Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma: a report of two cases and literature review

Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma. To our knowledge, only 11 cases have been previously reported. We recently encountered two cases of CLE in our clinical work. Reviewing the 11 cases in the literature and the two cases in our report indicates that large dose lipiodol infusion and absence of particulate embolization should be avoided. The presence of a right-to-left shunt and inferior phrenic artery injection seems to increase the risk of CLE. More caution should be taken in these situations.

     

奥曲肽联合经动脉插管化疗栓塞治疗伴肝硬化肝细胞癌

目的评价奥曲肽联合经动脉插管化疗栓塞(TACE)治疗伴肝硬化肝细胞癌的临床效果。方法选择Child-Pugh评分A或B级伴肝硬化肝细胞癌患者共55例。实验组24例,行TACE术后第1天开始使用奥曲肽0.2mg皮下注射,每天2次。对照组31例,接受TACE治疗。每3个月进行1次评价。对两组6个月及1、2、3年的生存率进行比较。结果两组均无CR,实验组中16例PR,有效率为66.67%。对照组中11例PR,有效率为35.48%。两组有效率差异有显著性(P<0.05)。实验组3年生存率为45.83%,而对照组3年生存率为19.35%。两组3年生存率差异有显著性(P<0.05)。实验组中位生存期为31个月,对照组中位生存期为20个月。实验组中位TTP为9个月,对照组为6个月。奥曲肽副作用主要为轻度腹泻。结论奥曲肽联合TACE治疗伴肝硬化肝细胞癌有明确的效果。     

Study on the Changes in Microvessel Density in Hepatocellular Carcinoma Following Transcatheter Arterial Chemoembolization

Transcatheter arterial chemoembolization(TACE) of hepatic artery has been accepted as aneffective treatment for unresectable hepatocellularcarcinoma (HCC) .The blood supply of tumortissue isblocked in TACE,and tumor tissues undergo necrosisbecause of anoxia and ischemia. However,thechanges in microvessel density (MVD ) in HCCfollowing TACE had not been evaluated in theprevious studies. In the present study,the tumorMVD was examined by using immunohistochemistryin2 2 casesof HCC samp…     

Pulmonary embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma： a retrospective analysis on 10 years＇ experience

Objective:To study the clinical characteristics and treatment of pulmonary embolism(PE)after transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC).Methods:The clinical records of 13 512 patients diagnosed with HCC and received TACE from January 2000 to December 2009 were reviewed.Among these patients,5 031 were allocated into group A who had one or more disorders like diabetes,hypertension,coronary heart disease,obesity or varicose vein of lower limb,while the other 8 481 patien...     

Expression of Angiogenic Factors in Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

We previouslyreportedthatthemicrovesseldensity (MVD)inresidualhepatocellularcarcinoma(HCC)wassignificantlyincreasedafterundergoingtranscatheterarterialchemoembolization (TACE) [1] ,andhypothesizedthattumorangiogenesisafterTACEmightberelatedtoabnormalexpressionofsomean giogenicfactors Therefore ,weexaminedtheexpres sionofvascularendothelialgrowthfactor (VEGF )andbasicfibroblastgrowthfactor (bFGF )byim munohistochemistryinliversamplesfromHCC pa tientswhohadundergonehepatectomyfollowingT…     

Effect of preoperative transcatheter arterial chemoembolization on apoptosis of hepatocellular carcinoma cells

Ｈｅｐａｔｏｃｅｌｌｕｌａｒｃａｒｃｉｎｏｍａ (ＨＣＣ)ｉｓｏｎｅｏｆｔｈｅｍｏｓｔｃｏｍｍｏｎｍａｌｉｇｎａｎｃｉｅｓ ＳｕｒｇｉｃａｌｒｅｓｅｃｔｉｏｎｉｓｒｅｃｏｇｎｉｚｅｄａｓｔｈｅｍｏｓｔｅｆｆｅｃｔｉｖｅｍｅｔｈｏｄｆｏｒｐａｔｉｅｎｔｓｗｉｔｈＨＣＣ Ｕｎｆｏｒｔｕｎａｔｅｌｙ,ｏｎｌｙａｍｉｎｏｒｉｔｙｏｆｐａｔｉｅｎｔｓｃｕｒｒｅｎｔｌｙｄｉａｇｎｏｓｅｄｗｉｔｈＨＣＣｍａｙｂｅｎｅｆｉｔｆｒｏｍｔｈｉｓｒａｄｉｃａｌｏｐｔｉｏｎ Ｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｃｈｅｍ…     

VEGF在肝癌经肝动脉栓塞化疗术后的表达及临床意义

目的探讨血管内皮生长因子(vascularendothelialgrowthfactorVEGF)在肝癌经肝动脉栓塞化疗(transcatheterhepaticarterialchemoembolizationTACE)术后复发和转移中的作用。方法选取经TACE治疗后2期切除的肝癌标本29例,以同期单纯手术切除的30例标本作为对照,采用免疫组织化学和图像分析的方法检测VEGF的表达。结果TACE治疗组与单纯手术组的VEGF吸光度值分别为(0.149±0.021)和(0.134±0.018),前者明显高于后者(P<0.05)。结论VEGF的高表达可能是引起TACE术后高复发和转移率的一个重要原因。     

原发性肝癌行肝动脉化疗栓塞术后的并发症观察及护理

目的：针对原发性肝癌行经导管肝动脉化疗栓塞术（TACE）后的并发症,分析其原因,探讨其防治方法和护理措施。方法：92例原发性肝癌行TACE的患者,针对术后的常见并发症,总结其发生的原因,采取相应的预防护理措施。结果：92例患者无穿刺部位血肿发生,发热37例,腹痛59例,恶心呕吐23例。结论：有效的护理预防护理措施可明显减少或防止TACE术后并发症的发生。     

Analysis of serious complications of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma

Objective： To analyze the inductive agents, post-surgical managements and precautions of the serious complications caused by transcatheter arterial chemoembolization （TACE） for the treatment of hepatocellular carcinoma. Methods： Clinical data of 2 375 cases of TACE for 832 patients with middlestage or advanced hepatocellular carcinoma from January 1994 to December 2002 were analyzed. Results： There were 7 cases of serious complications, one of which was liver carcinoma rupture and another was acute renal failure. Totally there were 4 cases of paraplegia and one case of conduit knotted. Conclusion： Deadly complications may happen after TACE and it needs close surveillance and management in time.     

Prognostic significance of neutrophil to lymphocyte ratio in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization

Background Accumulating evidence indicates that systemic inflammation response is associated with the prognosis of various cancers. The aim of this study was to investigate the neutrophil-lymphocyte ratio (NLR), which is one of the systemic inflammation markers, in the prognosis of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE).

Methods The clinical data of 178 HCC patients who received TACE were retrospectively analyzed. The optimal NLR cutoff was determined according to the receiver operating characteristic (ROC) analysis. All patients were divided into NLR-normal group and NLR-elevated group according to the cutoff, and the clinical features of these two groups were comparatively analyzed. Meanwhile, the overall survival and disease free survival (DFS) were analyzed using the Kaplan-Meier method. The risk factors of postoperative survival were investigated using univariate and multivariate Cox regression analyses.

Results The optimal NLR cutoff was defined at 1.85 and 42 (23.6%) patients had an elevated NLR (NLR>1.85). The median survival time was 9.5 months (range 1–99 months). The clinical data between the two groups were comparable, except for α-fetoprotein. Follow-up results showed that the median survival of patients with normal NLR was 17.5 months (range: 1–99 months) compared with 8 months (range: 8–68 months) of patients with elevated NLR. The 1, 3 and 5-year overall survival of patients in the NLR-normal group and NLR-elevated group were 57.3%, 44.1%, and 27.2% and 42.1%, 19.6%, and 9.5% respectively (χ2=194.2, P <0.001). Similarly, the disease free survival also has a significant difference (χ2=39.3, P <0.001). Multivariate Cox regression analysis showed that a high NLR was an independent factor affecting the survival rate of HCC after TACE (P=0.04).

Conclusion Preoperative NLR was an important prognostic factor to predict the prognosis of patients with intermediate HCC treated with TACE.

     

Effect of preoperative transcatheter arterial chemoembolization on tumor cell activity in hepatocellular carcinoma

ＴｈｅｍｕｃｕｓｌａｙｅｒｉｓｔｈｅｆｉｒｓｔｂａｒｒｉｅｒｗｈｉｃｈｐｒｏｔｅｃｔｓｉｎｔｅｓｔｉｎｅｆｒｏｍｄａｍａｇｅｂｙｌｕｍｅｎｂａｃｔｅｒｉａＩｇＡｉｎｔｈｅｍｕｃｕｓｌａｙｅｒｄｅｃｌｉｎｅｓａｆｔｅｒｂｕｒｎ,1　ｂｕｔｔｈｅｒｅｉｓｎｏｄｉｒｅｃｔｅｖｉｄｅｎｃｅｔｏｓｈｏｗｔｈｅｒｅｌａｔｉｏｎｓｈｉｐｂｅｔｗｅｅｎＩｇＡｄｅｃｌｉｎｉｎｇａｎｄｆｕｎｃｔｉｏｎａｌｃｈａｎｇｅｓｉｎｔｈｅｍｕｃｕｓｌａｙｅｒＷｅｓｔｕｄｉｅｄｔｈｅｃｈａｎｇｅｓｉｎｔｈｅｂａｒｒｉｅｒｆｕｎｃ…     

肝移植前行肝动脉介入栓塞化疗的远期效果分析

目的研究探讨肝移植术前行肝动脉介入栓塞化疗对于术后患者远期疗效的临床价值。方法采取回顾性分析法,选取我
科2009年11月~2011年11月进行肝移植的肝细胞性肝癌（HCC）患者46例,其中24例术前予以肝动脉介入栓塞化疗（TACE）,
22例术前未予以TACE治疗。比较两组患者术后1年的肝功能（ALT和AST水平）、免疫功能（CD3、CD4、CD8、CD4/CD8、NK
细胞、活化T细胞比例）、术后1年和术后2年的累计生存率和无瘤生存率。结果术后1年介入组的肝功能显著优于对照组,P<
0.01,免疫功能显著优于对照组,P<0.05;术后1年介入组和对照组的累计无瘤生存率分别为72%和46%,术后2年介入组和对照
组的累计无瘤生存率分别为57%和33%,P<0.05;术后1年介入组和对照组的累计生存率分别为84%和55%,术后2年介入组和
对照组的累计生存率分别为63%和34%,P<0.05。结论在肝移植前行肝动脉介入栓塞化疗可以显著改善HCC患者术后的肝
功能和免疫功能,提高其无瘤生存率和术后生存率,具有临床应用价值。
     

肝动脉化疗栓塞联合射频消融术治疗肝癌的临床观察

目的 探讨肝动脉化疗栓塞(TACE)联合射频消融术(RFA)对肝癌综合治疗的效果.方法 47例原发性肝癌,分为单纯TACE组25例,联合组22例,先行TACE治疗,再行RFA治疗.治疗效果以1个月后增强CT扫描及甲胎蛋白(AFP)水平评估.结果 治疗后TACE和联合组AFP转阴率分别为39.1%和52.6%(P=0.428);缓解率分别为40%和72.7%(P=0.025);1年生存率分别为64%和86.4%(P=0.007).结论 TACE联合RFA治疗效果优于单纯化疗栓塞.     

不同剂量碘化油经肝动脉化疗栓塞后兔肝VX2移植瘤转移与坏死的关系

目的：评价不同剂量碘化油经肝动脉化疗栓塞（TACE）后兔肝VX2移植瘤转移与坏死的关系。方法：将48只荷瘤兔随机分成3组,每组16只。对照组经肝动脉灌注0.5mL生理盐水;常规剂量组经肝动脉灌注5mg阿霉素与常规剂量碘化油的混悬液;大剂量组经肝动脉灌注5mg阿霉素与大剂量碘化油的混悬液。常规剂量组和大剂量组碘化油用量（mL）分别为肿瘤体积（cm^3）乘以0.5和1。经股动脉穿刺插管,依分组情况行介入治疗,比较不同处理组肝脏原位移植瘤治疗后2wk的坏死分级、肝内转移率、肺转移率及转移与坏死分级的关系。结果：与常规剂量组相比,大剂量组肿瘤的坏死分级明显增加（P〈0.01）,肝内转移、肺转移的转移率明显降低（P〈0.05）。肿瘤的转移率和肿瘤的坏死分级呈负相关。结论：大剂量碘化油TACE能明显降低兔肝VX2移植瘤肝内转移及肺转移的发生率;其可能通过致移植瘤完全坏死或大部分坏死以降低栓塞后肝内转移及肺转移的发生率。     

Relationship between the Changes of VEGF Level and Dendritic Cells in Peripheral Blood of Patients with Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

In order to investigate the relationship between the VEGF level and the counts of den-dritic cells (DCs) in peripheral blood of patients with hepatocellular carcinoma (HCC) before and af-ter transcatheter arterial chemoembolization (TACE), the peripheral blood was obtained from 37 pa-tients with HCC who treated by TACE. The blood was obtained on the day before TACE, the first day, the 7th day and the 15th day after TACE respectively. The counts of DCs were quantified by flow cytometry. The plasma VEGF level was measured by ELESA kit. It was shown after TACE, the counts of DCs in peripheral blood were decreased significantly (P<0.05), and the VEGF level in pe-ripheral blood was increased significantly (P<0.05). The counts of DCs in peripheral blood had an inverse correlation with the plasma VEGF level (r=-0.57, P<0.05) after TACE. It was concluded that in patients with HCC after TACE, the increased plasma VEGF level appeared to have the effect to suppress the maturation of DCs, which may contribute to reduction of the body's anti-tumor im-munity effect, with a consequence of recur and metastasis of tumor.     

适形放疗联合介入化疗治疗原发性肝癌的临床研究

目的评价肝动脉化疗栓塞（TACE）联合立体适形放射治疗（3DCRT）对原发性肝癌的效果和不良反应。方法自2002-2005年,66例原发性肝癌患者进行随机分组研究,治疗组34例进行TACE联合3DCRT治疗,先行2次TACE治疗,然后行3DCRT,总剂量为45-55Gy,2-5Gy/Fx/周,对照组32例单纯行TACE治疗,共4次。结果治疗组34例患者总有效率为（RR）76.5%（26/34）,对照组为（RR）46.9%（15/32）;治疗组和对照组1、2、3年生存率分别为61.8%、41.2%和29.4%比46.9%、18.8%、6.3%。两组总有效率（RR）、1年生存率差异无统计学意义（P〉0.05）,2年生存率、3年生存率差异有统计学意义（P〈0.05）。两组不良反应相似。结论TACE结合3DCRT治疗原发性肝癌能明显提高临床治疗效果,而不良反应未见增加。     

经导管肝动脉化学栓塞术联合无水乙醇注射治疗肝细胞性肝癌疗效分析

目的:对经导管肝动脉化学栓塞术(TACE)联合B超引导下肝脏瘤体内无水乙醇注射术(PEI)治疗肝细胞性肝癌进行疗效分析。方法:将50例肝癌患者随机分为两组,治疗组(24例)予TACE联合PEI治疗,对照组(26例)单用TACE治疗。结果:治疗组6、12、18个月生存率依次为83.33%、54.17%和33.33%,最长生存30个月以上;对照组仅5例生存达12个月以上,生存率为19.23%。经统计学处理有显著性差异(P<0.01)。结论:TACE联合PEI是提高肝细胞性肝癌患者远期生存率较好的治疗方式。     

术中双途径化疗栓塞置管介入治疗晚期肝癌的疗效观察

２１例手术探查证实为病灶不能切除的晚期肝癌病人,在术中作肝动脉和门静脉插管并将与导管相连的注药盒埋置皮下,术后经注药盒行反复化疗栓塞治疗。药物包括阿霉素１０～３０ｍｇ、丝裂霉素１０～２０ｍｇ、卡铂１００～３００ｍｇ及超乳化碘油１０～３０ｍｌ。结果１６例生存超过１年,１年内死亡５例。     

评价MRI对原发性肝癌经导管动脉化疗栓塞后残癌的检出价值

目的分析25例原发性肝癌(hepatocellular carcinoma,HCC)经导管动脉化疗栓塞(transcatheterarterial chemoembolization,TACE)治疗后残癌的磁共振(MRI)表现,并与数字减影血管造影(digital subtraction angi-ography,DSA)对比,了解MRI对残癌的检出价值。方法25例原发性肝癌行TACE治疗的患者,TACE治疗后4~6周常规行MRI平扫及腹部三维容积多期动态增强扫描,MRI检查后1~3天行DSA造影。结果初次TACE后,25例患者中,24例患者的41个残癌病灶被检出,MRI和DSA分别检出39个,其中21例患者的37个病灶MRI与DSA检出相符(37/41);另外4个病灶,DSA发现位于原发灶中心2个,而MRI未发现。MRI发现位于肝脏边缘2个,而DSA未发现。结论MRI是肝癌TACE术后了解残癌的理想检查方法。     

Efficacy of postoperative antiviral combined transcatheter arterial chemoembolization therapy in prevention of hepatitis B-related hepatocellular carcinoma recurrence

Background  Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence.

Methods  One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied.

Results  There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P=0.283), while it was significantly higher in the TACE group compared to control (P=0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P <0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P=0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients’ postoperative DFS (P=0.047) and vice verse (P=0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P <0.001 and P=0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P=0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P=0.034).

Conclusions  Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.