Six patients with moderate to advanced primary carcinoma of the liver were treated in this hospital with perfusion chemotherapy and embolization through the regional portal vein under the guidance of B-ultrasongraph rather than (with) operatie catheteization of the portal vein. The results show that all the tumor masses were reduced in size after the treatment (1.2-3.2cm, average value 1.9cm). It might be a new way for treating the primary carcinom of liver. The detailed procedure is descibed and the effects are also discussed in this article.
Objective To explore the risk factors of postoperative portal vein system thrombus (PVST) after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism. Methods Clinical data of 76 patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy in the Sichuan Provincial People’s Hospital from January 2012 to January 2017 were analyzed. Results There were 31 patients suffered from PVST (PVST group), and other 45 patients enrolled in non-PVST group.There were significant differences on age, diameter of splenic vein, diameter of portal vein, blood flow velocity of portal vein, level of D-dimer, and platelet count between the PVST group and the non-PVST group (P<0.05), but there were no significant difference on gender, Child-Pugh classification, etiology of cirrhosis, operation time, intraoperative blood loss, postoperative complications, and prothrombin time between the two groups (P>0.05). Multivariate logistic regression analysis showed that, patients with age >50 years (RR=1.31, P=0.02), splenic vein diameter >12 mm ( RR=1.29, P<0.01), portal vein diameter >13 mm (RR=1.55, P=0.01), blood flow velocity of portal vein <18 cm/s ( RR=1.47, P<0.01), increases level of D-dimer (RR=2.89, P=0.03), and elevated platelet count (RR=1.82 P=0.02) had higher risk of postoperative PVST than those patients with age ≤50 years, splenic vein diameter ≤12 mm, portal vein diameter ≤13 mm, blood flow velocity of portal vein ≥18 cm/s, normal level of D-dimer and platelet count. Conclusion For patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy, we should pay more attention to the risk factor, such as D-dimer and so on, to avoid the occurrence of postoperative PVST.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
Objective To summarize the updates of diagnosis and differential diagnosis for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) for providing evidences for early diagnosis and treatment of PVTT patients. Methods The related literatures on diagnosis and differential diagnosis for HCC with PVTT in recent years were collected and reviewed. Results The serious complications and tumor metastasis are attributed to the PVTT, then it is necessary to make diagnosis accurately according to clinical symptoms, hematological and imaging examinations. The differential diagnosis of PVTT and portal vein thrombosis, portal sponge degeneration and hepatic arteriovenous shunt diseases should be carried out. Conclusions The diagnosis and differential diagnosis of PVTT cannot rely on a single method, and it requires a comprehensive judgment of various diagnostic methods. More accurate and specific diagnostic methods are needed.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
ObjectiveTo explore the relation between vascular endothelial growth factor （VEGF） and the formation of tumor thrombosis in the main trunks of portal vein (PVTT). MethodsTumor specimens were collected from 36 patients (16 patients with PVTT, the other patients without PVTT and metastasis) undergoing resection of hepatocellular carcinoma (HCC) and portal thrombectemy, PVTT specimens of 16 patients named group A1, the same patients’ with HCC named group A2, tumor specimens of the other patients named group B. In situ hybridization and immunohistochemistry were used to investigate VEGF mRNA, protein and microvessel density (MVD) on surgical specimens. The intensity was evaluated using a computer image analyzercell analysis system.ResultsVEGF mRNA expression was detected in the tumor’ cell of the specimens. The expression rates of VEGF mRNA in the group B, A2, A1 were 30%, 100%, 100% respectively, and the expression rates of VEGF mRNA in group A2 and A1 were higher than that in group B （P＜0.01）. The intensity of VEGF mRNA in group A2 （0.078 5±0.019 6） were lower than in group A1 （0.194 4±0.059 0） （P＜0.01）. VEGF protein expression was often detected in the tumor cell, vascular endothelial cell and fibroblast cells. Invasion was detected in small vein in group A2, more tumor cell colony detected in group A1. The expression rates of VEGF protein in group B, A2, A1 were same as VEGF mRNA; the intensity of VEGF protein in A1 （0.165 6± 0.034 5） was higher than in group A2 （0.108 1±0.024 3） （P＜0.01）. MVD in group B, A2, A1 was 31.9±14.4, 63.3±15.1, 116±27.6/view of 200 microscopefield, MVD in group A1 was higher than group A2 （P＜0.01）, higher in group A2 than in group B. There was a statistically significant correlation between the intensity of VEGF expression and MVD in group B,A2 and A1. ConclusionVEGF could play an important role in the invasion, metastasis of HCC and the formation of PVTT. Angiogenesis in tumor is correlated well with the progression of HCC.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
Objective To observe the recovery of recipients with complex portal vein thrombosis (CPVT) underwent “multiple to one” anastomosis and patency of portal vein blood flow during liver transplantation, and to ensure the reliability of this method. MethodsThe clinicopathologic data of the recipients with CPVT underwent “multiple to one” anastomosis in the Beijing Friendship Hospital, Capital Medical University were collected retrospectively. The “multiple to one” portal vein reconstruction was defined as the anastomosis of multiple vessels of portal venous system with the portal vein of graft, or the anastomosis that connected the blood vessel of portal venous system and the left renal vein/inferior vena cava to the portal vein of graft. ResultsA total of 5 patients were collected, including 1 patient with Yerdel grade 3 thrombosis and 4 patients with Yerdel grade 4 thrombosis. In 3 cases, the left renal vein, inferior vena cava, left renal vein were combined with the parabiliary vein, respectively, in the anastomosis to the donor portal vein. In another 2 cases, portal vein and left renal vein were combined with gastric coronary vein, respectively, in the anastomosis to the donor portal vein. During the follow-up period of 162–865 d, all patients had the stable portal vein blood flow without any symptom of portal hypertension. One patient had thrombosis at the anastomosis with varicose vein, while the anastomosis with left renal vein was unobstructed, which did not affect the donor liver function. ConclusionMultiple blood supply of portal vein is established after “multiple to one” anastomosis, and stability of portal vein blood flow can be maintained after a blood redistribution of portal venous system following liver transplantation.
ObjectiveTo summarize the pathogenesis, epidemiology, and risk factors of portal vein thrombosis after splenectomy, and combined with the latest advances in clinical prevention, diagnosis, and treatment of portal vein thrombosis after splenectomy, so as to provide some references for clinical prevention and treatment in the future.MethodLiteratures on portal vein thrombosis after splenectomy were collected and reviewed.ResultsThe incidence of portal vein thrombosis after splenectomy was high and its occurrence was the result of multiple factors. It was mainly related to the change of splenic venous blood flow mechanics after splenectomy. In terms of diagnosis, enhanced CT scan was the first choice. Currently, there was no consensus on treatment options, which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-molecular-weight heparin may reduce the risk of portal vein thrombosis.ConclusionThe concept of tertiary prevention of portal vein thrombosis after splenectomy should be established, and individualized treatment should be adopted in combination with the patient’s condition.
Objective To review the advancement of surgical therapy for cavernous transformation of portal vein. Methods The relevant literatures on therapy for cavernous transformation of portal vein in recent years were collected and reviewed. Results The main symptoms of the patients are repeated haematemesis and hemafecia, hypersplenotrophy and hypersplenia. Most cases can be detected by ultrasonography or portal venography. Splenectomy and by-pass technique plus disconnection are the preferred operation. Conclusion Therapy for cavernous transformation of portal vein will be further developed.