Objective To evaluate the safety and feasibility of step-by-step balloon dilatation combined with contineous biliary drainage in treating benign biliary-enteric anastomosis stricture.Methods The clinical data and imaging materials of 49 patients with benign biliary-enteric anastomosis stricture,who were admitted to authors' hospital during the period from January 2008 to March 2014 to receive treatment,were retrospectively analyzed.Before treatment,the diagnosis of benign biliary-enteric anastomosis stricture was confirmed in all patients by color Doppler ultrasound,MRI and/or contrast-enhanced CT scan,endoscopic or DSA-guided anastomosis biopsy.Among the 49 patients,23 patients (study group) were treated with percutaneous transhepatic step-by-step balloon dilatation (the diameter of used balloon was 8 mm initially,then 10 mm balloon was used in the second month,and 12 mm balloon was used in the third month) together with contineous biliary drainage (lasting for 6 months);26 patients (control group) were treated with single percutaneous transhepatic balloon dilatation (balloon diameter of 6 mm or 8 mm) plus biliary drainage (lasting for 6 months).The improvement of clinical symptoms,the incidence of postoperative complications,and the anastomotic patency rate were compared between the two groups.Results Technical success was obtained in all patients.No procedure-related complications,such as biliary tract hemorrhage and perforation,occurred.One week after the treatment,the difference in bilirubin level between the two groups was not statistically significant (P＞0.05).Although the difference in 3-month anastomotic patency rate between the two groups was not statistically significant,the 6-month,12-month and 24-month anastomotic patency rates of the study group were significantly higher than those of the control group (P＜0.05).Three patients in the study group developed recurrent jaundice at 11.2,14.3 and 17.6 months after treatment respectively;MRI and contrast-enhanced CT scan confirmed the diagnosis of anastomotic stricture recurrence,and balloon dilatation together with drainage tube placement had to be carried out again.In the control group,16 patients developed recurrent jaundice within 3.1-17.1 months after balloon dilatation management,among them one patient died of disseminated intravascular coagulation and the remaining 15 patients received balloon dilatation together with drainage tube placement again.Conclusion For benign biliary-enteric anastomosis strictures,step-by-step balloon dilatation combined with persistent biliary drainage is a safe and effective minimally-invasive treatment.

Objective To discuss the influence of different antitumor treatments on the survival time of patients with obstructive jaundice caused by cholangiocarcinoma located at middle-low segment of common bile duct after receiving PTCD. Methods During the period from Jan. 2012 to March 2013, a total of 60 patients with pathologically-proved cholangiocarcinoma located at the middle-low segment of common bile duct were admitted to authors’ hospital. According to tumor TNM staging, stage Ⅱ was seen in 9 cases, stage Ⅲ in 39 cases and stage Ⅳ in 12 cases. Based on the degree of cell differentiation, highly differentiated cancer was observed in 9 cases, moderately differentiated cancer in 37 cases, and poorly differentiated cancer in 14 cases. The 60 patients were enrolled in this study. Drainage tube placement and stent implantation were performed in all patients so as to relieve the symptoms of jaundice. According to the antitumor treatment used, the 60 patients were randomly and equally divided into three groups with 20 patients in each group. Draining procedure with subsequent regular arterial infusion chemotherapy was employed in the patients of group A; draining procedure with subsequent particle chain placement in biliary tract was performed in the patients of group B; and draining procedure with subsequent regular arterial infusion chemotherapy together with particle chain placement in biliary tract was carried out in the patients of group C. The results were analyzed using SPSS17.0 statistical software. The death factors of patients were statistically evaluated by using multivariate Cox proportional hazards regression analysis method, P<0.05 was considered that the difference had statistical significance. Results The median survival periods of group A, B and C were (186.0±36.4) days, (183.0±26.5) days and (252.0±43.6) days respectively. The death factors of cancer patients were analyzed by using multivariate Cox proportional hazards regression analysis method, which indicated that tumor stage was a risk factor for death (HR=8.434, 95%CI 3.41-20.090);the treatment mode was a protection factor of death (HR=0.616, 95%CI 0.429-0.884); while the degree of tumor differentiation was unrelated to death(score test,字2=0.197, P=0.657>0.05). The risk of death in group B was not significantly different from that in group A (HR=1.012, 95%CI 0.558-2.179); while the treatment mode of group C was a protection factor of death (HR=0.334, 95%CI 0.148-0.075). Conclusion The TNM stage and treatment mode can influence the survival time of patients with cholangiocarcinoma located at the middle-low segment of common bile duct. Therefore, for the treatment of obstructive jaundice caused by cholangiocarcinoma, combination use of regular arterial infusion chemotherapy and particle chain placement in biliary tract should be employed immediately after draining procedure as this therapeutic mode can effectively prolong patient’s survival time.

Objective To explore the application of temporary balloon occlusion in multidisciplinary management of cesarean sec-tion for patients with pernicious placenta previa/accreta.Methods 42 patients with a diagnosis of placenta previa /accrete accepted the temporary aortic balloon occlusion in cesarean section in DSA hybrid operation room were retrospectively studied.Before cesare-an section,intravascular balloon catheter was placed in abdominal aortic.After delivery,the midpoint of filling state balloon was placed at the midpoint of the two renal arteries openings before placental dissection.The amount of blood loss and blood transfusion, operation time,the infants'radiation doses and postoperative complications were determined.Results All patients were successfully fulfilled cesarean section and conserved uteri.The amount of blood loss,blood transfusion,operation time,occlusion time and the infants’radiation doses were (586±355)mL,(422±283)mL,(75.5±1 1.9)min,(22.4±7.2)min and (4.2±2.9)mGy,respec-tively.During follow-up,complications were not found during operation and after operation.Conclusion In women with pernicious placenta previa/accreta,temporary aortic balloon occlusion can effectively control postpartum hemorrhage and reduce the risk of un-desirable hysterectomy.

Objective To evaluate the clinical effect of endovascular interventional therapy in treating Cockett syndrome associated with deep vein thrombosis (DVT) of left lower extremity.Methods The clinical data of a total of 256 patients with Cockett syndrome complicated by DVT of left lower extremity,who were admitted to authors' hospital during the period from January 2011 to January 2015,were retrospectively analyzed.The patients were treated with catheter-directed thrombolysis,balloon dilatation of the occluded or narrowed venous segment,and/or stent implantation.The circumference differences of the affected limbs before and after treatment and the long-term patency rates were compared.Results Of the 256 patients with Cockett syndrome complicated by DVT of left lower extremity,complete dissolution of thrombus was achieved in 232 (90.6％) and partial dissolution of thrombus in 24 (9.4％).The circumference difference of thigh and calf was (7.12±2.15) and (4.57±2.81) cm respectively before and after treatment.Iliac vein reconstruction was carried out in 206 patients,among them simple balloon dilatation was employed in 46 and balloon dilatation together with stent implantation was adopted in 160.The patients were followed up for 9-24 months with a mean of 15 months.In simple balloon dilatation group,3 patients lost touch with the authors during the following-up period,26 patients (60.5％) developed iliac vein occlusion and post-embolization syndrome occurred in 21 patients (48.8％).In balloon dilatation plus stent implantation group,11 patients lost touch with the authors during the following-up period,stenosis or occlusion of the stent was seen in 13 patients (8.7％),post-embolization syndrome was observed in 15 patients (10.1％).The differences in vascular stenosis or occlusion and in the occurrence of post-embolization syndrome between the two groups were statistically significant (P＜0.001).Conclusion For the treatment of Cockett syndrome complicated by DVT of left lower extremity,catheter-directed thrombolysis and balloon dilatation combined with stent implantation carry definite clinical curative effect.

Embolization, Therapeutic ; Hemorrhage ; Humans ; Liver Cirrhosis

ObjectiveTo investigate the effect of arsenic trioxide-loaded CalliSpheres beads (CBATO) in transarterial chemoembolization (TACE) in the treatment of rabbits with VX2 liver tumor. MethodsA total of 120 tumor-bearing rabbits were divided into control group, CalliSpheres beads (CB) group (blank beads for TACE), CBATO group, and conventional TACE (cTACE) group (arsenic trioxide lipiodol for TACE) using a random number table, with 30 rabbits in each group. Five rabbits in each group were sacrificed at 12 hours and on days 3, 7, and 14 after TACE, and immunohistochemistry was used to measure the proliferation index and apoptosis percentage of tumor cells in the residual tumor area. The tumor necrotic volume was measure on day 7 after TACE, and the growth rate and necrosis rate of tumor cells were calculated. Ten rabbits were randomly selected from each group for the observation of survival time. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kaplan-Meier survival analysis was used to evaluate survival time, and the log-rank test was used for comparison. ResultsOn day 7 after TACE, the CBATO group had a significantly lower growth rate and a significantly higher necrosis rate of tumor cells than the cTACE group, the CB group, and the control group (all P＜0.05). At each time point after TACE, there were significant differences in the proliferation index and apoptosis percentage of tumor cells between the CBATO group and the other three groups (all P＜0.05). The median survival time was 26 days in the CBATO group, 18.5 days in the CB group, 22 days in the cTACE group, and 15.5 days in the control group, and the CBATO group had a significantly longer survival time than the other three groups (χ2=3.95, 8.99, and 13.47, P=0.049, P=0.003, and P＜0.01). ConclusionCBATO has a better effect than cTACE and CB in the treatment of rabbits with VX2 liver tumor and can significantly improve tumor necrosis rate, promote the apoptosis of tumor cells, and prolong the survival time of experimental animals.

Objective To evaluate the clinic effect of transcatheter arterial chemoembolization (TACE) by using arsenic trioxide (ATO) drug-bearing CalliSpheres beads (CB) in treating BCLC stage B hepatocellular carcinoma (HCC) . Methods The clinical data of 13 patients with advanced HCC, who received TACE by using CB loaded with ATO (CBATO) during the period from January 2017 to September 2017, were retrospectively analyzed. The clinical data, imaging materials, laboratory examinations, interventional complications, prognosis, etc., were summarized and evaluated. Results The patients were followed up for9-15 months, with a median period of 11 months. The survival rate was 100％. One, 3, 6 and 9 months after treatment, the disease remission (CR+PR) rates were 76.9％, 76.9％, 69.2％ and 61.5％ respectively, and the disease control rates were 92.3％, 92.3％, 92.3％ and 84.6％ respectively. In all 13 patients, no severe complications such as hepatic failure, renal insufficiency, bone marrow suppression, liver abscess, bile leakage complicated by infection and gastrointestinal bleeding occurred. Conclusion For the treatment of BCLC stage B HCC, TACE by using CBATO is safe and effective with reliable short-term effect.

Objective To evaluate the efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervical cancer complicated with vesicovaginal fistula after radiotherapy. Method A prospective analysis was taken for 12 patients with cervical cancer complicated with vesicovaginal fistula after radiotherapy who were diagnosed by gynecological examination, imaging and cystoscopy. All patients received concurrent double percutaneous nephrostomy and ureter occlusion stent implantation.The improvement of symptoms and postoperative complications were observed.The number of white blood cells in urine,renal function,number of diapers in daily use(pieces),daily vaginal and urethral exudate, pain score,physical status (ECOG) score and quality of life score (KPS) before and 7 d after the procedure were compare by the paired Student's t test. Results Twelve patients were successfully implanted 24 ureter occlusion stents after successful nephrostomy. Postoperatively, urinary fistula immediately disappeared in all patients.One week after operation,bilateral hydronephrosis disappeared in 4 patients, renal insufficiency and renal function returned to normal in 4 patients. There were significant differences in the number of white blood cells in urine,the number of diapers in daily use,the daily vaginal and urethral exudate,pain score,KPS and ECOG score compared with before and 7 d after the procedure(all P<0.05).There was no significant difference in the creatinine and urea nitrogen (all P>0.05). No serious complications occurred after the operation.Conclusion Double percutaneous nephrostomy combined with ureter occlusion stent can effectively and safely treat cervical cancer complicated with vesicovaginal fistula after radiotherapy.

Objective:To evaluate the curative effect, safety and feasibility of percutaneous transhepatic cholangio drainage(PTCD) combined with balloon dilatation in treating benign biliary-enteric anastomosis stricture(BBES).Methods:The clinical data of 33 patients with benign biliary-enteric anastomosis stricture, who were admitted to the First Affiliated Hospital of Zhengzhou University during the period from January 2013 to May 2019, were retrospectively analyzed. There were 23 cases of benign etiology and 10 cases of malignant etiology, benign strictures of which 15 cases were located in the hepatic hilum and of which 18 cases outside of it. All patients were considered as benign stenosis by at least two imaging examinations of magnetic resonance imaging of pancreatic or enhanced MRI or enhanced CT, laboratory examinations of tumor markers and other clinical data before operation. 10 cases of malignant etiology were confirmed by intraoperative biopsy and pathology. All patients were treated with balloon dilatation at an interval of 1 to 4 weeks after PTCD. The changes of clinical symptoms, bilirubin and liver function before and after operation were compared and analyzed, and the postoperative complications and anastomotic patency rate were followed up.Results:PTCD combined with balloon dilatation was performed successfully in all patients, and the success rate was 100%. After operation, the benign biliary-enteric anastomosis stricture was significantly improved in all patients, and the clinical symptoms were improved obviously. The liver function and bilirubin decreased significantly in all patients after operation, and there was significant statistical significance ( P<0.05). There is no serious complications such as biliary bleeding and biliary fistula were found after operation. At 3 months, 6 months, 12 months, 24 months and 36 months after operation, the anastomotic patency rates of all patients were 90.9%(30/33), 72.7%(24/33), 63.6%(21/33), 63.6%(21/33), 60.6%(20/33), respectively. During the whole follow-up period, anastomotic restenosis happened in 13 patients, of which 9 cases with restenosis, the benign stenosis site of the anastomosis was the hepatic hilum and of which 4 cases located on the outside of the hepatic hilum. After treatment, the incidence of benign restenosis of the anastomosis at the hepatic hilum (60.0%, 9/15) was higher than that at outside of the hepatic hilum (22.2%, 4/18) and it's statistically significant ( P<0.05). Among the 13 patients with recurrence of BBES, 4 cases underwent choledochojejunostomy for malignant causes and 9 cases with benign causes. The recurrence rates after the first balloon dilatation were 40.0% (4/10) and 39.1% (9/23), respectively, and the average recurrence time was 5.8 months and 6.8 months respectively, the difference was not statistically significant( P>0.05). Conclusion:For the treatment of benign biliary-enteric anastomosis stricture, percutaneous transhepatic cholangio drainage combined with balloon dilatation with reliable curative effect, with high safety and less trauma, with less operative complications, and with repeatability, so it is worth applying in clinic.

Objective:To investigate the morphological feature and clinical significance of MRI around tumor after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) of primary hepatocellular carcinoma.Methods:We reviewed and analyzed the data of hepatocellular carcinoma patients admitted from January 2017 to December 2018 in the Department of Radiological Intervention of the First Affiliated Hospital of Zhengzhou University. A total of 42 patients were enrolled, including 35 males and 7 females, aged (57.0±11.9) years. For the first time after operation, MRI enhancement showed peri-tumor margin enhancement as the starting point of follow-up. Follow-up and measure enhanced edge thickness, delayed enhancement, progression or remission data.Results:A total of 49 tumors and 84 peritumoral enhancement margins were included in 42 patients, with 30 sharp type , 40 rough type and 14 nodular type. The thickness of sharp type is less than that of rough type and nsodular type, and the differences were statistically significant (all P<0.05). The sharp type is the majority of the tumors with maximum diameter <5 cm, rough type and nodule type are the majority of tumors with maximum diameter ≥5 cm. Most of the sharp type are continuously enhanced, while the rough type and nodular type are not. Most sharp type relief (93.3%, 28/30), while rough type (80.0%, 32/40) and nodular type ( n=12) are mostly of deterioration, the differences are statistically significant (all P<0.05). Conclusion:Compared with the rough type and nodular type, the sharp type usually occurs in smaller tumors and more prone to local mitigation in the enhanced morphology around MRI after DEB-TACE in primary hepatocellular carcinoma.