Postoperative interferon-alpha therapy appears to decrease recurrence after resection of hepatitis C virus-related hepatocellular carcinoma.
As a countermeasure to portal tumor thrombi, which are a serious danger in liver cancer, we did portal vein embolization (PVE) during percutaneous transhepatic portography. Our 21 patients later underwent hepatic resection. After PVE, portal pressure increased and there was slight liver function damage, but this procedure was safer than transarterial embolization (TAE). We examined the pathologic specimens to view the state of occlusion achieved and also for histological findings, and found that Lipiodol | mixed with fibrin was most effective. PVE done before hepatic resection strengthened the anticancer effect of TAE, prevented intrahepatic metastases, and caused permanent hypertrophy of the liver that may be useful as a kind of preparation for surgery.Recently in Japan, small hepatocellular carcinomas have been diagnosed more frequently because of regular measurements of serum alpha-fetoprotein levels in high-risk patients and also improvements in medical imaging. However, even small tumors often give rise to a tumor thrombus in the portal vein [1]. The prognosis is worsened by this complication. Even hepatic transarterial embolization (TAE) [2], which is effective against liver cancer, has almost no effect on tumor thrombi [3]. Since thrombi present such dangers in liver cancer, countermeasures are essential if the prognosis is to be improved. We devised a method using percutane-
In the past 4 years intraoperative sonography was performed on 83 patients with primary hepatic carcinoma, 11 with benign hepatic tumor, nine with intrahepatic lithiasis, five with metastatic hepatic carcinoma, and four with other benign hepatic diseases, for a total of 112 patients. Ultrasonography detected primary carcinoma in 80 of 83 patients (96.4%) and intrahepatic metastases in 30 of 33 patients (90.9%), as confirmed later in surgical specimens. Tumor thrombi in the portal vein were detected in nine of 13 patients (69.2%). In patients with intrahepatic lithiasis and benign space-occupying lesions, residual stones could be assessed easily and the nature and location of the lesions identified. Intraoperative sonography demonstrates intrahepatic ductal structures clearly and is the final diagnostic imaging procedure before surgery.
Comparative study of the clinical features of 125 cases of acute cholangitis revealed that acute obstructive suppurative cholangitis (AOSC, 19 cases) was characterized by leukocytosis, high transaminase levels, bilirubinemia, and a marked thrombocytopenia. Most species of bacilli isolated from the purulent bile were gram‐negative and in 9 of 12 cases of AOSC that we checked, the same species were found in the blood as in the bile. In 12 of the 19 cases of AOSC, plasma endotoxin levels were assayed by theLimulus test and found to be elevated. Of the 22 cases of cholangitis other than AOSC, only 5 showed transitory positive results. Laparotomy decompression of the bile duct in 8 patients with AOSC resulted in 4 deaths from post‐operative complications. However, 7 of the 11 patients placed on emergency percutaneous transhepatic cholangio‐drainage (PTCD) recovered from shock and underwent successful surgery later. We confirmed in an experimental study the initiation of cholangiovenous reflux in mongrel dogs. The cholangiovenous reflux of bacteria or endotoxin seems to induce the state of shock in patients with AOSC. In conclusion, we recommend that emergency decompression of the biliary tract even for AOSC patients in shock be performed by a procedure less risky than laparotomy, such as PTCD.
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