Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular...Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular carcinoma(HCC),while transcatheter arterial infusion(TAI)is another effective interventional treatment for HCC.In recent years,hepatic arterial infusion chemotherapy(HAIC)has gained increasing attention as an application-regulated modality for TAI.Owing to the current debate in the medical community regarding the use of HAIC and TACE for the treatment of HCC,the application of both approaches should be considered at a higher level,with a broader perspective and a more normative aspect.Accordingly,we aimed to define the rational combination of liver cancer TAI/HAIC with TACE as infusion transcatheter chemoembolization(iTACE),which suggests that the two interventions are not superior but lead to a mutually beneficial situation.In this review,we sought to discuss the development,specification,application,challenge and innovation,debate,and union of TAI/HAIC and TACE,and the clinical application and latest research on iTACE.We aimed to introduce new concepts of iTACE and expect new breakthroughs in the treatment of liver cancer owing to the combined use of the two major interventional tools.展开更多
Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies...Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.展开更多
Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive jaundice.Major bleeding complications occur in approximately 2–3%of patients after PTBD,which can result ...Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive jaundice.Major bleeding complications occur in approximately 2–3%of patients after PTBD,which can result in death.A case involving a 63-year-old male with malignant obstructive jaundice,who experienced severe bleeding after PTBD,is reported.Emergency digital subtraction angiography,celiac trunk artery and superior mesenteric artery angiography were performed;however,no signs of arterial bleeding were found.To identify etiology,portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed.Ultimately,selective portal vein embolization successfully stopped the bleeding.展开更多
文摘Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular carcinoma(HCC),while transcatheter arterial infusion(TAI)is another effective interventional treatment for HCC.In recent years,hepatic arterial infusion chemotherapy(HAIC)has gained increasing attention as an application-regulated modality for TAI.Owing to the current debate in the medical community regarding the use of HAIC and TACE for the treatment of HCC,the application of both approaches should be considered at a higher level,with a broader perspective and a more normative aspect.Accordingly,we aimed to define the rational combination of liver cancer TAI/HAIC with TACE as infusion transcatheter chemoembolization(iTACE),which suggests that the two interventions are not superior but lead to a mutually beneficial situation.In this review,we sought to discuss the development,specification,application,challenge and innovation,debate,and union of TAI/HAIC and TACE,and the clinical application and latest research on iTACE.We aimed to introduce new concepts of iTACE and expect new breakthroughs in the treatment of liver cancer owing to the combined use of the two major interventional tools.
基金Financial support from the Municipal Hospital Joint Research Project of Emerging Frontier Technology(Project SHDC12014112)Shanghai City,Shen Kang Group,and medical guided technology project of Shanghai Committee of Science and Technology,China(project 14411967500).
文摘Background and aims:Biliary thermal injury caused by microwave ablation(MWA)for a hepatocellular carcinoma(HCC)close to the central bile ducts always results in severe complications and leads to mortality.Some studies have demonstrated that intraductal cooling of the biliary tract with chilled saline during thermal ablation can successfully prevent these complications.In this study,we present a novel bile duct cooling technique through a percutaneous transhepatic cholangial drainage(PTCD)tube for preventing biliary thermal injury caused by MWA,and compare the feasibility and safety of the intraductal cooling technique when performed with a PTCD tube and with an endoscopic nasobiliary drainage(ENBD)tube.Methods:Participants were randomly assigned to undergo MWA of HCC with intraductal chilled saline perfusion through a PTCD tube or an ENBD tube.The main study outcomes were bile duct complications related to MWA and local tumor recurrence,p value<0.05 was considered to indicate a statistically significant difference.Results:A total of 23 patients with an HCC(23 nodules)close to a central bile duct were enrolled in this study.Of these patients,12 had a PTCD tube and 11 had an ENBD tube placed into the hepatic duct close to the lesions.There were no PTCD-and ENBD-related mortality cases.There was no complication related to the PTCD procedure;however,3 patients(27.27%)developed acute pancreatitis and 1 patient(9.09%)had hemorrhage in the ENBD group(p=0.037).One patient(8.33%)in the PTCD group had bile leakage and 2 patients(18.18%)in the ENBD group developed a biloma.Within 5 years,1 patient in the PTCD group and 2 patients in the ENBD group had local recurrence.There was no significant difference in local recurrence,nonlocal hepatic recurrence,mortality rate,or median cumulative overall survival between the 2 groups.Conclusions:The intraductal cooling technique using a PTCD tube is a feasible and effective method for preventing bile duct thermal injury caused by MWA for an HCC close to the central bile ducts.It does not increase local recurrence and may be safer than intraductal cooling through an ENBD tube.
基金supported by the National Science Foundation of China(31971249)
文摘Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive jaundice.Major bleeding complications occur in approximately 2–3%of patients after PTBD,which can result in death.A case involving a 63-year-old male with malignant obstructive jaundice,who experienced severe bleeding after PTBD,is reported.Emergency digital subtraction angiography,celiac trunk artery and superior mesenteric artery angiography were performed;however,no signs of arterial bleeding were found.To identify etiology,portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed.Ultimately,selective portal vein embolization successfully stopped the bleeding.
