Chemoembolization by using ethanol-soaked gelatin sponge combined with chemotherapeutic drugs and/or iodized oil for HCC complicated by moderate-to-severe hepatic arterio-portal shunts: analysis of curative effect / 介入放射学杂志

Objective To evaluate the safety and efficacy of peripheral chemoembolization by using ethanol-soaked gelatin sponge (ESG) combined with chemotherapeutic drugs and/or iodized oil in treating patients with hepatocellular carcinoma (HCC) complicated by moderate-to-severe hepatic arterio-portal shunts (APS).Methods The clinical data of 106 HCC patients associated with moderate-to-severe APS,who were treated with ESG chemoembolization during the period from June 2008 to December 2015,were retrospectively analyzed.The postoperative improvement of APS,the procedure-related complications,the tumor response,the survival time,the prognostic factors,etc.were statistically analyzed.Results In the 106 HCC patients associated with moderate-to-severe APS,the median survival time was 278 days,and the 6-,12-and 18-month cumulative survival rates were 70.8％,36.1％ and 16％,respectively.Univariate analysis showed that sex,total bilirubin level,maximal tumor diameter,history of previous treatment,tumor response and postoperative improvement of APS were closely correlated with the patient's prognosis.Multivariate regression analysis indicated that tumor response and postoperative improvement of APS were the independent protection factors,while the female sex and the maximal tumor size ≥5 cm were the independent risk factors.Conclusion For the treatment of HCC complicated by moderate-to-severe hepatic APS,transarterial chemoembolization by using ESG combined with chemotherapeutic drugs and/or iodized oil is safe and effective.The presence of tumor response to treatment and the postoperative improvement of APS indicate a better prognosis.The female sex and the maximal tumor size ≥5 cm are the independent prognostic risk factors.

Embolization of hepatic arterio-portal shunt in patients with HCC complicated by portal vein tumor ;thrombus treated with TACE combined with portal vein stenting：its clinical significance / 介入放射学杂志

Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.

Current status of hepatic surgery in Korea / 대한간학회지

Since the first liver resection was carried out in Korea in 1959, there have been remarkable changes in the field of surgery. With technical advancement and the improvement of perioperative care, liver resections are widely performed and surgical mortality is approaching zero. In the early 1990s, liver transplantation evolved as a feasible option in the treatment of end-stage liver disease in Korea, with successful adult living-donor liver transplantation (LDLT) as one of the greatest achievements. Various innovations in surgical approaches have been introduced. We review the current status of hepatic surgery in liver disease in Korea.

Current status of hepatic surgery in Korea / 대한간학회지

Since the first liver resection was carried out in Korea in 1959, there have been remarkable changes in the field of surgery. With technical advancement and the improvement of perioperative care, liver resections are widely performed and surgical mortality is approaching zero. In the early 1990s, liver transplantation evolved as a feasible option in the treatment of end-stage liver disease in Korea, with successful adult living-donor liver transplantation (LDLT) as one of the greatest achievements. Various innovations in surgical approaches have been introduced. We review the current status of hepatic surgery in liver disease in Korea.

Stenosis-occlusion of Shunt Tract after TIPSS:Angiographic Manifestatioss in 58 Patients / 介入放射学杂志

Purpose:To study the angiographic characteristics and mechanism of shunt stenosis-occlusiion after TIPSS.Materials and methods:Eighty-nine portal venograms were obtained in 58 patients.Venograms analysis had been performed according to shape,position and degree of shunt stenosis.Results:Thirty-six shunt abnormaloties were found in the portal venograms of 58 patients,Shunt stenosis(diameter

The X-Ray Diagnosis and Interventional Therapy of Arterio-Partal Shunt in Patients with Hepatocellular Carcinoma / 介入放射学杂志

In this paper, we reported the radiographic characteristics of arterio-portal shunt in 59 cases with hepatocellular carcinoma. All eases were arbitrarily divided into three types, the peripheral, central, and mixed. The angiographic manifestations of all types were described in detail with emphases on discusion of the mechanism of the pormation of arterio-portal shun, and the orientation of interventional approach. We suggested that active and solemn attitude should be taken but with different ways be considered rather than ignoring it, for obtaining the positive results.

An experimental study on the reconstruction of hepatic blood flow with flow-restricted arterio-portal shunt / 解放军医学杂志

Objective To study the effect of flow-restricted arterio-portal shunt(APS)on the liver.Methods Experimental model of APS and flow-restricted APS were reproduced in rats,and its effects on hepatic blood flow(HBF)and portal venous pressure(PVP)were observed,and the changes in liver structure were investigated six months after the operation.Results Compared with that of pre-operation,both HBF and PVP in APS group at the sixth month after operation changed significantly(P0.05).The PVP changed significantly(P0.05).No obvious lesions were found in the liver by histological examination.Significant differences of both PVP and HBF were found at the sixth month between the two groups(P