Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.
ObjectiveTo summarize the experience of combined treatment of conventional transcatheter arterial chemoembolization (cTACE) and drug-eluting-bead chemoembolization(D-TACE) in a case of advanced hepatocellular carcinoma with intrahepatic metastasis.MethodsA patient with advanced hepatocellular carcinoma who was admitted to The Second Affiliated Hospital of Chongqing Medical University in October 2018 was treated with TACE for three times.ResultsAfter MDT discussion, three interventional operations were performed on this patient in The Second Affiliated Hospital of Chongqing Medical University. CT examination after the first treatment with cTACE showed that lipiodol deposited in liver lesions and the lesions were more stable than before; after the second treatment with cTACE and D-TACE, CT examination showed more lipiodol deposited in the tumors, and the tumors were more limited and significantly reduced; after the third treatment with cTACE, CT examination showed that the tumors were effectively controlled and no progress was made. This patient was followed-up for 2 months after the fourth cTACE, tumors were effectively controlled and no progress occurred.ConclusionsIn advanced hepatocellular carcinoma with intrahepatic metastasis, TACE is the best treatment. Combination of D-TACE and cTACE can achieve better clinical efficacy.
ObjectiveThe present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer.MethodsThe MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer.ResultsAn elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up.ConclusionsThepatient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.
Objective To determine the expression levels of micro RNA (miR)-196, miR-217, and transforming growth factor β receptor 1 (TGFβR1) protein in the pancreatic ductal adenocarcinoma tissues and its adjacent tissues, to reveal the relationship among them in the pathological process of pancreatic ductal adenocarcinoma. Methods A total of 30 cases’ pancreatic ductal adenocarcinoma tissues and its adjacent tissues were collected. The expression levels of miR-196b and miR-217 in the pancreatic ductal adenocarcinoma and adjacent tissues were detected by real-time fluorescence quantitative polymerase chain reaction method, the level of TGFβR1 protein was detected by Western blotting method. Results In the pancreatic ductal adenocarcinoma tissues, the expression levels of miR-196b and TGFβR1 protein were significantly higher than those of adjacent tissues (P<0.001), while the level of miR-217 was significantly lower than that of adjacent tissues (P=0.001). For further detection, the level of miR-196b in pancreatic ductal adenocarcinoma tissues was significantly positively correlated with the expression level of TGFβR1 protein (r=0.803, P<0.001), while the expression level of miR-217 was negatively correlated with the expression level of TGFβR1 protein (r=–0.839, P<0.001). Conclusions Expression TGFβR1 protein in pancreatic ductal adenocarcinoma tissues may be bi-directionally regulated by miR-196b and miR-217. This two-way regulating mechanism may be one of the important mechanisms for restricting the development of pancreatic ductal adenocarcinoma, implying a potential target for treatment of pancreatic cancer.
目的探讨经脐单孔腹腔镜胆囊切除术（LC）的临床应用。方法分析我院2009年1月至2010年5月期间120例因结石性胆囊炎和胆囊息肉行经脐单孔LC患者的临床资料。结果98例患者手术成功，手术时间38～126 min，平均50.3 min。22例单孔手术失败改成两孔完成手术。住院时间2～4 d，平均2.5 d。全组患者无出血及漏胆并发症发生，仅2例（1.7%）脐部戳孔处术后轻度感染，经局部换药治疗2周愈合。89例（90.8%）采用单孔法患者获得1～15个月（平均7.3个月）随访，均无并发症发生。结论单孔LC安全可行，但使用现有腹腔镜设备操作难度较大，器械及技术尚需进一步完善。