Ethanol ablation of hepatocellular carcinoma Up to 5.0 cm by using a multipronged injection needle with high-dose strategy.

PURPOSE: To investigate whether ethanol ablation by using a multipronged needle delivery system (multipronged ethanol ablation) could eradicate hepatocellular carcinoma (HCC) up to 5.0 cm in diameter with a single-session high-dose strategy. MATERIALS AND METHODS: The hospital ethics committee approved the prospective study, and each patient provided written informed consent. One hundred forty-one patients (125 men, 16 women; mean age, 53 years; range, 27-76 years) with 164 primary or recurrent HCC ranging from 1.3 to 5.0 cm in diameter (mean, 2.9 cm +/- 0.9) were treated with high-dose multipronged ethanol ablation. Patients were unsuitable for surgery, declined surgery and radiofrequency ablation, or had tumors located at unfavorable sites. Primary technique effectiveness (PTE) (complete ablation within two sessions), local tumor progression (LTP), and complications after the treatment were observed. Twenty risk factors of local effectiveness and complications were analyzed by means of univariate and multivariate analysis. RESULTS: Mean number of treatment sessions was 1.1. The mean volume of ethanol per tumor was 31 mL (range, 8-68 mL). PTE was achieved in 134 (95%) of 141 patients and was significantly associated with tumor pattern (capsulated vs noncapsulated, P = .018). After a mean follow-up period of 25 months, LTP was observed in 16 (12%) of 134 patients, and in nine (56%) patients, LTP occurred in tumors 3.1-5.0 cm in diameter. Alanine aminotransferase level (P = .023) was the independent risk factor for LTP. Three (2%) of 141 patients had major complications. CONCLUSION: Multipronged ethanol ablation with a high-dose strategy can be used to treat HCC up to 5.0 cm in diameter effectively and safely, often in a single session.

[Prevention, diagnosis and treatment of biliary complications after liver transplantation].

OBJECTIVE: To study the prevention, diagnosis and treatment of biliary complications after liver transplantation. METHODS: One hundred and twenty-three recipients who had received liver transplantation between April 1993 and November 2001 were retrospectively reviewed. RESULTS: Biliary complication was diagnosed by cholangiography in 11 patients. Nine patients were cured, 1 patient was improved and 1 patient died. The incidence for biliary complications was 8.9% (11/123), and the mortality was 0.8% (1/123). The incidence of biliary complications due to T tube was 4.2% (5/119). The incidence of biliary complications due to hepatic artery was 1.6% (2/123). In recipients with WIT > 3 min and CIT > 8 h, the incidence of biliary complications elevated significantly. CONCLUSIONS: The most important reason for biliary complications was preservative and ischemic injury. While repairing donor liver, damage to the blood supply system of donor liver bile ducts should be avoided. Meticulous T tube placement may reduce the incidence of biliary complications. Early cholangiography is helpful to diagnose biliary complications.