radiofrequency ablation (TACE-RFA), and to predict the short-term recurrence rate by establishing a nomogram model.Methods:The clinical data of patients with hepatocellular carcinoma treated with TACE-RFA at the PLA General Hospital from January 2010 to December 2019 were retrospectively analyzed. Of 125 patients who were included, there were 103 males and 22 females, aged (56.6±8.9) years old. Based on whether tumors had recurred within 12 months after treatment, the patients were divided into two groups: the recurrent group ( n=86) and the non-recurrent group ( n=39). The baseline conditions, tumor characteristics and preoperative laboratory examination resultss were collected and the patients were followed-up by outpatient reexaminations. Multivariate logistic regression analysis was used to study the risk factors of short-term recurrence. C-index, correction model and ROC curve were used to evaluate the model. Results:Multivariate logistics regression analysis showed that the neutrophil to lymphocyte ratio (NLR) >1.25 ( OR=2.87, P=0.048), albumin-γ-glutamyltransferase ratio (AGR)≤0.3 ( OR=3.40, P=0.043), incomplete tumor encapsulation ( OR=3.81, P=0.007) and maximum tumor diameter ( OR=1.98, P=0.003) were independent risk factors for short-term recurrence after TACE-RFA. Applying the above factors to construct the nomograph, the C-index was 0.767, the area under the curve was 0.77 (95% CI: 0.67-0.85), and the calibration curve had a good consistency. Conclusion:NLR>1.25, AGR≤0.3, incomplete tumor encapsulation and tumor maximum diameter were risk factors of short-term recurrence after TACE-RFA in patients with HCC. The nomogram model based on the above factors was of good value in predicting short-term recurrence after TACE-RFA.

A multicenter retrospective study of renal cell carcinoma with Mayo level Ⅳ inferior vena cava tumor thrombus: comparison of different surgical approaches / 中华泌尿外科杂志

Objective:To explore the clinical efficacy and safety of different surgical procedures of Mayo level Ⅳ inferior vena cava tumor thrombus(IVC-TT).Methods:The clinical and pathological data of 36 patients with Mayo level Ⅳ tumor thrombus were collected in three large clinical centers in China, including 18 cases in PLA General Hospital, 7 cases in Nanfang Hospital, and 11 cases in Renji Hospital. There were 25 males and 11 females.The median age was 56.5 years (53-67 years old). The average body mass index was 24.18±2.55 kg/m 2. The average diameter of renal tumors was 8.24±3.25 cm. The average length of inferior vena cava tumor thrombus was 12.89±2.50 cm. Mayo level Ⅳ tumor thrombus were divided into level Ⅳa and level Ⅳb (301 classification) based on the criterion of whether the proximal end of the thrombus has invaded the right atrium. Among them, level Ⅳa patients underwent robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass(CPB-free group, 6 cases). Level Ⅳb patients underwent robot-assisted inferior vena cava thrombectomy with cardiopulmonary bypass(CPB group, 12 cases) or cardiopulmonary bypass with deep hypothermic circulatory arrest assisted inferior vena cava thrombectomy(CPB/DHCA group, 18 cases). The baseline data of the three groups of patients were comparable. The perioperative results and long-term survival data after surgery were compared with different surgical methods for grade Ⅳcancer thrombosis. Results:All operations were successfully completed. Compared with the CPB group, the CPB-free group had a shorter first portal blocking time[17.5(15-36)min vs. 36.5(12-102)min, P=0.044], less intraoperative bleeding [2 350(1 000-3 000)ml vs. 3 500 (1 500-12 000)ml, P=0.043] and a lower allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 185(700-5 800)ml, P=0.049]. Compared with the CPB/DHCA group, the CPB-free group had an advantage in reducing intraoperative allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 700(1 200-10 000)ml, P=0.003]. There were no significant differences between groups in terms of duration of surgery and postoperative hospital stay. Among the 36 patients in this group, 23(64%) developed major complications (level Ⅲ or above), including 9 (25%) grade Ⅲ, 12 (33%) grade Ⅳ, and 2 (6%) grade Ⅴ. The CPB-free group had a relatively low complication rate of grade Ⅳ or above [ 17% (1/6) vs.42% (5/12) vs.44% (8/18)]. There were no statistical differences in median progression-free survival (16.4 vs.12.3 vs.18.0 months, P=0.695) and overall survival (30.1 vs.30.2 vs.37.7 months, P=0.674) between the groups. Conclusions:Robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass has the advantages of short ischemia time of organs, less intraoperative bleeding, and low incidence of major complications, which can be used as a safe and feasible surgical strategy for selected level Ⅳ tumor thrombus.

The progress and advance on diffusion-weighted imaging in locoregional interventional treatment of hepatocellular carcinoma / 中华肝胆外科杂志

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Unfortunately, most of HCC patients were diagnosed at the intermediate or advanced stage, losing the chance to receive the surgical intervention. Locoregional interventional treatment is one of the major therapeutic options for inoperable HCC treatment and prolongs the survival of the patients. Evaluation of the efficacy of the treatment is the important to determine the further therapy strategies. Currently, the evaluation of patients’ response is mainly based on CT and MR anatomic morphological images, but characteristics of tumor biology changes can be observed earlier than the morphological changes. In the recent years, with the development of diffusion weighted imaging (DWI), its value in clinical application has been continuously explored, and it has been increasingly used for quantitative evaluation the diffusion of water molecular and microcirculation perfusion of blood flow in tumor tissue, with some progress in evaluating the tumor response. This paper mainly reviewed the recent research findings of DWI on locoregional interventional treatment for HCC, thereby providing guidance on clinical practice.

Research progress of stem cells imaging technology in the diagnosis and treatment of liver diseases / 中华肝胆外科杂志

Liver disease is one of the main causes of human deaths in the world. Orthotopic liver transplantation is the most effective treatment for severe liver diseases, such as liver cirrhosis, hepatocellular carcinoma, etc. However, liver transplantation was limited because of donors shortage, and immunological. In recent years, stem cell therapy with the ability of multi-directional differentiation has potential application value in the treatment of patients with liver diseases. However, the mechanisms of stem cell therapy have not yet been fully understood. Stem cells can be detected under in vivo cell imaging. It can noninvasively trace the distribution, migration, proliferation and differentiation of stem cells, and it is an important link to study the mechanism of stem cells in the treatment of liver diseases. Therefore, this review briefly introduces the latest research progress of stem cell in vivo imaging techniques in the field of stem cell diagnosis and treatment of liver diseases.

Pretreatment apparent diffusion coefficient as a predictor of prognosis after combined treatment of TACE and radiofrequency ablation for solitary large hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the predictive value of pretreatment apparent diffusion coefficient (ADC) on prognosis in patients with isolated large hepatocellular carcinoma(SLHCC) treated by combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA).Methods:A retrospective analysis was performed on 40 patients with SLHCC who were treated at the Department of Interventional Radiology, the First Medical Center of PLA General Hospital from December 2014 to July 2018, with combined TACE and RFA. There were 34 males and 6 females, with an average age of 55.9 years. All patients underwent enhanced abdominal MRI within 1 week before and 1 month after treatment. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy value of ADC. The survival curves were plotted by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate prognostic analyses were performed using the Cox proportional hazard models.Results:After treatment, there were 18 patients with complete response and 12 with partial response. The objective response rate was 75.0% (30/40). The area under ROC curve of ADC in predicting the effectiveness of TACE combined with RFA (complete response + partial response) was 0.86 (95% CI: 0.74-0.98). The optimal threshold was 1.32×10 -3 mm 2/s, the sensitivity was 0.63, and the specificity was 1.00. The progression-free survival rate and cumulative survival rate in the high ADC group (≥1.32×10 -3mm 2/s, n=19) were better than that in the low ADC group (<1.32×10 -3mm 2/s, n=21), with significant differences (both P<0.05). On multivariate analysis, ADC<1.32×10 -3mm 2/s ( HR=3.711, 95% CI: 1.705-8.074; P<0.05) was an independent risk factor for progression-free survival, while ADC < 1.32×10 -3mm 2/s ( HR=3.518, 95% CI: 1.016-12.185, P<0.05) was an independent risk factor for overall survival. Conclusion:Preoperative ADC was an independent risk factor for prognosis in patients with SLHCC undergoing TACE combined with RFA. It has value in prognostic prediction.

Surface-enhanced Raman nanoparticles for cancer theranostics / 中华核医学与分子影像杂志

Raman spectroscopy is amplified by surface-enhanced Raman scattering nanoparticles(SERS-NPs),and Raman signal can be enhanced by SERS-NPs,which can achieve high-resolution imaging of tumors.Meanwhile,SERS-NPs have high molecular specificity and sensitivity,showing a good prospect of tumor diagnosis and treatment.The advantages of SERS-NPs and its application in tumor diagnosis and treatment,and related experimental studies are reviewed in this article.

Mesenchymal stem cells: the cell replacement therapy for liver cirrhosis / 中华肝胆外科杂志

Cirrhosis is an advanced stage of liver fibrosis that causes fatal complications and and threats human health.Liver transplantation is the preferred treatment method of cirrhosis patients,but the therapeutic effect of liver transplantation is limited.In recent years,researchers at home and abroad have proposed the concept of cell replacement therapy for liver cirrhosis.Among them,mesenchymal stem cells (MSCs) have a wide range of sources,the MSCs can inhibit immunity and reduce the infiltration of inflammatory cells and release of pro-inflammatory cytokines,and they can also be induced to differentiate into hepatocytes to mitigate fibrosis,which become the preferred drug of cell replacement therapy for cirrhosis.Here,we mainly reviewed the mesenchymal stem cells from the features,the mechanisms of treatment for cirrhosis,and recent experimental studies and clinical trials.

The experience of robot-assisted thrombectomy in treating renal tumor with Mayo level Ⅲ to Ⅳ inferior vena caval thrombus (report of 5 cases) / 中华泌尿外科杂志

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.

Applications of nano-drug delivery systems in interventional-targeted for hepatocellular carcinoma: a review / 中华肝胆外科杂志

The development of hepatocellular carcinoma is insidious and rapid.Most patients can not undergo surgery after diagnosis.Transcatheter arterial chemoembolization (TACE) is considered to be the best modality for treatment of advanced hepatocellular carcinoma.However,there are some bottlenecks in TACE,such as low targeting of chemotherapy drugs and incomplete treatment.How to improve the curative effect of TACE has become a key issue in the interventional treatment of hepatocellular carcinoma.In recent years,the study of nano-drug delivery systems has been expected to solve these problems,and has become a hot spot in the field of targeted therapy for hepatocellular carcinoma.In this paper,the current research status of nano-drug delivery systems and its application in the interventional-targeted therapy of hepatocellular carcinoma are reviewed.

The clinical efficacy of Dyna computer tomography guided radiofrequency ablation combined immediately with transarterial chemoembolization to treat large solitary hepatocellular carcinomas / 中华肝胆外科杂志

Objective To study the clinical efficacy of Dyna computer tomography (Dyna CT) guided radiofrequency ablation (RFA) followed immediately by transcatheter arterial chemoembolization (TACE) in the treatment of large solitary hepatocellular carcinomas (HCC),and to provide the basis for the rational use of Dyna CT.Methods A retrospective analysis was performed on 23 patients with a large solitary hepatocellular carcinoma (tumor diameter ≥5 cm) who were admitted to Chinese PLA General Hospital from January 2014 to October 2015 and treated with Dyna CT guided RFA followed immediately by TACE.After treatment,the success rate of the combined technique,the treatment time,the radiation dose received by the patient,the complication and the efficacy of the combined therapy were evaluated.Results The success rate of the combined technique was 100％.The treatment time was (45.3 ± 4.8) min.The radiation exposure dose was (730.5 ± 78.8) mGy.There was no serious complication after treatment.The complete remission rate of the targeted lesion was 91.3 ％ (21/23),the partial remission rate was 8.7 ％ (2/23).On follow-up,5 patients had died.The 6,12,18 month survival rates were 100％,81.5％ and 48.0％,respectively.Conclusions Dyna CT guided RFA for a large solitary HCC was efficacious and safe.The immediate combination of TACE with RFA provided a new alternative strategy for the treatment of a large solita-ry HCC.Dyna CT has important clinical values.

Weight loss after transcatheter left gastric arterial embolization in rabbit model / 中华放射学杂志

Objective To investigate weight, ghrelin changes following transcatheter left gastric artery embolization in rabbit model of obesity, and evaluate its safety. Methods Thirty New Zealand rabbits were randomly divided into three groups, ten New Zealand rabbits in each group, group A:left gastric artery embolization using gelatin sponge, group B:left gastric artery and gastroduodenal artery embolization using gelatin sponge, group C (control group): left gastric artery and gastroduodenal artery perfusion using normal saline. Ghrelin, weight and liver and kidney function were measured at preoperative and postoperative 1, 2, 3, 4 weeks. T test was used to compare the differences in the levels of preoperative and postoperative average ghrelin, weight, alanine transaminase (ALT), aspartate transaminase (AST), creatinine and urea in each group. The ANOVA of repeated measurement was used to compare the difference of preoperative and postoperative each time points between the three groups. Results The preoperative and postoperative ghrelin levels in group A were (4057±61)and (3708±141) pg/ml with statistically significant differences (t=4.5, P<0.05). The preoperative and postoperative ghrelin levels in group B were (4137 ± 89) and (3608 ± 239) pg/ml with statistically significant differences (t=6.8, P<0.05). The preoperative and postoperative ghrelin levels in the control group were (3986 ± 82)and (4044 ± 72) pg/ml with no statistically significant differences (t=0.7, P>0.05). The level of ghrelin in group B decreased significantly compared with group A and the difference was statistically significant (t=3.8, P<0.05). There was a statistically significant difference in postoperative ghrelin levels between the three groups (F=15.6, P<0.05). The preoperative and postoperative weight in group A were (6.12±0.38)and (5.66±0.39) kg with statistically significant differences (t=2.7, P<0.05). The preoperative and postoperative weight in group B were (5.99 ± 0.57)and (5.24 ± 0.61) kg with statistically significant differences (t=3.1, P<0.05). The preoperative and postoperative weight in the control group were (5.94 ± 0.45)and (6.24 ± 0.42) kg with no statistically significant differences (t=1.2, P>0.05). The weight loss of group B was significantly greater than that of group A and the difference was statistically significant (t=5.2, P<0.05). There was a statistically significant difference in postoperative weight between the three groups (F=5.1, P<0.05). There were no statistically significant differences in ALT, AST, creatinine and urea levels at preoperative and postoperative each time points in each group (P>0.05). Conclusion Left gastric artery embolization can become a safe and effective minimally invasive treatment for obesity and left gastric artery and gastroduodenal artery embolization at the same time could achieve more weight loss.

Surface-enhanced Raman nanoparticles for tumor theranostics applications

Raman spectroscopy, amplified by surface-enhanced Raman scattering (SERS) nanoparticles, can provide an imaging modality due to its high molecular specificity, high sensitivity, and negligible autofluorescence. The basis, composition, and methodologies developed for SERS nanoparticles are herein described. The research hotspots that are the focus in this paper are tumor imaging-guided theranostics and biosensing. The next breakthrough may be the development of biocompatible SERS nanoparticles and spectroscopic devices for clinical applications.

Clinical effect of ultraselective transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma originating from the caudate lobe: an analysis of 13 cases / 中华肝脏病杂志

Objective@#To investigate the clinical effect of ultraselective transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) originating from the caudate lobe.@*Methods@#A retrospective analysis was performed for 13 patients with solitary HCC originating from the caudate lobe who were admitted to Department of Interventional Radiology in PLA General Hospital from March 2013 to December 2016. A 2.6-F microcatheter was used to perform ultraselective TACE, and the embolization material was ultra-liquefied iodinated oil. The number of tumor-feeding arteries, success rate and short-term efficacy of ultraselective technique, and long-term survival were evaluated after surgery.@*Results@#Of all patients, 8 (61.5%) had a single tumor-feeding artery and 5 (38.5%) had multiple tumor-feeding arteries. The success rate of ultraselective technique was 84.6% (11/13). The complete remission rate at 1 month after ultraselective TACE was 63.6% (7/11). During the follow-up period after the expiration date, 10 out of 11 patients who underwent successful ultraselective TACE survived, and one out of two patients who underwent failed ultraselective TACE survived.@*Conclusion@#Ultraselective TACE has good feasibility, clinical effect, and safety in the treatment of HCC originating from the caudate lobe, with an important clinical significance in the prognosis of such disease.

The establishment of animal model with liver cancer and the experimental interventional procedure / 介入放射学杂志

For the treatment of liver tumors,interventional therapy is becoming more and more important.The development of interventional therapy relies on the development and application of new materials,new equipment and new drugs,and the preclinical animal testing of these applications is an important part of assessing the safety and effectiveness of interventional procedures.The animal HCC model plays an important leading role in exploring the new approach of interventional therapy.However,the animal HCC models which are suitable for experimental researches are limited,at present,the animal HCC models are mainly confined to rats and rabbits.Due to the limitation of animal body shape,routine interventional instruments and equipment are not suitable to perform interventional procedures for some small animals.Nowadays,there is still a shortage of devices for interventional hepatic artery surgery in mice,and interventional instruments for rats are also limited.This paper aims to make a summary about the types of HCC model in rats and rabbits which are often used in the experimental researches,the modeling methods,the interventional procedures,the anesthesia and imaging examinations,etc.

Interventional therapy for primary hepatic carcinoma associated with IVC-RA tumor thrombus:initial experience in 17 cases / 介入放射学杂志

Objective To evaluate the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE) in treating primary hepatic carcinoma (PHC) complicated by tumor thrombus in inferior vena cava and right atrium (IVC-RA).Methods A total of 17 patients with PHC complicated by tumor thrombus in IVC-RA were included in this study.After the tumor-feeding arteries were confirmed with selective arteriography,TACE was carried out.The used embolization materials included chemotherapy drug-lipiodol emulsion and particle type embolic materials,and the target arteries included branches of hepatic artery,right inferior phrenic artery,branches of left gastric artery,etc.All patients were periodically followed up,and further treatment would be conducted if it was necessary.Results A total of 45 interventional procedures were performed in the 17 patients and all procedures were successful without any significant complication.Explicit blood supply arteries of IVC-RA tumor thrombus were observed in all the 17 patients,including hepatic artery branches (n=12) and extra-hepatic arteries (n=9),which included left gastric artery (n=1) and right inferior phrenic artery (n=8).CT reexamination showed that lipiodol deposition in IVC-RA tumor thrombus was found in 15 patients.In the 17 patients,the median survival time was 12 months,and the one-year and 2-year overall survival rates were 52.9％ and 29.4％ respectively.Conclusion IVC-RA tumor thrombus has rich blood supply,and its main blood supply arteries include hepatic artery and right inferior phrenic artery.For the treatment of PHC associated with IVC-RA tumor thrombus,TACE is safe and effective.

Clinical application of preoperative interventional embolization for benign and malig-nant retroperitoneal tumor / 中国肿瘤临床

Objective:Characteristics of the retroperitoneal tumor blood supply arteries were analyzed to evaluate the safety and effec-tiveness of preoperative interventional embolization for benign and malignant retroperitoneal tumors. Methods:A total of 241 cases were divided into benign retroperitoneal tumor group and malignant retroperitoneal tumor group. Each group was divided into groups A, B, and C according to the long diameter of the tumor tissue. Group A>10.0 cm, 5.0 cm0.05). Significant differences in intraoperative bleeding and intraoperative blood transfusion were found between groups A and B (P<0.05). Main arteries of the abdominal retroperitoneal tumor are the lumbar, internal iliac, and adrenal arteries. The main artery of pelvic retroperitoneal tumor is the internal iliac artery. Conclusion:Preoperative interventional embolization can effec-tively reduce the risk of bleeding during malignant retroperitoneal tumor surgery and improve the perioperative safety of patients. No significant benefit of benign retroperitoneal tumors and no increased risk of bleeding during surgery were observed. Retroperitoneal tumor preoperative embolization should focus on investigating the lumbar, internal iliac, and adrenal arteries.

The application of hypothermic perfusion via renal artery balloon catheter in laparoscopic partial nephrectomy / 介入放射学杂志

Objective To evaluate the feasibility and safety of hypothermic perfusion via renal artery balloon catheter before laparoscopic partial nephrectomy.Methods A total of 35 patients,who were arranged to receive laparoscopic partial nephrectomy during the period from March 2013 to December 2016 at the General Hospital of PLA,China,were enrolled in this study.The tumor was located in the left kidney in 22 patients and in the right kidney in 13 patients.The long diameter of the tumors was 2.3-7.0 cm,with a mean of (4.1±1.2) cm.Before laparoscopic partial nephrectomy,the implantation of renal artery balloon catheter was performed in all patients.The intraoperative renal cold-ischemia time,the time spent for operation and the amount of intraoperative blood loss were recorded.The creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR) were determined before operation as well as at one,3 and 7 days after operation.The intraoperative and postoperative complications were analyzed.Results Successful implantation of renal artery balloon catheter was accomplished in all 35 patients,with the technical success rate being 100％.Slipping of balloon catheter before laparoscopic partial nephrectomy occurred in one patient;in 2 patients incomplete occlusion of renal artery was found during operation and artery forceps had to be used to occlude the renal artery.In the other 32 patients,laparoscopic partial nephrectomy under the condition of hypothermic perfusion via renal artery balloon catheter was successfully carried out.No severe complications occurred during and after the operation.The average cold-ischemia time of the diseased kidney was 45 (20-125) min,the mean time for interventional procedure was 28 (20-40) min,the average surgery time was 147(95-235) min,the average amount of intraoperative blood loss was 180(50-1000) ml.The Ccr values determined before and at one,3,7 days after nephrectomy were (96.5±15.1),(75.2±10.5),(54.3±13.8) and (91.8±14.1) ml/min respectively.The eGFR values determined before and at one,3,7 days after nephrectomy were (99.5±15.3),(70.3±12.5),(65.5±11.7) and (96.8±12.3) ml·min-1·m-2 respectively.Statistical analysis indicated that in both groups the preoperative and 7-day postoperative Ccr values and eGFR values were significantly different from their one-day and 3-day postoperative values (P＜0.01),but no statistically significant differences existed between preoperative values and 7-day postoperative ones (P＞0.05).Conclusion Hypothermic perfusion via renal artery balloon catheter before laparoscopic partial nephrectomy is clinically safe and feasible,it can prolong the safe time of renal ischemia and protect renal function.

Nano knife: a newly-developed technique for the treatment of liver cancers / 介入放射学杂志

Hepatocellular carcinoma is a commonly-seen malignant tumor with high morbidity and mortality all over the world.With the rapid development of molecular biology and scientific technology,in treating HCC the use of nano knife technology,which is developed on the principle of irreversible electroporation,has come into clinicians' consideration.The authors are hereby making a comprehensive review about nano knife,focusing on the principles of nano knife therapy for liver cancer,the advantages of nano knife,and the latest developments in clinical practice and researches,etc.

Transcatheter arterial chemoembolization combined with local ablation in treatment of large hepatocellular carcinoma: a review of current status and perspectives / 中华肝胆外科杂志

Large hepatocellular carcinoma,of which diameter is considered to be ≥ 5 cm,has mostly invaded vascular system or been liver function reserve loss when found,resulting in opportunities to surgical therapy are lost.Combined interventional therapy based on transcatheter arterial chemoembolization (TACE) has become one of the main treatments for the surgically unresectable large hepatocellular carcinoma.In particular,TACE combined local ablation has gradually replaced the interventional therapy model of TACE alone.The current combination therapy is mainly sequential combination.With the development of imaging equipment,real-time synchronization is becoming increasingly important and has become one of the current research hotspots.This article focuses on the research status and perspectives of image guidance,local ablation methods,the order of the joint,the number of times and the timing of the joint situation of TACE combined local ablation in treatment of large hepatocellular carcinoma.

Transcatheter Arterial Chemoembolization in Elderly Patients with Primary Hepatocellular Carcinoma / 中国医学影像学杂志

Purpose Elderly patients with primary hepatocellular carcinoma (HCC) have gradually increased in recent years. Most patients also have systemic disease with poor cardiac and pulmonary function, thus can only receive non-surgical treatment. This paper is to assess the clinical efficacy of transcatheter arterial chemoembolization (TACE) and prognostic factors of HCC in elderly patients. Materials and Methods A retrospective analysis was performed in 106 patients with HCC diagnosed by US, dynamic CT or dynamic MRI [average age (74.9±3.3) years, range 71-84 years] and treated by TACE. The clinical characteristics, survival and prognosis factors were analyzed. Results Follow-up was performed at a median of 18 months (range 1–40 months). The 1-, 2-, and 3-year overall survival (OS) rates were 80.2%, 42.5% and 22.6%, respectively. Univariate analysis showed that the patient's gender and cirrhosis, HBV/HCV infection, diabetes and systemic disease were not significantly correlated with prognosis (P>0.05). Child grade, Eastern Cooperative Oncology Group (ECOG) grade, tumors size, number of tumors, serum alpha-fetoprotein level, portal vein tumor thrombus and Barcelona clinic liver cancer stage were significantly related to OS (P<0.05, P<0.001). Moreover, the Cox multivariant survival analysis revealed that portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level and ECOG stage were independent prognostic indicators (P<0.05, P<0.001). Conclusion Systemic disease does not impact long-term survival in elderly patients with HCC. Portal vein tumor thrombus, tumor size, serum alpha-fetoprotein level, and ECOG grade are independent prognostic indicators.