Objective To find out how to choose the doses of hepatic artery chemotherapy(HAC)in hepatic cell carcinoma(HCC) cases with abnormal liver function.Methods There were 80 HCC patients with one or more liver function index(ALT,AST,TB,DB)above at least 2 times normal,who underwent 105 times HAC or hepatic artery chemoembolization(HACE) with routine chemotherapy doses,and their pre-and postoperative liver and kidney functions had been observing by the end of three weeks after HAC or HACE.Results 1.Postoperative ALT and AST took a favorable turn in preoperative ALT ≥80 U/L group(44 cases)(?

Objective To investigate the variations of hepatic artery and its extrahepatic arteries on hepatic arteriogram and to provide benefit for transhepatic arterical chemoemblization.Methods The hepatic arteriograms of 200 cases with unresectable hepatic malignant tumor before interventional therapy were analysed.Two interventional radiologists in common reviewed the incidences of various types according to Michels' classification,the absence of proper hepatic artery,and the variations of extrahepatic arteries originating from hepatic artery.Results The most common hepatic artery variation was Michels type Ⅲ(n=17,8.5%),followed by type Ⅱ(n=10,5.0%) and Ⅴ(n=9,4.5%).Proper hepatic absence was found in 25 cases and appeared as 5 subtypes.5 kinds of extrahepatic arteries were found.The most common extrahepatic artery was the right gastric artery(n=156,78.0%),followed by cystic artery(n=126,63.0%),accessory left gastric artery(n=19,9.5%),the hepatic falciform artery(n=5,2.5%),and accessory left inferior phrenic artery(n=4,2.0%).Conclusion There are some other variations of hepatic artery beside Michels' classification,and there are many variations of extrahepatic arteries originating from hepatic artery,it is important to assure interventional therapy effect for hepatic cancer and prevent complication.

With the development of molecular biology,molecular targeted therapy has become main direction and trend at the aspect of oneotherapy in the 21th century.Molecularly targeted agents which target VEGF/VEGFR,EGFR.Raf/MAPK-ERIC,HGFR,as well as associating with other therapies are available in the clinical treatment of primary hepatic carcinoma,and inspiring results have also achieved in some clinical trials.The review attempts to summarize the clinical research advancemem in molecularly targeted therapy of primary hepatic carcinoma.

Isolated hepatic perfusion(IHP)is the best re gional chemotherapy modal ity for treatment of unresectable liver primary cancer and liver metastases.The main principle of isolated hepatic chemotherapy is to achieve higher regional d rug concentrations and thus higher exposure of tumor tissue to the agents,resul ting in increased response rates,while shielding the organism from the systemic toxicity because of the much lower concentrations in the systemic circulation.At present the methods of IHP include surgical methods and methods with balloon c atheter technique,which promise to provide a micro-invasive procedure,bu t are not fully mature.The key point of successful IHP is low leakage or leakage-free.The more beneficial aspect of IHP is that it can simultaneously apply hyperthe r my and biologic agent TNF to improve sensitivity of chemotherapy,which is not p ossible in other regional chemotherapy.From previous literatures this overview is to describe the principle,procedure techniques,leakage monitor methods,hyp erthermy application,administration agents,therapeutic reaction,complications and perspective of IHP.

Objective: To analyze and evaluate of the long-term follow-up data of 152 patients with inoperable malignant biliary obstruction who underwent percutaneous placement of metallic stents. Me-thods: From 2000 through 2006, 152 consecutive patients with malignant biliary obstruction were treated with PTCD or placement of metallic stents. The causes of obstruction were bile duct carcinoma (n=35),pancreatic carcinoma (n=32), hepatocellular carcinoma and metastatic (n=61), lymphadenopathy in the hepatoduodenal ligament (n=24). We used 86 stents: 31 Cook Zilver Stents,25 Sinus Superflex Stents,12 Wall Stents,3 Sinus-s Iliaca Stents,3 ZA-S Bliary Design Stents,5 Smart Stents and 7 other stents. Every three months we followed up all patients except those who died. Patient survival and stent patency rates were estimated by life-table analysis. The Kaplan-Meier method (log-rank test) was used to compare the patency and survival rates among different groups. And the COX regression model was established to compare the relative risks. Results: The overall median length of patency of all stents was 314 days. The median length of survival for the entire patient group was 215 days. The survival rate was 79.1%,51.7% and 26.8% after 3, 6, and 9 months, respectively. Six patients developed recurrent jaundice or cholangitis. The patients with hepatic hilar obstruction group indicated worse prognosis (P≤0.05). Conclusion: Metallic stents showed a favorable patency rate with regard to patient survival. In patients with hilar obstruction, the clinical prognosis was worse than that in patients with common bile duct (CBD) obstruction. We believe that the placement of metallic stents is the procedure of choice for palliation of malignant biliary obstruction.

Objective:To explore the appearances o f digital subtraction angiograph y (DSA) and therapeutic efficacy of interventional therapy of hepatic carcinoma accompanied with arteriovenous shunting (AVS). Methods: To retro spectively analy ze clinical material of 97 patients with hepatocellular carcinoma with hepatic artery-portal vein shunting(HA-PVS) , of whom, 16 had upper gastrointestinal hemorrhage, 51 had middle to l arge amounts of ascites, and 53 had varices of esophagus and fundus gastricus . All the patients were treated with transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion chemotherapy (TAI). Shunts were embolized by lipidol i n 40 patients, by lipidol and spon-gia gelatinosa particle in 34 patients, and by coi l in 6 patients. The remaining 17 were treated only with TAI. Results:Twelve (12.4%) case s had hepatic artery-hepatic vein shunting (HA-HVS),while 32 (33%)cases had portal vein tumor thrombosis (PVTT). In 70(72.2%) patients, all shunts we r e completely closed successfully, in 15(15.5%) patients, the shunts were partly closed, and in 12(12.3%)patients, the shunts were not closed. In 12 patients, the shunts reopened in later therapy, their blood flow was smaller than before and they were closed after second embolization. In 17 patients, new shunts emerged. After TACE therapy,the tumors were smaller in 57(58.7%),bi gger in 24 (24.7%),and 16(16.5%) were the same in size before and after TACE. Ascit es disappeared in 29 patients, decreased in 18 patients and had no change in 4 pati ents. Five patients who had upper gastrointestinal hemorrhage pre-operation had n ew hemorrhage. Of the 47 patients who had diarrhea, 23 improved. In 67 alph a fetoprotein (AFP) positive patients, degree of AFP in 53 patients decreased. Eighty-one patients died and their Corresp onding author’s e-mail, renjieyang2007@163.commiddle survival period was 12.9 months. No serious dama ge to hepatic function due to the treatment was observed in most patients. Concl usion:Primary hepatic carcinoma with AVS increases difficulty of interv entional therapy,but as long as we take active and proper treating measure,we could ac quire satisfactory curative effect without serious syndrome. DSA can demonstrate the type, the site and the degree of AVS completely and directly, thus having import ant value in treating primary hepatic carcinoma and improving prognosis.

Objective To investigate the indications and complications in the treatment of benign and malignant strictures using esophageal stents in order to avoid abusing effects in clinical practice. Methods A series of 20 patients, 12 men, 8 women, aged from 45～72, with esophageal stricutre. There were 3 cases had stricture at the anastomosis site. 4 cases with esophago bronchial fistula. 1 case with esophago mediastinal fistula after surgical operation ten cases used imported stents and another 10 with domestic Nickel Titanium stents. Results Successful stent placement was achieved in all cases. Dysphagia were relieved in most of 20 cases. The fistula vanished in 5 cases of complications with esophago bronchial and esophago mediastinal fistulas. Conclusions The esophageal stent placement is an effective treatment for benign and malignant esphageal strictures. The domestic Nickel Titanium stents is well effective as the imported ones.

Objective Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture.Methods Esophageal stenosis model of the rats was created by 5ml of 50% NaOH solution burn with double balloon method, and esophageal restenosis (RS) model was developed by esophageal stenosis with dilation of PTCA balloon catheter. Quantitative and quanlitative analysis of esophageal stenosis and RS formation in the rats were observed and recorded by analytic measurements imaging and immunohistologic chemistry respectively. Results Esophageal benign stricture and RS model of 49 rats were developed. Cross section area and perimeter of esophageal mucosa layer, muscule layer and the whole layer had increased in experimental group. Comparing to control group, it had remarkable significance in statistics ( P

Objective To assess the effectiveness of balloon dilation and airway stenting performed under fluoroscopic guidance for the treatment of benign and malignant tracheal stenosis. Methods Under fluoroscopic guidance,balloon dilation and airway stenting were performed in 45 patients with tracheobronchial stricture. Of the 45 patients, malignant tracheal stenosis was seen in 37, including mediastinal nodal metastases (n = 14), esophageal carcinoma (n=13), lung carcinoma (n = 4), adenocarcinoma of bronchus (n = 3), lymphoma (n = 2) and laryngocarcinoma (n = 1), and benign tracheal stenosis was seen in 8, including endobronchial tuberculosis (n = 6), retrosternal thyroid adenoma (n = 1) and endotracheal intubation (n = 1). Airway stenting with serf-expandable metal stent was employed in 38 patients and balloon dilation in 7 patients. All the procedures were performed under fluoroscopic guidance. Results A total of 53 self-expandable metal stents was implanted in 38 patients. The clinical symptoms were immediately relived after the procedure in all patients except for one patient who died from choking of sputum. No stent migration was observed. Restenosis developed in 4 patients, which was successfully treated with repeated stenting and balloon dilation. Nineteen times of balloon dilation procedure were accomplished in 7 patients. Marked remission of clinical symptoms was seen in most cases. During a follow-up period (ranged from 0 to 124 months with a mean of 24.5 months) 31 patients died. Conclusion For both benign and malignant tracheal stenosis, balloon dilation with airway stenting performed under fluoroscopic guidance is a safe and efficient therapy with instant curative effect in relieving clinical symptoms.

Objective To study the characteristics of satellite nodules of hepatocellular carcinoma (HCC) and the treatment methods by transcatheter hepatic arterial chemoembolization (TACE). Methods Forty one cases of massive HCC and single nodular HCC proved by pathology underwent the examination of spiral CT and angiography for observing the characteristics of satellite nodules. All the patients were treated by TACE and the results were analyzed. Results The satellite nodules were found in 17 out of 41 cases by CT and/or angiology of which 10 were hypervascular and 7 hypovascular. The satellite nodules located within 1 cm from the margin of the main HCC in 11 out of 17 cases. In the treatment of TACE, the tip of catheter was located on the proximal end of feeding artery of tumor so that the embolization area included the area of satellite nodules. After 6-19 months follow up, 5 patients were complete response (CR) and partial response (PR) in 17 cases but no progressive patients were found. Conclusion The satellite nodules extensively exist in HCC and can be effectively treated using reasonable methods.