AIM:To determine the clinical value of a splenorenal shunt plus pericardial devascularization(PCVD)in portal hypertension(PHT)patients with variceal bleeding.METHODS:From January 2008 to November 2012,290 patients wit...AIM:To determine the clinical value of a splenorenal shunt plus pericardial devascularization(PCVD)in portal hypertension(PHT)patients with variceal bleeding.METHODS:From January 2008 to November 2012,290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding:207 patients received a routine PCVD procedure(PCVD group),and83 patients received a PCVD plus a splenorenal shunt procedure(combined group).Changes in hemodynamic parameters,rebleeding,encephalopathy,portal vein thrombosis,and mortality were analyzed.RESULTS:The free portal pressure decreased to 21.43±4.35 mmHg in the combined group compared with24.61±5.42 mmHg in the PCVD group(P<0.05).The changes in hemodynamic parameters were more significant in the combined group(P<0.05).The long-term rebleeding rate was 7.22%in the combined group,which was lower than that in the PCVD group(14.93%),(P<0.05).CONCLUSION:Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT.It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.展开更多
Aim:According to the current guidelines,transarterial chemoembolization(TACE)remains the first-line therapies for hepatocellular carcinoma(HCC)patients at Barcelona Clinic Liver Cancer(BCLC)B-stage and sorafenib is a ...Aim:According to the current guidelines,transarterial chemoembolization(TACE)remains the first-line therapies for hepatocellular carcinoma(HCC)patients at Barcelona Clinic Liver Cancer(BCLC)B-stage and sorafenib is a small molecule target drug for BCLC C-stage.In clinical practice,clinicians have attempted to use stereotactic body radiation therapy(SBRT)plus TACE for treating intermediate-to advanced-stage HCC.However,the therapeutic effects are still inconsistent.This meta-analysis was conducted to elucidate the validity and safety of the combination therapy of SBRT plus TACE in the patients with intermediate-to advanced-stage HCC.Methods:PubMed,MEDLINE,Web of Science,China Biology Medicine,Chinese Knowledge resources integrated and Chinese Scientific Journal Full-Text Database was searched from their inception date to November 2018.The survival rates(half-year,one-year and two-year)were analyzed and compared between the observation groups and the control groups.The negative conversion rate of AFP and the total effective rate were also assessed.Risk ratios(RR)and 95%CI were calculated to express therapeutic effects. ;Results:A total of 1,210 patients from 13 eligible studies were included.The cooperation of TACE and SBRT notably ameliorated the whole survival rates of half-year,one-year,two-year,the negative conversion rate of AFP,and the total effective rate,compared with TACE or SBRT monotherapy[RR(the total effective rate),1.412,95%CI:1.309-1.523,P<0.001],[RR(half-year survival rate),1.196,95%CI:1.121-1.276,P<0.001],[RR(one-year survival rate),1.327,95%CI:1.236-1.424,P<0.001],[RR(two-year survival rate),1.479,95%CI:1.284-1.703,P<0.001]and[RR(negative conversion rate of AFP),1.756,95%CI:1.502-2.059,P<0.001].Sensitivity analysis supported the above results.Conclusion:Combination therapy of SBRT and TACE provides survival benefits in intermediate-to advanced-stage HCC patients compared to monotherapy of SBRT or TACE.展开更多
文摘AIM:To determine the clinical value of a splenorenal shunt plus pericardial devascularization(PCVD)in portal hypertension(PHT)patients with variceal bleeding.METHODS:From January 2008 to November 2012,290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding:207 patients received a routine PCVD procedure(PCVD group),and83 patients received a PCVD plus a splenorenal shunt procedure(combined group).Changes in hemodynamic parameters,rebleeding,encephalopathy,portal vein thrombosis,and mortality were analyzed.RESULTS:The free portal pressure decreased to 21.43±4.35 mmHg in the combined group compared with24.61±5.42 mmHg in the PCVD group(P<0.05).The changes in hemodynamic parameters were more significant in the combined group(P<0.05).The long-term rebleeding rate was 7.22%in the combined group,which was lower than that in the PCVD group(14.93%),(P<0.05).CONCLUSION:Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT.It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.
基金This study was funded by the National Natural Science Foundations of China(81773488,81172287).
文摘Aim:According to the current guidelines,transarterial chemoembolization(TACE)remains the first-line therapies for hepatocellular carcinoma(HCC)patients at Barcelona Clinic Liver Cancer(BCLC)B-stage and sorafenib is a small molecule target drug for BCLC C-stage.In clinical practice,clinicians have attempted to use stereotactic body radiation therapy(SBRT)plus TACE for treating intermediate-to advanced-stage HCC.However,the therapeutic effects are still inconsistent.This meta-analysis was conducted to elucidate the validity and safety of the combination therapy of SBRT plus TACE in the patients with intermediate-to advanced-stage HCC.Methods:PubMed,MEDLINE,Web of Science,China Biology Medicine,Chinese Knowledge resources integrated and Chinese Scientific Journal Full-Text Database was searched from their inception date to November 2018.The survival rates(half-year,one-year and two-year)were analyzed and compared between the observation groups and the control groups.The negative conversion rate of AFP and the total effective rate were also assessed.Risk ratios(RR)and 95%CI were calculated to express therapeutic effects. ;Results:A total of 1,210 patients from 13 eligible studies were included.The cooperation of TACE and SBRT notably ameliorated the whole survival rates of half-year,one-year,two-year,the negative conversion rate of AFP,and the total effective rate,compared with TACE or SBRT monotherapy[RR(the total effective rate),1.412,95%CI:1.309-1.523,P<0.001],[RR(half-year survival rate),1.196,95%CI:1.121-1.276,P<0.001],[RR(one-year survival rate),1.327,95%CI:1.236-1.424,P<0.001],[RR(two-year survival rate),1.479,95%CI:1.284-1.703,P<0.001]and[RR(negative conversion rate of AFP),1.756,95%CI:1.502-2.059,P<0.001].Sensitivity analysis supported the above results.Conclusion:Combination therapy of SBRT and TACE provides survival benefits in intermediate-to advanced-stage HCC patients compared to monotherapy of SBRT or TACE.
