Rupture of hepatocellular carcinoma following transcatheter arterial embolization

In one of our patients, intra-abdominal bleeding caused by rupture of hepatocellular carcinoma occurred after TAE. The tumor did not become completely necrotic after TAE and there was fairly rapid recurrence. TAE was then performed a second time and the tumor, which projected from the surface of the liver, ruptured after six days. Among the diagnostic imaging methods, CT proved most useful in locating the site of tumor rupture.     

自发性肝癌破裂出血的急诊动脉栓塞治疗

目的评价自发性肝癌破裂出血急诊动脉导管栓塞(TAE)治疗的疗效。方法回顾性分析1997年9月-2005年9月的16例自发性肝癌破裂出血急诊TAE治疗过程。16例患者中6例伴有低血容量性休克。结果16例患者急诊TAE治疗均止血成功,成功率100%。从肿瘤破裂出血引起失血性休克或发现血性腹水到TAE治疗结束时间为1.5～5h,平均3.6h,其中3例为1.5h。TAE止血治疗后每例患者进行了2～6次动脉导管化疗栓塞(TACE),平均3.7次,结合CT导引肿瘤内无水乙醇注射(CT-PEI)5～9次/例,平均6.8次/例;3例未再进行介入及外科治疗;1例TAE术后3d进行了肝移植手术。平均生存时间为14.3个月。结论急诊栓塞是治疗自发性肝癌破裂出血安全有效的手段。在TAE止血后对肿瘤进行TACE联合CT-PEI治疗取得了良好的效果。     

Using contrast-enhanced sonography to assess the effectiveness of transcatheter arterial embolization for hepatocellular carcinoma

OBJECTIVE: We evaluated the usefulness of contrast-enhanced wideband harmonic gray-scale sonography in assessing the therapeutic effects of transcatheter arterial embolization for patients with hepatocellular carcinoma and compared the findings of this imaging modality with those of helical CT. SUBJECTS AND METHODS: Twenty-nine patients with 39 hepatocellular carcinoma lesions were examined. We scanned lesions before and after therapy using contrast-enhanced wideband harmonic gray-scale sonography after injection of a galactose-palmitic acid contrast agent. All patients held their breath for 20--50 sec after injection while the vascularity of the tumor was observed. We then monitored tumor enhancement between 60 and 180 sec after injection with patients breath-holding for a few seconds. Lesions were considered to exhibit viable tumor residue if hypervascular enhancement was observed in the tumor. We compared this enhancement with helical CT findings. RESULTS: After therapy, 36 of the 39 lesions showed viable tumor residue on contrast-enhanced wideband harmonic gray-scale sonography, with no artifacts from iodized oil. Helical CT revealed a high-attenuation area in 12 of the 36 lesions, whereas 24 of the 36 lesions could not be evaluated for tumor residue as a result of artifacts from iodized oil accumulation in the tumor. The remaining three lesions showed complete deposition of iodized oil and complete necrosis on contrast-enhanced wideband harmonic gray-scale sonography. CONCLUSION: Contrast-enhanced wideband harmonic gray-scale sonography is useful in evaluating the therapeutic effects of transcatheter arterial embolization for hepatocellular carcinoma.     

肝癌肝动脉碘油栓塞术后肝区平片的诊断价值

目的：探讨肝癌动脉碘油栓塞术后肝区平片诊断价值。材料与方法：40例原发性肝癌，男36例，女4例，平均年龄52岁，无经肝固有动脉行DSA及碘油乳剂栓塞，栓塞术后1周每月摄取肝区平片，分析肝区平片碘油聚集形式、碘油聚集大小、空缺现象与肿瘤大小、复发的关系。结果：肝癌动脉碘油栓塞术后肝区平片，检查简便、经济、能初步估价肝癌磺油栓塞术的疗效及有无复发。     

经肝动脉热化疗及热碘油栓塞治疗原发性肝癌

目的 评价经肝动脉热化疗及热碘油栓塞治疗原发性肝癌的疗效.方法 将116例原发性肝癌分为3组.A组(常规组)38例,采用常温动脉灌注化疗及常温碘油栓塞.B组40例,采用热化疗及常温碘油栓塞.C组38例,采用热化疗及热碘油栓塞.B组加C组为热疗组.结果 热疗组肿瘤缩小率优于常规组,3组术后肝功能变化情况无显著性差异.6、12、18、24个月生存率常规组分别为97%、58%、39%和18%,热疗组分别为99%、79%、57%、36%.B组和C组间在肿瘤缩小率及生存率方面均无显著性差异.结论 肝动脉热化疗栓塞治疗原发性肝癌有明显的疗效,而对肝功能无明显的损害.     

肝细胞癌TACE治疗进展

肝细胞癌(HCC)是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括:经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞(TACE)是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

肝细胞癌TACE治疗进展

肝细胞癌（HCC）是世界上第五大常见肿瘤,我国肝癌的死亡率也位居前列。目前,手术是唯一有可能治愈HCC的方法。绝大多数病人来医院就诊时已经处于肝癌中晚期,对于此类病人,介入治疗是最主要的一种治疗方法。介入治疗又可分为血管性介入治疗和非血管性介入治疗。血管性介入治疗包括：经导管动脉化疗栓塞、肝动脉栓塞、肝动脉灌注化疗。经导管动脉化疗栓塞（TACE）是肝癌介入治疗的主要方法。主要对HCCTACE治疗的现状和进展进行综述。     

Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma

Cone-beam computed tomography (CBCT) using a flat-panel detector is an alternative method of obtaining cross-sectional images. This technique is now being used during transcatheter arterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC). Several CBCT techniques are performed to detect HCC lesions: CBCT during portography (CBCTAP), CBCT during hepatic arteriography (CBCTHA), CBCT after iodized oil injection (LipCBCT), CBCT during arteriography (CBCTA) of extrahepatic collaterals. Almost all HCC lesions can be detected using these CBCT images. Three-dimensional arteriography using maximum intensity projection from CBCTHA images can identify the tumor-feeding branch. In particular, this technique is useful when the tumor stain cannot be demonstrated on arteriography. In addition, dual-phase CBCTHA can improve the diagnostic accuracy for hypervascular HCCs because corona enhancement can be detected around the tumor. To monitor the embolized area during TACE, selective CBCTHA or LipCBCT at the embolization point is useful. Two sequential CBCT scans without and with contrast material injection is also useful to confirm each embolized area of two vessels. Furthermore, CBCTA can prevent nontarget embolization. Although the image quality of CBCT is low compared to that of conventional CT, CBCT provides useful information that helps perform TACE for HCCs safely and effectively.     

Visualization of hepatic lymphatic vessels during transcatheter arterial chemoembolization for hepatocellular carcinoma

PURPOSE: To analyze visualization of hepatic lymphatic vessels during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Retrospective review was conducted of 255 tumors in 161 patients treated by TACE with catheterization of the most distal portion of the tumor-feeding branches. All TACE procedures were performed with use of a mixture of iodized oil and anticancer drugs followed by gelatin sponge particles. Arteriograms and spot radiographs obtained during TACE were reviewed to determine whether hepatic lymphatic vessels appeared. Serial computed tomography (CT) images after TACE were evaluated along with clinical symptoms in cases that exhibited lymphatic vessel visualization. RESULTS: Hepatic lymphatic vessels were demonstrated in eight tumors (3.1%) in eight patients during TACE. The mean tumor diameter was 1.7 cm +/- 0.7 (range, 1.0-3.3 cm), and mean volume of injected iodized oil was 1.7 mL +/- 1.0 (range, 1-4 mL). Lymphatic vessels were demonstrated followed by marked portal vein visualization (n = 5) or extravasation of a small amount of contrast material (n = 2). In the remaining patient, these were depicted during the early stage of the TACE procedure. On CT after 1 week, iodized oil in the lymphatic systems in the hepatoduodenal ligament was seen in six patients, and it was shown to have been retained in four of these patients on follow-up CT performed 2, 7, 11, and 21 months later, respectively. None of these patients presented any clinical symptom other than postembolization syndrome. CONCLUSIONS: Hepatic lymphatic vessels were demonstrated in 3.1% of tumors treated by ultraselective TACE. Iodized oil in the lymphatic vessels may be retained for a relatively long time without specific symptoms.     

Solitary hepatocellular carcinoma fed by the cystic artery: Limitation of transcatheter arterial embolization

Purpose: To clarify the limitations of transcatheter treatment for hepatocellular carcinoma (HCC) with parasitic feeders from the cystic artery. Methods: Three male patients had a solitary HCC (average diameter 3 cm) fed by the cystic artery among 221 patients with HCC from 1994 to 1997. One tumor was nourished entirely from the cystic artery arising from the medial branch of the left hepatic artery, and two tumors were fed partially by the cystic arteries arising from the anterior inferior branch of the right hepatic artery. We analyzed the indications for transcatheter treatment for these three patients. Results: We chose not to embolize the cystic artery for fear of necrosis of the gallbladder. Although embolization of the anterior branch of the right hepatic artery was performed in one patient with a tumor fed partially by the cystic artery, only half the tumor was embolized. Two patients underwent hepatic resection, and one received percutaneous ethanol injection therapy. At follow-up of 28–40 months (average 33 months) all patients are alive. Conclusion: Feeding by the cystic artery represents a limitation of TAE for HCC.     

Color Doppler sonography of hepatocellular carcinoma before and after treatment by transcatheter arterial embolization.

Color Doppler sonographic findings on 38 lesions in 31 patients who had primary hepatocellular carcinoma were evaluated before and after transcatheter arterial embolization and compared with dynamic CT and hepatic arteriographic findings. All lesions that were observed with dynamic CT or arteriography were correctly identified on color Doppler sonography. Peritumoral pulsatile flow was the predominant color Doppler flow seen in all lesions. Mixed pulsatile and continuous flow were noted in larger tumors and in tumors with a higher degree of vascularity, as determined by arteriography. Two weeks after treatment, color Doppler flow was still identified in 18 lesions (47%), corresponding to dynamic CT or arteriographic findings documenting residual tumor. Histopathologic examination, performed in 10 other lesions, showed that the tumor was completely necrotic in five. These five necrotic tumors were not visible on color Doppler flow images after treatment. Viable tumor was observed in the five remaining lesions, all of which were shown on color Doppler flow images after treatment. During the 6- to 16-month follow-up period, color Doppler flow images showed recurrence of 13 (50%) of 26 lesions, corresponding to tumor recurrence as shown by CT and arteriography. We conclude that color Doppler sonography is useful for imaging hepatocellular carcinoma, for evaluating residual tumor after treatment, and for imaging tumor recurrence during follow-up.     

Iatrogenic dissection of the celiac artery and its branches during transcatheter arterial embolization for hepatocellular carcinoma: Outcome in 40 patients

Purpose To study the sequelae of iatrogenic dissection of the celiac axis and its branches in a large patient population. Methods We analyzed 40 patients with hepatocellular carcinoma (HCC) whose celiac artery or its branches were dissected during transcatheter arterial emboiization (TAE) and underwent follow-up angiography within 2 months. Results The two most common sites of dissection were the celiac artery in 13 patients (32.5%) and the proper hepatic artery in 11 patients (27.5%). Follow-up angiography revealed complete recanalization in 32.5% (13/40), irregularity and narrowing of the lumen in 40% (16/40), and complete obstruction in 27.5% (11/ 40). Therefore, 72.5% (29/40) of the dissected arteries recanalized. Pseudoaneurysm formation of the dissected artery was observed in 32.5% (13/40). Subsequent TAE was possible via the dissected arteries in 79% (27/34) of patients in this series. Conclusion Iatrogenic dissection of the celiac and proximal hepatic arteries heals spontaneously in the majority of patients, and in most instances allows subsequent TAE.     

Study of response to naproxen in patients with hepatocellular carcinoma who developed fever following transcatheter arterial embolization

Good antipyretic response was obtained when naproxen was given at 600 mg/day for about one week to patients who developed fever after transcatheter arterial embolization (TAE). Fever recurred in several patients, but subsided again when naproxen was given at 300 mg/day. No patients developed gastric mucosal lesions of clinical concern that seemed to be related to naproxen.     

Advanced hepatocellular carcinoma: treatment with high-intensity focused ultrasound ablation combined with transcatheter arterial embolization

PURPOSE: To evaluate ultrasonographically (US)-guided high-intensity focused ultrasound ablation combined with transcatheter arterial chemoembolization (TACE) in the treatment of stage IVA hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. From November 1998 to May 2000, 50 consecutive patients with stage IVA HCC (TNM classification, T4N0-1M0) were alternately enrolled in one of two treatment groups: group 1 (n = 26), in which TACE was performed alone, and group 2 (n = 24), in which transcutaneous ablation of HCC with high-intensity focused ultrasound was performed 2-4 weeks after TACE. The tumors were 4-14 cm in diameter (mean, 10.5 cm). Immediate therapeutic effects were assessed at follow-up with Doppler US and computed tomography or magnetic resonance imaging. All patients were followed up for 3-24 months (mean, 8 months) to observe long-term therapeutic effects and complications in both groups. Tumor reduction rates, median survival time, and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method. RESULTS: No severe complication was observed after focused ultrasound ablation, and no unexpected side effects were noted after TACE. Follow-up images showed absence or reduction of blood supply in the lesions after focused ultrasound ablation when compared with blood supply after TACE alone. The median survival time was 11.3 months in group 2 and 4.0 months in group 1 (P = .004). The 6-month survival rate was 80.4%-85.4% in group 2 and 13.2% in group 1 (P = .002), and the 1-year survival rate was 42.9% and 0%, respectively. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after treatment, respectively, were 28.6%, 35.0%, 50.0%, and 50.0% in group 2 and 4.8%, 7.7%, 10.0%, and 0% in group 1 (P < .01). CONCLUSION: The combination of high-intensity focused ultrasound ablation and TACE is a promising approach in patients with advanced-stage HCC, but large-scale randomized clinical trials are necessary for confirmation.     

Transcatheter arterial embolization in unresectable hepatocellular carcinoma

Seven hundred thirty-nine patients with unresectable hepatocellular carcinoma have been treated by transcatheter arterial chemoembolization using gelatin sponge particles soaked in a solution of Mitomycin C and Adriamycin. This therapy can be equal, or superior to surgical resection and serves both as embolic therapy and targeted chemotherapy.     

Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma

The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n = 11), TAE followed by radiotherapy (group B, n = 17), or radiotherapy alone (group C, n = 11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief.     

Transcatheter arterial embolization for spontaneous rupture of hepatocellular carcinoma

Transcatheter arterial embolization (TAE) was performed in 20 patients with ruptured hepatocellular carcinoma (HCC). Bleeding was improved in all patients, but only four survived for over three months. Rerupture occurred in seven patients (35%) and the prognosis was extremely poor. TAE should be considered the treatment of choice for ruptured HCC; however, long-term survival was limited to those patients without portal extension of HCC. The severity of rupture also influenced the prognosis.     

原发性肝癌动脉栓塞联合手术治疗的预后因素分析

目的：研究和分析接受栓塞及手术治疗的原发性肝癌病例的预后因素。方法：1991年～1999年接受栓塞及手术治疗的原发性肝癌53例，选择组织学分型、术前肝功能、肿瘤大体形态等9项指标为研究因素，采用Cox回归模型进行多因素分析。结果：对患者生存期影响显著的因素包括临床分期、组织学分型、术前肝功能、肿瘤大体形态、TA～CE次数，其中TACE次数为正相关，其余为负相关。结论：原发性肝癌的预后因素有多种，依治疗方法的不同所起影响也不尽相同。当手术治疗与动脉栓基治疗联合应用时，对预后影响较大的因素包括肝功能情况、肿瘤的临床分期和组织学分型。非疾病因素的影响也应受到重视及研究。