The efficacy of transcatheter embolization of severe arterioportal shunts in hepatocellular carcinoma

Transcatheter arterial embolizations of severe arterioportal shunt (A-P shunt) were performed with steel coils in 3 patients with hepatocellurlar carcinoma (HCC) as shown below. Case 1: A 56-year-old man with HCC associated with portal hypertension (esophageal varices and ascites abnominal pain), portal vein tumor thrombus and severe A-P shunt was performed in critical conditions. Case 2: A 51-year-old man with HCC, lung and adrenal gland metastases was accompanied with severe portal hypertention caused by A-P shunt and was in a harmful condition similar to case 1. Case 3: A 68-year-old woman with HCC associated with autoimmune hepatitis was performed a hepatic resection. Then multiple intrahepatic recurrences appeared 6 months later. A-P shunt made impossible to detect the feeding artery of tumor. After embolization of A-P shunt, esophageal varices and ascites resolved, and abdominal pain improved in cases 1 and 2. In addition, embolization enabled to perform transcatheter arterial chemoembolization in case 3. This procedure is a useful tool to improve various symptoms due to A-P shunt and to continue treatments for HCCs.     

Retrospective study of short survival cases in hepatocellular carcinoma after transcatheter arterial embolization therapy

Twenty-two patients with hepatocellular carcinoma were treated with transcatheter arterial embolization therapy. In the six who died within about a month, serum albumin and Ch-E were lower, and total bilirubin and ICG R15 were higher than in the other cases. In four of them, more than 50% of the liver was occupied by tumor, and tumor thrombosis were found in the portal trunk or bilateral first portal branch. Five patients died of hepatic failure followed by upper gastrointestinal bleeding. One died of cachexia. The causes of short survival were 1) severe liver cirrhosis, 2) portal obstruction, 3) large tumor, 4) widespread TAE, 5) retrograde flow of gelfoam.     

脾动脉部分栓塞联合肝动脉化疗栓塞治疗原发性肝细胞癌合并脾亢的临床研究

背景与目的：原发性肝细胞癌（primary hepatocellular carcinoma,PHC）患者70％-90%有肝硬化、脾功能亢进以致患者术前外周血象偏低或术后外周血象恢复缓慢常影响经肝动脉化疗栓塞（transcatheter hepatic arterial chemoembolization,TACE）的正常进行。本研究探讨脾动脉部分栓塞（partial splenic embolization,PSE）联合经TACE治疗合并脾功能亢进的PHC的方法和意义。方法：对26例PHC患者采用PSE联合TACE治疗的方法,26例PHC患者单用TACE治疗。结果：PSE联合TACE较单用TACE治疗明显改善PHC患者外周血象,PSE术后3天、1周、2周及4周外周血白细胞、红细胞、血小板较栓塞前明显提高。结论：PSE联合TACE是PHC合并脾亢的安全、有效治疗方法。     

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。     

Assessment of future remnant liver regeneration after portal vein embolization using three‐dimensional CT and MR volumetric analyses

The purpose of this study is to portray right portal vein embolization (PVE) as a valuable technique that helps in expanding the volume of the left liver lobe and discuss the relevant published work. We describe our experience with four patients who underwent PVE and analyse the value of CT and MRI in the preoperative evaluation of these patients. Four patients with hepatic malignancy (hepatocellular carcinoma) (n = 2) and metastatic liver disease (n = 2) underwent portal vein occlusion. PVE was carried out in three patients using polyvinyl alcohol and stainless steel coils. Portal vein ligation was carried out in the fourth patient. In patients who were candidates for right hepatectomy, CT volumetric analysis was carried out before the surgery to assess the total liver volume and the future remnant liver, which is the residual left hepatic volume (in cases of right hepatectomy) or left lateral segment volume (in cases of right tri‐segmentectomy). Because the left lobe volumes were insufficient, patients were selected to undergo right PVE. Computed tomography volumetry was carried out 2–4 weeks after embolization to assess left hepatic lobe regeneration. Magnetic resonance volumetric analysis was carried out in two patients before and after embolization. All four patients had significant regeneration of the left lobe and tolerated the surgery with uneventful postoperative recovery.     

A case of hepatocellular carcinoma (acute abdominal type) misdiagnosed as acute appendicitis and satisfactorily treated by a two-stage operation

A 66-year-old man was admitted because of right lower abdominal pain and was operated on for acute appendicitis on March 12, 1983. It was found that his appendix was not inflamed, but a bleeding tumor was encountered in the posterior segment of the liver. Bleeding was controlled by suturing the liver above the tumor. Postoperative celiac angiography revealed many daughter tumors scattered in, but restricted to, the right lobe of the liver. The patient was treated by transcatheter arterial embolization combined with transcatheter arterial infusion of lipiodol and Adriamycin on April 25. Subsequently, a curative operation (right hemihepatectomy) was performed on May 24. The patient is still alive without recurrence 6 months after the resection. In case of ruptured hepatocellular carcinoma, it appears to be better to perform a two-stage operation with careful estimation of functional reserve of the liver, and to conduct transcatheter arterial embolization between operations to prevent the growth of the tumor during that period.     

Successful treatment for advanced cholangiocellular carcinoma with intrahepatic metastasis and/or portal vein tumor thrombi by intraarterial chemotherapy combined with 5-fluorouracil, adriamycin and cisplatin (FAP)--two cases report

The patients of unresectable cholangiocellular carcinoma (CCC) have extremely poor prognosis. Case 1 was a 72-year-old male who had CCC in the left lobe of liver with intrahepatic metastasis. From June 2003, he received hepatic arterial infusion chemotherapy (FAP: 5-fluorouracil 250 mg/day continuous infusion, day 1-5, adriamycin 10 mg/day, day 1, and CDDP 10 mg/day, day 1). After 5 courses, abdominal CT revealed that the main tumor had regressed. Case 2 was a 66-year-old male who had CCC with portal vein tumor thrombus of anterior branch (Vp2). He received FAP arterial infusion chemotherapy that was a same regimen as with the case 1 patient. After 5 courses were administered, Abdominal CT revealed that the size of the main tumor at S8 had not changed, and that portal vein tumor thrombus had disappeared. In both cases, there was no complication related to the chemotherapy. They are alive for more than 1 year after chemotherapy had started. FAP hepatic arterial infusion chemotherapy might be promising as an effective therapy for non-resectable CCC without extra hepatic metastasis.     

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。     

肝动脉门静脉双重栓塞术治疗肝癌对肝脏储备功能的影响

１０例原发性肝癌患者经腹脉动脉门静脉双重插管，同时化疗栓塞，并观察了术前术后肝脏储备功能指标的变化。１０例患者的肝实质栓塞率在８．３６％～４７．８％。其中４例接近或超过４０％，血浆中ｃＡＭＰ基础浓度，术前术后相比无显著变化，Ｐ＞０．０５，经胰高血糖素负荷后，ｃＡＭＰ浓度从术前的２７８．３１降至术后的１４２．３８ｐｍｏｌ／ｍｌ，Ｐ＜０．０５，４例术后ｃＡＭＰ明显低下（小于９０ｐｍｏｌ／ｍｌ）；患者术前肝动脉门静脉血流灌注指数与肝硬化时改变相似，８例中２例肝动脉门静脉血流均增加，３例肝动脉血流增加，门静脉减少，另外３例则相反；３例栓塞率较高。负荷后ｃＡＭＰ低下者出现了一过性黄疸和腹水。结果表明：①双重栓塞可损害一部分肝实质，对肝脏储备功能产生一定影响，但尚在代偿范围之内；②双栓范围较大，ｃＡＭＰ低下时注意保护功能；③双栓后肝血流的变化复杂，应进一步研究必手术操作简便，方法可靠安全。