Usefulness of caerulein in suppressing post-TAE complications of the gallbladder

While transcatheter hepatic arterial embolization (TAE) has been extensively performed as a form of treatment for nonresectable malignant hepatic tumors, complications, such as abdominal pain, fever or leukocytosis due to gallbladder infarction by embolic materials frequently occur and have not yet been overcome. We devised a new procedure for reducing the incidence of gallbladder infarction by administering caerulein prior to TAE. Between 1984 and 1986, 63 patients with hepatocellular carcinoma were treated by TAE with the use of Gelfoam. These patients were divided into 3 groups. Fourteen patients underwent TAE in which the tip of the catheter was placed in the right hepatic artery distal to the origin of the cystic artery (group A). In the other patients the tip of the catheter was placed proximal to the origin of the cystic artery; 40 patients were not treated by caerulein (group B); 9 patients were administered caerulein 20 micrograms intramuscularly 15 to 30 minutes prior to TAE. The incidence of complications after TAE, such as abdominal pain, fever over 38 degrees C, leukocytosis and ultrasonographical abnormalities of the gallbladder was compared in these 3 groups. The results showed that in group C (TAE after administration of caerulein), the incidence of complications was significantly decreased compared with group B(TAE without caerulein). The authors suggest that post-TAE infarction of the gallbladder is effectively diminished by contracting it with caerulein.     

Clinical study of porous gelatin sphere (YM 670) in transcatheter arterial embolization

A clinical study on the use of porous gelatin particles(sterile gelatin embolization material, YM 670, Gelpart) in transcatheter arterial embolization (TAE) was performed in patients with hepatocellular carcinoma, and the efficacy (embolization,anti-tumor effect, recanalization and operationality) and safety (tolerability) were studied. An additive agent comprising porous gelatin particles and low osmolarity contrast media was administered peripherally through a catheter into the hepatic artery proper of 63 patients with hepatocellular carcinoma. Good hepatic arterial embolization was confirmed in all cases (embolization: 100%), and a tumor necrosis effect was obtained in most cases (35/62 patients, 56.5%). Moreover, operationality was assessed as "highly easy to use" or "easy to use" in all cases. Frequencies of adverse events in which a relationship to TAE was not excluded and abnormalities of clinical laboratory data were high at 71.4% and 9 8.4%, respectively. The most common adverse reactions were pyrexia, abdominal pain, queasiness and blood pressure increase;abnormalities in clinical laboratory data included hepatic function with increased AST (GOT), increased ALT (GPT), decreased cholinesterase, increased LDH and increased total bilirubin. These adverse reactions and abnormalities in clinical laboratory data, however, were transient and attributed to the TAE procedure itself, and no adverse reactions related to YM 670 as an embolic material were observed. In addition, with regard to tolerability (safety), the treatment was assessed as suitable for use in all the present cases.     

超常规剂量碘油超选择TAE与常规TAE后Ⅱ期肝癌切除-27例手术病理及随访研究

目的评价术前应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的价值。方法1987年8月～1999年12月12年间27例原发性肝癌分为两组治疗组17例,应用常规导管或球囊导管超选择至肿瘤供血动脉,阻断其血流,使注射碘油时不产生逆流,将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞,栓后25天～121天手术切除;对照组10例,应用一般导管,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉,栓后20天～140天手术切除。对两组病人切除的标本均进行了详细的病理学研究,同时对全部病人随访3～8年。结果治疗组17例中11例肿瘤100%坏死,其余6例坏死率为85%～95%,3、5年生存率分别为88.2%(15/17)、45.5%(5/11),3例现生存6～8年;对照组10例中2例肿瘤完全坏死,另8例坏死率为75%～95%,3、5年生存率分别为60.0%(6/10)、14.3%(1/7)。结论术前应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。     

Application of EGFR inhibitor reduces circulating tumor cells during transcatheter arterial embolization

Purpose

Transcatheter arterial embolization (TAE) has been widely used in treating non-curative hepatocellular carcinoma (HCC). However, it is noticed that TAE may cause invasion of some cancer cells into circulation, resulting in distal metastasis and poor therapeutic outcome. Here, we aimed to reduce the side effects of TAE using the inhibitors for epidermal growth factor receptor (EGFR).

Methods

Transient hepatic artery ligation (HAL) was used as a mouse model for TAE. EGFR inhibitors were applied. Tumor size, presence of tumor cells in circulation, distal tumor formation, and activation of genes associated with tumor cell invasion and metastasis were analyzed.

Results

Inhibitors for EGFR significantly reduced the size of primary tumor, presence of tumor cells in circulation, and distal tumor formation after HAL. Further studies showed that EGFR inhibition suppressed several genes associated with tumor cell invasion and metastasis, such as vascular endothelial growth factor-A, stromal cell-derived factor 1, and Slug.

Conclusion

EGFR inhibitor application may reduce circulating cancer cells during TAE and thus improve the therapy for advanced HCC.

     

132例原发性肝癌灌注化疗及栓塞治疗疗效观察

目的 探讨影响肝动脉灌注化疗＋栓塞治疗疗效的因素。方法 １９９３年１月￣１９９７年１０月,对１３２例不能切除的原发性肝癌行选择性插管灌注化疗及栓塞治疗５９７次,肝动脉灌注化疗＋栓塞者１２２例,单纯灌注化疗１０例。结果 １,２,３年生存率分别为８１．８％、３６．４％和１８．２％,疗效较治疗初期有显著提高。肿瘤分期、栓塞剂及其用量、侧支循环的形成以及肝动脉超选择性插管是影响疗效的主要因素。结论 合理施     

晚期肝癌肝脏内外侧支供血及临床意义

目的：探讨肝癌肝脏内、外侧支供血的产生机理。方法：收集TAE治疗资料完整的中晚期肝癌340例，对其血管造影表现进行分析。结果：肝内侧支供血227例：叶间侧支207例，叶内侧支20例；肝外侧支供血78例：胃左肝在动脉共干21例、网膜动脉29例、右IPA13例、左IPA5例、结肠中动脉9例、右肾动脉1例；肝内合并肝外侧支同时供血35例。结论：侧支供血形成的机制与肝脏的解剖及肿瘤生长部位有关。认为了解肿瘤侧支供血的造影表现，对肝癌TAE及手术治疗有重要的临床意义。     

肝动脉导管治疗肝癌的急性并发症

从１９９０年开展肝癌肝动脉导管治疗以来发生３例急性并发症：其中１例为脾脏梗死，１例为胆囊梗死，发生的原因主要是栓塞物进入脾动脉、胆囊动脉，造成缺血。为避免这种并发症，尽量超选择插管和在Ｘ线透视下缓慢灌注栓塞物；另１例为毛细血管渗漏综合征。分析了各自的临床表现和治疗方法，对以后减少并发症、更好地开展此项工作有重要意义。     

不同剂量碘油肝动脉栓塞术治疗原发性肝癌

目的探讨应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的疗效,并对其进行比较研究。方法1987年8月～1999年12月12年间276例原发性肝癌被分为两组治疗组167例,应用常规导管或球囊导管超选择至肿瘤供血动脉,阻断其血流,使注射碘油时不产生逆流,将全部动脉肿瘤血管、病变周围正常的细小动脉及肝实质和门静脉分支栓塞;对照组109例,应用一般导管,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉。结果治疗组中,栓塞全部动脉肿瘤血管、病变周围正常的细小动脉及肝实质167例,门静脉分支栓塞109例。1、2、3、4、5年生存率分别为98.8%(165/167)、79.9%(107/134)、48%(47/98)、36.6(26/71)、25.5%(12/47);对照组中,仅栓塞了部分或全部动脉肿瘤血管,1、2、3、4、5年生存率分别为79.9%(87/109)、45.5%(40/88)、21.3%、(13/61)、10.2%(5/49)、3.1%(1/32)。两组病人1、2、3、4、5年生存率经统计学处理有极显著差异(P<0.01-0.001),两组病人均无严重合并症发生。结论应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。     

卵巢动脉供血对盆腔肿瘤介入治疗效果的影响

目的 评价卵巢动脉(OA)供血对盆腔肿瘤介入治疗的疗效和安全性.方法 对63例盆腔肿瘤患者进行OA栓塞术.患者平均年龄43.6岁(16～66岁).子宫颈癌28例,子宫肌瘤22例,卵巢癌6例,绒癌3例,子宫肉瘤2例,纤维肉瘤、自肠癌侵犯子宫及附件各1例.63患者例中,阴道出血行介入治疗8例.栓塞材料采用聚乙烯醇微球(PVA)者24例,采用明胶海棉碎粒者10例,采用PVA+明胶海绵碎粒者26例,采用PVA+明胶海绵碎粒+微型钢丝圈者3例.结果 OA栓塞成功率为100%.栓塞两侧OA者19例,单侧者44例(左侧27例,右侧17例),均未发生与栓塞术相关的并发症.8例阴道出血患者经补充栓塞参与出血的OA后,出血立即停止,住院期间未再复发出血.术后随访2周至36个月,肿瘤明显缩小56例,稳定7例.有2例患者出现一过性卵巢功能减退症状,分别于术后3个月和4个月后自行恢复正常月经.结论 OA可参与盆腔肿瘤供血,是导致常规栓塞两侧髂内-子宫动脉疗效不佳的原因之一.介入治疗盆腔肿瘤时,应常规做OA造影,如OA参与盆腔肿瘤供血,补充做选择性OA栓塞化疗或栓塞术是安全有效的.     

Successful treatment of postoperative multiple hepatic recurrence with hepatic arterial infusion of cisplatin and degrable starch microspheres

A 38-year-old man had multiple recurrence of hepatocellular carcinoma (HCC) with portal vein thrombosis after hepatectomy and postoperative transcatheter arterial chemotherapy with 5-fluorouracil (5-FU). He was treated by trans hepatic arterial embolization (TAE) with 100 mg of cisplatin (CDDP) and degrable starch microspheres (DSM). After 3 courses were administered, the recurrent lesions almost disappeared on CT, and the postoperative rise in PIVKA-II level and AFP level normalized. There were no side effects except slight fever and general fatigue. We recognized a partial response, and the patient is still alive 14 months after hepatectomy. This case suggests that TAE with CDDP and DSM might be useful for prolonging the survival of advanced HCC patients.     

Two case reports-a control of the bleeding from advanced gastric cancer, unable to undergo resection, but was possible by transcatheter arterial embolization (TAE)

CASE 1: A 61-year-old man having advanced gastric cancer was presented with massive hematemesis. We could not control bleeding by gastrointestinal endoscopic hemostatic therapy, so we performed a transcatheter arterial embolization (TAE). We performed embolization on the left gastric artery. CASE 2: A 58-year-old man having advanced gastric cancer was presented with hematemesis. We could not control bleeding by gastrointestinal endoscopic procedure, so we conducted TAE. We performed embolization on the left gastric artery and right gastric artery. In both cases, hemostasis was achieved by TAE, and effectively controlled the bleeding from advanced gastric cancer.     

肝癌介入治疗后并发上消化道大出血的原因探讨

目的　探讨肝癌介入治疗后并发上消化道大出血的原因。方法　报道 42例肝癌患者介入治疗后发生上消化道大出血。结果　根据介入治疗后发生上消化道大出血的时间 ( <2周 ,2～ 4周和 >4周 )分组为 :急型、亚急型和慢性上消化道大出血分别有 5例、14例和 2 3例。结论　介入术后发生上消化道大出血的原因和机制非常复杂 ,搞清楚这些对本症的预防和治疗具有重要意义。     

A case report of postoperative recurrent hepatocellular carcinoma effectively treated with HCFU administration combined with TAE]

A 62-year-old man was found to have recurrent hepatocellular carcinoma (HCC) 2 cm in diameter in the left lobe in June 1990. After right lobectomy of the liver which contained the tumors of S6 2 cm and S8 3 cm in diameter 7 months before, the patient was treated with hepatic arterial embolization (TAE) combined with infusion of anti-cancer drug (ADM, CDDP) four times since June 1990. HCFU 300 mg per day was administered orally since June 1990. Since the 3rd TAE in December, 1990, the tumor stain in the left lobe disappeared for 10 months till October, 1991. No remarkable side effect of HCFU was noticed during this period. HCFU administration combined with TAE effectively prevented post-surgical recurrence of HCC in this case.     

Transcatheter arterial embolization for advanced hepatocellular carcinoma--indications and limitations

Many patients with advanced hepatocellular carcinoma (HCC) in stage IV have no surgical indications. Transcatheter methods such as transcatheter arterial embolization (TAE) and hepatic arterial infusion chemotherapy play a main role of the treatment for advanced HCC. Conventional TAE (from proper hepatic artery) is performed for patients without liver dysfunction. Patients with severe liver dysfunction could not in the past be treated with TAE, but lately it has become possible to treat them with the method of segmental TAE or subsegmental TAE due to the development of a microcatheter and advances in equipment. Although technical progress is remarkable, there are no fixed guidelines for advanced HCC. Suitable methods for individuals need to be discussed.     

Re-resection of the liver as reduction surgery for hepatocellular carcinoma

In this study, we report four cases of re-resection of the liver as reduction surgery for a failure of transcatheter hepatic arterial embolization (TAE) for multiple intrahepatic recurrences after hepatic resection. In all of the 4 cases, a liver function was well preserved and portal vein thrombosis was not revealed in preoperative CT scan. Although bile leakage was observed in one case, no major complications were observed in other 3 cases and their hospital stay after surgery was within 13 days. To date, one year survival rate after re-resection is 100%, and a short-term prognosis is good. On the basis of the result, re-resection of the liver as reduction surgery could be considered as one of options of the locoregional treatment for a failure of TAE for multiple intrahepatic recurrences.     

One-shot therapy and transcatheter arterial embolization (TAE) therapy of unresectable hepatocellular carcinoma

407 cases of unresectable hepatocellular carcinoma (HCC) occurring from 1970 to March 1985, including 107 cases receiving conservative therapy, 176 cases receiving one-shot therapy and 124 cases receiving transcatheter arterial embolization (TAE) therapy, were studied and the efficacy of chemotherapy was compared with that of TAE therapy. The results were as follows; One-year survival rate was 2.8% with a median survival time of 1.3 months in conservative therapy. In the 176 cases of one-shot therapy, one-year survival rate was 21.0%, two-year 6.8% and three-year 2.3% and the median survival time was 4.8% months. In 120 cases of one-shot therapy which were compatible with criteria for one-shot injection of anticancer drugs via the hepatic artery for HCC, one-year survival rate was 30%. However the rate was 1.8% in 56 cases which were not compatible with the criteria. In 37 cases in which Mitomycin C (MMC) and Adriamycin (ADR) were administered alternately, one-year survival rate was 41.7%, two-year 16.1% and three-year 4.3%. The highest survival rate was obtained by TAE therapy. One-year survival rate was 66.9%, two-year 33.8% and three-year 28.9%. Decrease of AFP after therapy was noted in 42.4% of cases given one-shot therapy and in 95.2% of cases given TEA therapy. The results suggest that alternate administration of anticancer agents produces good chemotherapeutic effects and that the best life-prolongation is obtained by TAE therapy.     

Improved time to progression for transarterial chemoembolization compared with transarterial embolization for patients with unresectable hepatocellular carcinoma

BackgroundEmbolizing branches of the hepatic artery lengthens survival for patients with unresectable hepatocellular carcinoma (HCC), but the benefit of combining chemotherapy with the embolizing particles remains controversial.MethodsA retrospective review was undertaken of sequential patients with advanced HCC undergoing embolization in the past 10 years at 2 neighboring institutions and with 2 years of follow-up data. TACE was generally performed with doxorubicin plus mitomycin C. Results: One hundred twenty-four patients were included; 77 received TACE and 47 received TAE. On multivariable analysis stratified by institution, type of embolization and CLIP score significantly predicted PFS and time to progression (TTP), whereas CLIP score and AFP independently predicted overall survival (OS). TACE significantly prolonged PFS and TTP (P = .0004 and P = .001, respectively), but not OS (P = .83).ConclusionsThe addition of chemotherapy to TAE prolongs PFS and TTP. Future efforts should focus on adjunctive therapies after the embolization to increase survival.     

超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用(英文)

目的探讨经导管超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用价值。方法 12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和/或明胶海绵颗粒栓塞肿瘤供血动脉,全部患者于栓塞后3～7d 手术切除肿瘤。结果 12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果结论本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻叫血管纤维瘤摘除术前的临床应用是安全有效的。     

超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用

目的探讨经导管超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用价值。方法12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和/或明胶海绵颗粒栓塞肿瘤供血动脉,全部患者于栓塞后3-7d手术切除肿瘤。结果12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果。结论本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用是安全有效的。     

A patient with hepatocellular carcinoma and portal vein thrombosis in 1st branch who was treated by transcatheter arterial embolization]

We report a patient with hepatocellular carcinoma (HCC) with portal vein thrombosis in the 1st branch who was treated by transcatheter arterial embolization (TAE) and survived more than 3 years. A 58-year old male was diagnosed as having unresectable massive type HCC in the area of S8 with portal vein thrombosis from the P8 branch to the right portal branch. He was treated by TAE via the anterior branch of right hepatic artery. One week later, localized hepatic infarction in the anterior segment was recognized. Five months later, the portal vein thrombosis had disappeared and become necrotic. After 3 years and 4 months, he died of a relapse of a gastric varix, but with no portal thrombosis and a well controlled intra-hepatic recurrence that was treated by repeated TAE. This case suggests that TAE might be effective for cases of HCC with portal vein thrombosis in the 1st branch, if the liver function and portal flow are suitable.