38例原发性肝癌动-静脉瘘介入治疗的疗效分析

目的回顾性评价超选择性动脉插管栓塞原发性肝癌合并动-静脉瘘的疗效,以期提高患者的生存质量和延长生存期。方法本院近2年实施经动脉插管栓塞化疗的原发性肝癌425例,其中合并动-静脉瘘38例,采用超选择性动脉插管分别对动-静脉瘘以无水乙醇或无水乙醇＋明胶海绵颗粒、对肿瘤病灶以无水乙醇＋碘油（1：1）或碘油＋2～3种化疗药物实施栓塞。观察术后的临床表现,并随访复发率与生存率。结果425例原发性肝癌合并动脉-门静脉瘘38例（8．9％）,其中,高流量型21例（55％）,低流量型17例（45％）,同时伴有肝动脉-肝静脉瘘8例（21％）。38例均成功实施动-静脉瘘及肿瘤病灶的超选择性动脉插管栓塞术,其中,35例经过2～3次治疗。术后肝功能好转23例（61％）;腹水消失13例（34％）,腹水明显减少20例（53％）;6个月生存率84％（32例）,1年生存率61％（23例）。结论超选择性动脉插管栓塞术治疗肝癌伴动-静脉瘘,能缓解其导致的门静脉高压及其严重后果,疗效肯定,并且为同期实施的肿瘤病灶栓塞治疗奠定了基础,该方法可明显提高患者的生存质量,延长生存期。     

Transcatheter arterial embolization for bleeding from bile duct tumor thrombi of hepatocellular carcinoma

BACKGROUND/AIMS: Advanced hepatocellular carcinoma usually invades the portal vein, forming tumor thrombi. Invasion of the bile duct, i.e., intrabile tumor growth or bile duct tumor thrombi is rare. Patients with bile duct tumor thrombi present with obstructive jaundice, abdominal pain or hemobilia. Hemobilia due to bile duct tumor thrombi is sometimes massive and fatal. The purpose of our study was to evaluate the effectiveness of transcatheter arterial embolization for hemobilia caused by bile duct tumor thrombi of hepatocellular carcinoma. METHODOLOGY: Between 1993 January and 2000 December, transcatheter arterial embolization was performed in 4 patients with hemobilia and gastrointestinal bleeding from bile duct tumor thrombi of hepatocellular carcinoma. RESULTS: In all 4 patients, transcatheter arterial embolization was successfully performed and resulted in cessation of bleeding. One patient had recurrent hemobilia, which was controlled by another transcatheter arterial embolization. Three patients were discharged from hospital after transcatheter arterial embolization. Patients died of hepatic failure or multiple tumors 5 to 7 months after the onset of hemobilia, although hemobilia had been fully controlled. CONCLUSIONS: Transcatheter arterial embolization seemed to be effective for the control of massive hemobilia caused by bile duct tumor thrombi associated with hepatocellular carcinoma.     

Subsegmental transcatheter arterial embolization for small hepatocellular carcinoma

BACKGROUND/AIMS: The evaluation of long-term outcome of subsegmental transcatheter arterial embolization, which was designed to bring about sufficient anti-tumor effect, in the primary cases of small hepatocellular carcinoma. METHODOLOGY: We analyzed and compared the anti-tumor effect and the survival rate in the primary cases of solitary small hepatocellular carcinoma (< or = 3 cm) with cirrhosis treated by subsegmental transcatheter arterial embolization, chemolipiodolization or percutaneous ethanol injection therapy during the last eight years, retrospectively. RESULTS: The complete tumor necrosis by one session of subsegmental transcatheter arterial embolization, which means that treated tumor showed complete response and did not show local recurrence thereafter, was seen in approximately 50% of the cases. The rate of complete tumor necrosis was superior to that in the patients treated by chemolipiodolization although it was lower than that in the patients treated by percutaneous ethanol injection therapy. Both of the 5- and 7-year survival rates in the patients treated by subsegmental transcatheter arterial embolization were 41.2%. It was slightly higher than those in the other treatment groups without significant difference. CONCLUSIONS: Subsegmental transcatheter arterial embolization might be effectively performed as an initial treatment for the primary cases of the solitary small hepatocellular carcinoma when tumor was fully supplied by hepatic arterial blood regardless of small size.     

Portal venous hemodynamics in hepatocellular carcinoma. Effects of hepatic artery embolization

Portal hemodynamics were studied in 55 patients with hepatocellular carcinoma in comparison with 41 normal subjects, using the duplex system that consists of an electronic sector scanner and a pulsed Doppler velocitometer. Changes of portal hemodynamics after transcatheter hepatic artery embolization were also investigated in 15 of the patients with hepatocellular carcinoma. The duplex system showed that 9 of the 55 had no Doppler signal in the portal trunk, suggesting portal vein thrombosis, 2 had hepatofugal flow in the portal trunk indicative of arterioportal shunts, and 44 had hepatopetal flow in the portal trunk. One of the 9 patients with no significant portal venous flow showed hepatopetal flow in collateral veins at the porta hepatis, suggesting cavernous transformation of the portal vein. All of these ultrasound findings were confirmed by subsequent celiac-mesenteric angiography. In 44 of the 55 patients there was no tumor invasion in the portal trunk, and portal venous flow was found to be close to that of normal subjects regardless of the stage or size of tumor, and tumor invasion into relatively large portal branches. After transcatheter hepatic artery embolization, portal venous flow was increased, even on the next day, and it remained increased for at least 2 wk. Thus, the duplex system is useful to study qualitative and quantitative changes of portal hemodynamics in hepatocellular carcinoma. Our observations suggest that the portal venous flow is kept relatively constant by some homeostatic mechanism even in advanced hepatocellular carcinoma until the tumor invades into the portal trunk, and that it increases when hepatic arterial flow is occluded.     

Long-term follow-up of hepatic arterial chemoembolization with cisplatin suspended in iodized oil for hepatocellular carcinoma

BACKGROUND/AIMS: We developed a method to suspend cisplatin in lipiodol (lipiodol-cisplatin suspension) for treating hapatocellular carcinoma. We evaluated the results of the long-term follow-up of lipiodol-cisplatin suspension therapy and the augmentation of its anti-cancer effect when in combination with transcatheter arterial embolization. METHODOLOGY: Hepatic arterial injection chemotherapy with lipiodol-cisplatin suspension was performed in 239 patients with hepatocellular carcinoma without distant metastases. One hundred and forty-three patients treated with lipiodol-cisplatin suspension alone were clinically compared to 96 patients treated with lipiodol-cisplatin suspension and transcatheter arterial embolization. RESULTS: Complete and partial responses were obtained in 83 cases (53.2%) in the lipiodol-cisplatin suspension alone group compared to 60 cases (62.5%) in the lipiodol-cisplatin suspension and transcatheter arterial embolization group. The survival rate of the former was 29.6% at 5 years, and of the latter was 24.2% at 5 years. The difference in survival rates between the two groups was not significant, however, in both groups excellent anti-cancer effects and prolongation of survival were seen compared to previous transcatheter arterial embolization methods. CONCLUSIONS: Lipiodol-cisplatin suspension therapy has an excellent anti-cancer effect superior to previous transcatheter arterial embolization methods and prolongs the survival rate for the patients with hapatocellular carcinoma.     

Staged hepatectomy following arterial embolization for ruptured hepatocellular carcinoma

BACKGROUND/AIMS: While hemostasis by transcatheter arterial embolization is often the first choice in the initial treatment of ruptured hepatocellular carcinoma, post-transcatheter arterial embolization treatment has not fully been established. We studied the prognoses of ruptured hepatocellular carcinoma cases where hepatectomy was possible after transcatheter arterial embolization. METHODOLOGY: We retrospectively reviewed 10 cases of ruptured hepatocellular carcinoma which had been treated in our institution between 1989 and 1998. In all the 10 cases, emergency transcatheter arterial embolization was performed, which successfully achieved hemostasis. RESULTS: Following the achievement of hemostasis by transcatheter arterial embolization, hepatectomy was carried out in 5 cases after evaluation of general condition, functional liver reserve and extent of tumor spread. There was neither operative nor hospital death. One-year and 3-year survival rates were 100% and 40%, respectively, and 50% survival time was 36 months. In the other 5 patients, hepatectomy was decided to be impossible after evaluation of general condition, functional liver reserve and extent of tumor spread; all of them died within 0.5-10 months after transcatheter arterial embolization. CONCLUSIONS: Among the patients with ruptured hepatocellular carcinoma, those in which hepatectomy was decided to be possible after evaluation of general condition, functional liver reserve and extent of tumor spread, following successful hemostasis by transcatheter arterial embolization, had fairly good prognoses.     

Transcatheter arterial embolization for advanced hepatocellular carcinoma resulting in a curative resection: report of two cases

Transcatheter hepatic arterial embolization and lipiodolization have been reported to be effective palliative treatments for patients with unresectable hepatocellular carcinoma. We experienced 2 patients with advanced hepatocellular carcinoma which were initially considered to be unresectable due to the extreme extension of the primary lesions. Therefore, transcatheter hepatic arterial embolization with lipiodolization were selected as the treatments of choice. Thereafter, these tumors markedly decreased in size and, as a result, curative resections could subsequently be performed. The pathological examination of the resected specimens revealed necrosis and hyaline degeneration in the main tumors. Viable tumor cells, however, still remained adjacent to the main tumors. Such evidence indicated the limited efficacy of transcatheter hepatic arterial embolization with lipiodolization and the necessity of performing surgical treatment in combination with transcatheter hepatic arterial embolization with lipiodolization. Based on these findings, transcatheter hepatic arterial embolization with lipiodolization both appear to be a good mode of therapy for advanced hepatocellular carcinoma, and in selected patients, subsequent surgery can also be considered.     

Benefit of transcatheter arterial embolization for ruptured hepatocellular carcinoma complicating liver cirrhosis

In 6 patients with spontaneous rupture of hepatocellular carcinoma complicating liver cirrhosis, but with no occlusion of the main portal trunk, transcatheter arterial embolization was performed within 7 days of the rupture. All 6 patients were thought to be inoperable because of shock state or severe hepatic dysfunction. In all 6 patients, the progressive decrease in the hematocrit ceased soon after the embolization. Five patients survived for 31-168 days after the embolization; 1 patient who developed septicemia died 10 days later. We conclude that transcatheter arterial embolization is beneficial as a procedure of first choice for ruptured hepatocellular carcinoma when the portal blood flow is maintained.     

Efficacy of prophylactic sclerotherapy in patients with hepatocellular carcinoma and varices negative for the red color sign

Background: A prospective randomized controlled study was performed to evaluate the usefulness of prophylactic endoscopic sclerotherapy in patients with hepatocellular carcinoma complicated by esophageal varices. Methods: The subjects included 58 patients with esophageal varices negative for the red color sign and hepatocellular carcinoma without tumor emboli in the portal trunk or primary portal branches. Patients were randomly assigned to prophylactic sclerotherapy (n = 29) or control (n = 29) groups, and their bleeding and survival rates were compared. Results: A mean of 3.0 sclerotherapy sessions was required for complete disappearance of varices in patients receiving prophylactic sclerotherapy. During the observation period, transcatheter arterial embolization for hepatocellular carcinoma was performed more often in patients with prophylactic sclerotherapy (mean 3.8 times) than in control patients (mean 2.0 times) (p < .05). Percutaneous ethanol injection therapy was performed more often in patients with prophylactic sclerotherapy than in controls (mean 8.1 times vs 5.0 times, respectively) (p < .05). The 3-year bleeding rates were 50% for the control group and 18% for the prophylactic sclerotherapy group (p < 0.05), and the 3-year survival rates were 16% for the control group and 37% for the therapy group (p < 0.05). Conclusions: Prophylactic sclerotherapy improves survival in patients with hepatocellular carcinoma complicated by red color sign–negative esophageal varices without tumor emboli in the portal trunk or primary portal branches. (Gastrointest Endosc 1997;45:498-502.)     

Resection of an icteric type hepatoma with tumor thrombi filling the right posterior bile duct

A 67-year-old male with jaundice was found to have hepatocellular carcinoma in the right hepatic lobe and tumor thrombi in the common hepatic duct. Physicians initially considered the tumor unresectable, and treated the patient with transcatheter arterial infusion chemotherapy and biliary endoprosthesis. The patient developed a liver abscess after the second transcatheter arterial infusion, and the physicians consulted our department for another form of therapy. Percutaneous transhepatic biliary drainage was performed to relieve revived obstructive jaundice. Cholangiography revealed tumor thrombi extending through the right posterior segmental bile duct into the common hepatic duct. Most biliary branches of the caudate lobe joined with the left lateral posterior segmental branch. Arterial and portal venous branches of the caudate lobe were not involved. Right hepatic lobectomy and extrahepatic bile duct resection were performed 1 year after initial diagnosis. On histologic examination, the epithelium of the right posterior segmental bile duct, which was filled with the tumor thrombi, was not detected. The patient is alive without recurrence 24 months after surgery. Careful investigation of biliary branches of the caudate lobe on cholangiography is essential to determine the necessity of caudate lobectomy in patients with hepatocellular carcinoma and tumor thrombi filling the right posterior segmental bile duct.     

Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors.

Of 270 consecutive patients with hepatocellular carcinoma who underwent surgery, 50 who had recurrence and were subsequently treated with transcatheter arterial embolization were analyzed. The longest interval between surgery and recurrence in the 50 patients who underwent transcatheter arterial embolization was 7 yr. Recurrence was initially found in the remnant liver in all patients but one; extrahepatic metastases were detected in 13 patients (26%) during follow-up. A "multiple" type was the most common (64%) hepatic recurrence pattern on angiography, followed by the "solitary" (16%) and "tumor thrombus" (12%) patterns. Hepatic recurrence was most frequently found in the ipsilateral lobe (48%) relative to the site of the primary hepatocellular carcinoma. Multivariate analysis of the factors affecting survival after transcatheter arterial embolization indicated that recurrence pattern (p = 0.025) and distant metastases (p = 0.011) were significant. Of 13 patients with distant metastases, 11 had the "multiple" pattern of hepatic recurrence. Survival rates for all 50 patients after initial surgery and after transcatheter arterial embolization were 90% and 64%, respectively, at 1 yr; 52% and 24%, respectively, at 3 yr; and 27% and 5%, respectively, at 5 yr. On analysis of survival rates after transcatheter arterial embolization in 37 patients with recurrence only in the liver and of the response of recurrent hepatocellular carcinoma to transcatheter arterial embolization, a significant difference was noted between those with "partial response" and "progressive disease" (p less than 0.05) and between those with "no change" and "progressive disease" (p less than 0.05).     

Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature

A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.     

Evidence of gallbladder function changes in hepatoma after transcatheter arterial embolization by quantitative Tc-99m DISIDA cholescintigraphy

BACKGROUND/AIMS: Transcatheter arterial embolization is the treatment of choice for inoperable hepatocellular carcinoma. Gallbladder infarction following transcatheter arterial embolization has been reported, therefore, the gallbladder functions were studied using the quantitative Tc-99m DISIDA cholescintigraphy in the present study. METHODOLOGY: The gallbladder functions which were presented as the filling fraction and the ejection fraction in 24 patients with hepatoma before and after transcatheter arterial embolization. The patients were separated into two groups. Group 1: 12 patients received precystic artery transcatheter arterial embolization and group 2: 12 patients received postcystic artery transcatheter arterial embolization. RESULTS: After transcatheter arterial embolization, significantly decreased both gallbladder functions of filling fraction (61.2 +/- 7.4% and 48.3 +/- 6.5%) and ejection fraction (47.8 +/- 6.0% and 36.5 +/- 5.3%) were found in group 1 patients. However, no significant change of filling fraction (59.0 +/- 5.0% and 58.8 +/- 7.4%) and ejection fraction (49.9 +/- 2.4% and 49.3 +/- 5.7%) in group 2 patients. CONCLUSIONS: Impaired gallbladder functions were common in hepatoma patients who received precystic artery transcatheter arterial embolization, and Tc-99m DISIDA cholescintigraphy may be useful for evaluating the gallbladder functions in hepatoma patients who received transcatheter arterial embolization.     

Therapy of HCC-radiofrequency ablation

Radiofrequency interstitial hyperthermia has been used for percutaneous ablation of hepatocellular carcinoma, under ultrasound guidance in local anesthesia. Conventional needle electrodes require a mean number of 3 sessions to treat tumors of diameter < or = 3 cm. Tumors up to 3.5 cm in diameter can be treated in 1 or 2 sessions by expandable needle electrodes. With both methods in all treated cases, ablation of tumors was obtained. In a group of patients with long follow-up, survival rate at 5 years was 40%. In a mean follow-up of 23 months 41% of patients had recurrences (local recurrences in 5%; new lesions in 36%), which often could be retreated by a new course of radiofrequency application. In recent experience large hepatocellular carcinomas (up to 6.8 cm in diameter) were treated by a combination of segmental transcatheter arterial embolization followed by radiofrequency application. In this way most tumors were ablated in one session of radiofrequency therapy. No fatal complications were observed. Major complications were: strong pain due to capsular necrosis in one patient; hemotorax in one case; a fluid collection in the site of ablated tumor in one patient treated by combination of transcatheter arterial embolization and radiofrequency application.     

Clinical efficacy of portal vein stent placement in patients with hepatocellular carcinoma invading the main portal vein

BACKGROUND/AIMS: Hepatocellular carcinoma frequently invades the portal veins, and when it invades the main portal vein, the patient's prognosis is extremely poor. This study was undertaken to evaluate the clinical efficacy of stent placement into the portal vein in these patients. METHODS: Twenty-one patients with hepatocellular carcinoma invading the main portal vein were studied. Stents were placed in the portal veins to compress tumor thrombi after percutaneous transhepatic portography. RESULTS: Stents were successfully placed in the portal veins in all patients. Portal venous pressure significantly decreased from 25.3 +/- 7.4 mmHg to 22.4 +/- 6.6 mmHg (p < 0.0001) immediately after stent placement, leading to improvement in gastroesophageal varices, melena and ascites. Although a pseudoaneurysm of the hepatic artery related to portal vein puncture developed in one patient, there were no major complications in the other 20 patients. Blood flow through the stent was maintained during the survival period in 15 patients. The mean stent patency period was 12.4 months. Fifteen patients underwent transcatheter arterial chemoembolization without major complications after stent placement. The survival rate was 64.2% at 6 months and 29.2% at 1 and 2 years, respectively. The mean survival period was 13.7 months. CONCLUSION: Stent placement into the portal vein is a relatively safe and feasible procedure. It improves portal hypertension, expands treatment options, and helps to prolong the survival period in patients with hepatocellular carcinoma invading the main portal vein.     

Hepatic Arterioportal Fistulas: A Retrospective Analysis of 97 Cases

Background and AimsHepatic arterioportal fistulas (HAPFs) are abnormal shunts or aberrant functional connections between the portal venous and the hepatic arterial systems. Detection of HAPFs has increased with the advances in diagnostic techniques. Presence of HAPFs over a prolonged period can aggravate liver cirrhosis and further deteriorate liver function. However, the underlying causes of HAPFs and the treatment outcomes are now well characterized. This study aimed to summarize the clinical characteristics of patients with HAPFs, and to compare the outcomes of different treatment modalities.MethodsData of 97 patients with HAPFs who were admitted to the Second Xiangya Hospital between January 2010 and January 2020 were retrospectively reviewed. Demographic information, clinical manifestations, underlying causes, treatment options, and short-term outcomes were analyzed.ResultsThe main cause of HAPF in our cohort was hepatocellular carcinoma (78/97, 80.41%), followed by cirrhosis (10/97, 10.31%). The main clinical manifestations were abdominal distention and abdominal pain. Treatment methods included transcatheter arterial embolization (n=63, 64.9%), surgery (n=13, 13.4%), and liver transplantation (n=2, 2.1%); nineteen (19.6%) patients received conservative treatment. Among patients who underwent transcatheter arterial embolization, polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy.ConclusionsHepatocellular carcinoma and cirrhosis are common causes of HAPFs. Transcatheter arterial embolization is a safe and effective method for the treatment of HAPFs, and polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy in our cohort.     

Experimental and clinical studies on liver regeneration following transcatheter portal embolization

BACKGROUND/AIMS: We studied compensatory hypertrophy following transcatheter portal embolization experimentally in dogs and clinically under the condition of cholestasis. METHODOLOGY: Experimental study: Sixteen dogs were used for this study. Transcatheter portal embolization was performed in the left lobes (70% of the total liver) using Gelfoam powder in dogs with 2-week obstructive jaundice. Liver weight, liver blood flow and the intracellular adenosine triphosphate content of isolated hepatocytes were measured after transcatheter portal embolization. Clinical Study: transcatheter portal embolization of the right portal branch was performed in 13 patients with cancer of the biliary tract and 3 patients with hepatocellular carcinoma before (extended) right lobectomy, using Gelfoam powder and thrombin. Six patients who had a total bilirubin level > 5 mg/dLunderwent a percutaneous transhepatic biliary drainage before transcatheter portal embolization. Liver function tests, a volumetric study with computed tomography and immunohistochemical staining for profilerating cell nuclear antigen and apoptosis in the resected livers were performed. RESULTS: Experimental study: The weight ratio of the non-embolized lobes to the total liver, 2 weeks after transcatheter portal embolization in the dogs with jaundice, was significantly lower than that of the normal dogs with transcatheter portal embolization (40.5 +/- 4.5% vs. 47.6 +/- 3.2%), but significantly larger than that of the dogs without transcatheter portal embolization. The cellular adenosine triphosphate content and tissue blood flow in the embolized lobes were significantly lower than those in the nonembolized lobes in the normal and cholestatic livers. Clinical study: The postoperative course in all patients was uneventful, with no serious complication or liver dysfunction. Extended right lobectomy with caudate lobectomy was equivalent to 65% before transcatheter portal embolization and to 56% after, transcatheter portal embolization owing to compensatory hypertrophy of the left lobe. However, there was no significant difference in liver volume in the patients with or without obstructive jaundice. Apoptosis was observed in the embolized lobe. CONCLUSIONS: Preoperative transcatheter portal embolization with percutaneous transhepatic biliary drainage for the purpose of liver regeneration would be useful for treating extended hepatectomy with obstructive jaundice.     

多模式介入治疗伴失代偿性肝硬化肝癌

目的探讨伴失代偿性肝硬化肝细胞癌（HCC）多模式介入治疗的临床价值。方法在内科治疗稳定后,147例伴肝硬化失代偿HCC患者接受不同介入模式的治疗,其中36例采用肝动脉化学栓塞（TACE,A组）,54例采用肝动脉节段性化学栓塞治疗（S-TACE,B组）,57例采用S-TACE后序贯射频消融（RFA）或（加）无水乙醇局部注射（PEI）的多模式介入治疗（C组）。结果随访6～72月,A组、B组和C组患者中位生存期分别为4．1月、9．4月（P〈0．05）和13．7月（P〈0．01和P〈0．05）;累计生存率6个月分别为22．2％、51．8％（P〈0．05）和75．44％（P〈0．01）,12个月分别为5．6％、31．5％（P〈0．05）和40．35％（P〈0．05）,24个月分别为0、9．3％和19．30％（P〈0．05）;AFP复常率分别为23．3％、60．5％（P〈0．05）和71．1％（P〈0．01）;瘤体缩小（〉50％）分别占8．3％、31．5％（P〈0．05）和50．9％（P〈0．01）。单变量分析显示包括HBVDNA在内的14项因素与预后显著相关,多因素Cox模型分析显示肝功能Child—Pugh分级、吲哚氰绿15min储留率（ICGR,s）、门静脉癌栓、介入模式及甲胎蛋白术前升高者介入后变化与预后显著相关。结论多模式介入治疗是伴肝功能失代偿HCC的有效治疗方法,对HBVDNA阳性患者应该考虑抗病毒治疗。     

Cimetidine reduces impairment of cellular immunity after transcatheter arterial embolization in patients with hepatocellular carcinoma

BACKGROUND/AIMS: Natural killer cells have an intrinsic ability to recognize and attack some tumor cells and infected cells. Natural killer cell cytotoxicity is depressed in patients with hepatocellular carcinoma. In particular, cell-mediated immunity is impaired after transcatheter arterial embolization, which is an effective therapy for hepatocellular carcinoma. There have been reports that cimetidine can activate cellular immunity and increase the survival time in patients with some cancers. Therefore, we investigated whether cimetidine could improve cellular immunity after transcatheter arterial embolization, especially in relation to natural killer activity. METHODOLOGY: Thirty-four patients with hepatocellular carcinoma and cirrhosis who underwent transcatheter arterial embolization at our hospital were studied prospectively after giving informed consent. The patients were divided into three groups. In group A, 14 patients were administered 800 mg of cimetidine a day. In group-B, 13 patients were administered 40 mg of famotidine or 300 mg of nizatidine a day. In group-C 7 patients did not receive histamine 2 receptor antagonists. Natural killer cell activity in peripheral blood was measured before transcatheter arterial embolization and on days 1 and 7. RESULTS: The % natural killer cell activity on day 1 was 74 in group A, 52 in group B, and 52 in group. The % activity on day 7 was 98 in group A, 71 in group B, and 82 in group C. Cimetidine group showed the significant higher % natural killer cell activity on day 1 (p = 0.032). CONCLUSIONS: Our study raises the possibility that cimetidine has the effect to preserve cell-mediated immune response during transcatheter arterial embolization.     

Long-term prognosis after arterio-portal embolization for hepatocellular carcinoma

BACKGROUND/AIMS: Resection is the treatment of choice for hepatocellular carcinoma. However, relatively few patients with hepatocellular carcinoma are surgical candidates. The efficacy of a radiologic hepatectomy, achieved by combined embolization of the arterial and portal tumor blood supply, was determined and compared to surgical hepatectomy in a retrospective analysis. METHODOLOGY: The records of 32 patients treated for hepatocellular carcinoma between 1989 and 1992 were reviewed. The outcome in 15 patients treated with combined selective segmental portal vein embolization and hepatic artery embolization without hepatectomy (Embolization group) was compared with the outcome in 17 patients who under went curative hepatic resection (Resection group). The recurrence-free and cumulative survival rates were compared in the two groups. RESULTS: Except for a greater number of men in the Resection Group (p=0.03), the demographics and clinical characteristics of the two groups were similar at baseline. There was no patient who died within 30 days of treatment. The recurrence-free survival rates after embolization and resection were 20.8 and 23.4% at 5 years, respectively. The corresponding cumulative survival rates were 23.2 and 51.3%. CONCLUSIONS: Combined embolization without hepatectomy may be a viable alternative to curative hepatectomy for selected patients with hepatocellular carcinoma.