Objective To explore the imaging diagnostic value of gastrointestinal stromal tumor(GIST).Methods The retrospective study on GIST proved by operation and pathology in 11 cases was done.There were pneumobarium double contrast examination in 10 cases,CT scanning in 4 cases,superior mesenteric ateriography in 2 cases and fiberoptic endoscopy in 7 cases.Results The locations of tumors at gastric were 7 cases,intestinal 2,lipper and row oseophagus to gastric cardiac in 1,respectively.The detective rate of GIST was 100%,75%,100% and 100% respectively by pneumobarium double contrast examination,CT,arteriography and fiberoptic endoscopy.Conclusion Pneumobarium double contrast examination and fiberoptic endoscopy are important methods for diagnosis of GIST.CT and arteriography can better show the location of tumors and differential diagnosis of benign and malignant of tumor.

At present,the combined interventional therapy that is based on transcatheter arterial chemoembolization (TACE) technique can control the progression of primary hepatocellular carcinoma (PHC)in different degrees,at the same time the clinical objectives,such as relieving portal hypertension,eliminating portal vein occlusion,controlling refractory ascites and lowering upper gastrointestinal bleeding probability,can be reliably achieved.Thus,the quality of life of the patients can be effectively improved and the survival time will be reliably prolonged.This paper aims to make a comprehensive review about the medical articles concerning TACE combined with other interventional therapies for PHC complicated by portal vein tumor thrombus,which have been published both at home and abroad in recent years,in order to provide practical help for clinical diagnosis and treatment of PHC.

Objective To explore the relationship of MDR1 and its encoded product P-gp expressions with clinical efficacy of transcatheter arterial chemoembolization (TACE)in primary liver cancer and their clinical significance.Methods We selected 108 patients with primary liver cancer who came to our hospital between June 2010 and June 2013 as observation subjects.Meanwhile 50 healthy people in our hospital for liver biopsy were selected as controls.MDR1 mRNA level in observation group and control group was determined by real-time quantitative PCR.P-gp protein level was analyzed by immunohistochemistry.According to P-gp level,the 108 patients were divided into drug-resistance groups and non-resistance group;the relationship between P-gp expression level and clinical efficacy was analyzed.Results MDR1 mRNA level in liver tissues significantly enhanced in observation group compared with that in control group (P <0.05).In observation group 32 patients had the ratio of MDR1 mRNA level-normal level of more than 2 and 76 patients had the ratio of MDR1 mRNA level-normal level of less than 2. Immunohistochemistry revealed that MDR1 encoded product P-gp was brownish yellow, mainly expressed in the cell surface of liver cancer cells.There were 35 P-gp protein-negative patients (non-resistance group)and 73 positive patients (resistance group).Clinical efficacy was significantly higher in non-resistance group (74.28%)than in resistance group (43.28%)(P <0.05).The 1 year and 2-year cumulative survival rates were 54. 12% and 27.40% in resistance group and 77.14% and 42.86%% in non-resistance group.They were significantly higher in the latter group (P <0.05 ).Conclusion The overexpressed MDR1 encoded product P-gp in primary liver cancer is associated with multidrug resistance in tumor chemotherapy,suggesting that P-gp can be used as one of the guiding clinical markers of chemotherapy.

Objective Toinvestigatethemethod,safetyandefficacyoftranscatheterarterialchemoembolization(TACE)combined withargonheliumknifecryoablationintreatmentofadvancedprimaryhepaticcancer.Methods FiftyGfourpatientswithadvanced primaryhepaticcancerunderwentTACEfirstly,andfollowedbytheargonhelium knifecryoablationunderCT/ultrasoundguiding percutaneouspunctureafter1－2weeks.2－3cyclesofcryotherapywereperformedduringtheoperation.Afteroperation,enhanced CT/MRIwasperformedtofollowGup.Results Themediansurvivaltimewas17.6months.The6Gmonthsurvivalratewas100%,the 12Gmonthsurvivalratewas89.34%,thetumorprogressiontimewas9.3 months,andtheshortestsurvivalperiodwas8 months.Recent curativeeffectevaluationshowedCRin9patients,PRin34patients,SDin6patients,PDin5patients(RR＝79.62%,DCR＝90.74%). Conclusion TACEcombinedwithargonheliumknifecryoablationisasafeandeffectivetreatment,whichprovidesanewtreatment planforpatientswithprimaryhepaticcancer.

Objective ToexploretheeffectofTIPS+GCVEcombinedwithPSEonhemodynamicsinpatientswithlivercirrhosis,portal hypertensionandsplenomegaly.Methods 56patientswereincludedfromJanuary2015toDecember2016 whounderwentTIPS+GCVEcombinedwithPSE.Patientswerefollowed-upon1month,3months,6monthsand1yearaftersurgery,andstatisticanalysis weredoneonportalveinhemodynamicindex:portalveintrunkdiameter(PVD),portalveinvelocity(PVV),portalvenousbloodflow (PVF),splenicveintrunkdiameter(SVD)andvelocityofbloodflowinsplenicvein(SVV).Results Thereweresignificantdifferencesinportal veinpressurebeforeandafterthebypassinall56patients.PVDandPVV weresignificantlydifferentbetween3and6 monthsafter surgeryandpre-surgery.PVF wassignificantlydifferentcomparing6 monthsand1yearaftersurgery withpre-surgery.SVDand SVV weresignificantlydifferentbetween3 months,6 monthsand1yearaftersurgeryandpre-surgery.Conclusion TIPS+GCVE combinedwithPSEcouldeffectivelyreduceportalveinpressure,improveportalveinandspleenveinbloodflow,increaseportalvenousblood flow,andimprovepatients’liverfunction.

Objective To observe the efficacy of hepatic artery infusion chemotherapy(HAIC)combined with lenvatinib for treating Barcelona clinic liver cancer(BCLC)stage B or C hepatocellular carcinoma(HCC),and to explore the impact factors of patients'survival time.Methods Data of 104 patients with BCLC stage B or C HCC were retrospectively analyzed.The patients were divided into observation group(n=46,underwent HAIC combined with lenvatinib)and control group(n=58,underwent HAIC alone).The clinical efficacy and adverse reactions of treatments,as well as patients'overall survival(OS)and progression free survival(PFS)were recorded and compared between groups.Cox regressions were used to explore the impact factors of patients'survival time.Results Three months and 6 months after HAIC,the results of modified response evaluation criteria in solid tumors(mRECIST)in observation group were both better than those in control group(both P＜0.05),while no significant difference was found between groups one year after HAIC(P＞0.05).The overall survival rate in observation group was higher than that in control group(P＜0.05),while there was no significant difference of progression free survival rate between groups(P＞0.05).The incidence of rash in observation group was higher than that in control group(P＜0.05).Multiple Cox regression showed prolonged OS in HCC patients in observation group(hazard ratio[HR]=0.425,95%CI[0.255,0.791])compared with that in control group.Compared with pre-treatment Eastern Cooperative Oncology Group(ECOG)score 1,AFP≥400 μg/ml,the number of tumor foci≥3 and BCLC stage C,pre-treatment ECOG score 0,AFP＜400 μg/ml,the number of tumor foci≤2 and BCLC stage B were all independent protective factors of OS in HCC patients(all P＜0.05).Conclusion HAIC combined with lenvatinib was safe and effective for treating BCLC stage B or C HCC.Pre-treatment ECOG score,serum AFP level,the number of tumor foci and BCLC stage were all independent impact factors of OS.