Based on the experience of more than 10 000 times of radiofrequency ablation treatment and the clinical and basic research results of radiofrequency ablation treatment of liver cancer obtained during the period, the author shares the experience of radiofrequency ablation indication selection, preoperative preparation, concept of radiofrequency ablation and postoperative follow-up of liver cancer. The purpose is to explore how to improve the curative effect of RFA treatment for small liver cancer, and reduce local residue, recurrence, as well as relevant complications.
Objective To investigate the regulatory effect of somatostatin analogue (SMS201995,SMS) on proliferation and apoptosis in human cholangiocarcinoma cell line in vitro. MethodsProliferation curve, flow cytometry, agarose gel electrophoresis, Annexin VFITC and flow cytometric immunofluorescent technique were performed to identify the inhibitory effect on cell proliferation and the induction of apoptosis of human cholangiocarcinoma cells (SKChA1). ResultsSMS significantly reduced the SKChA1 cell growth by serum in long experiments and transiently accumulated it in G0/G1 phase. Dotplot analysis of cells duallabeled with Annexin VFITC and PI confirmed the induction of apoptosis by SMS in SKChA1 cells.AnnexinVFITC labeling was markedly enhanced following treatment with SMS for 24 h. DNA of treated SKChA1 cells appeared a ladder pattern characteristic of apoptosis. Besides, timedependent increase in bax and decrease in bcl2 occured during SMS treatment. Conclusion SMS could inhibit the proliferation activity and induce apoptosis of cholangiocarcinoma cell line SKChA1. The mechanisms of apoptosis might be correlated with the expression of apoptosisregulatory gene bax and bcl2.
In 2022, there were 367.7 thousands new cases and 316.5 thousands deaths of primary liver cancer in China. Radiofrequency ablation (RFA) is one of the radical treatments for liver cancer. It has the characteristics of definite curative effect, minimal invasion and low cost. In patients with early liver cancer, the curative effect is similar to surgical resection. The concept and practice of precision surgery provide new ideas for improving the efficacy of RFA. Based on the RFA treatment experience of more than ten thousand cases, the author’s team has carried out research on the precise ablation treatment of primary liver cancer. Now, the author will combine the existing literature and our team’s experience to discuss the application and prospect of the precise surgery concept in RFA treatment.
Objective To investigate the molecular signal mechanism of transform growth factor (TGF)-β induced arterial endothelial-mesenchymal transition. Methods Rat arterial endothelial cells were primarily cultured by ex-transplant method. The endothelial cells were incubated by combinant TGF-β (10 ng/mL) for 48 hours and then were detected by immunofluorescence staining and western blotting to observe the cell surface marker expression profile and Akt/mTOR signal activation. On the other hand, the endothelial cells were preincubated by Ly294002 (20 μmol/L) and rapamycin (10 nmol/L) to inhibit the Akt/mTOR signal, and then the cells were further treated with TGF-β (10 ng/mL) for 48 hours to observe the cell surface marker expression profile without Akt/mTOR signal activation. Results Rat artery endothelial cells by TGF-β after incubation, the expressions of smooth muscle cell markers α-smooth muscle actin (α-SMA) and smooth muscle-22α (SM-22α) were up-regulated, and the endothelial cell markers CD31 and vW factor were significantly down-regulated, at the same time, the expressions of phosphorylated Akt and mTOR were also up-regulated. However, after preincubation of Ly294002 (20 μmol/L) and rapamycin (10 nmol/L) to inhibit the phosphorylation of Akt and mTOR signal, above TGF-β-induced expressions of α-SMA and SM-22α in arterial endothelial cells were significantly suppressed and the expressions of CD31 and vWF were preserved. Conclusion TGF-β-induced arterial endothelial-mesenchymal transition is dependent on activation of Akt/mTOR signal, suggesting that Akt/mTOR-dependent arterial endothelial-mesenchymal transition would be one of the mechanisms for intima hyperplasia in transplant arteriosclerosis.
Objective To establish the model of hepatic VX2 tumor in rabbits and to offer the experimental evidences for the application of the model. Methods The hepatoma model was reproduced with VX2 cell lines in rabbits. The method to reproduce the model was improved. The changes of liver function (ALT, AST and TB) were determined at a different phase. Tumor’s growth and metastases, pathological changes, images and spontaneous survival time of the animal were observed. Results The tumors could grow up to 1.5-2.0 cm in diameter in 3 weeks after implanting. The successful rate of implantation was 100%. Nodular enhanced echo was found in the liver by color ultrasound. CT scans showed the low density foci in liver, while enhanced CT scans demonstrated asymmetrical intensification in the foci. Macroscopic observation showed that the tumors were grayish white in color and felt harder, necrotic foci was present in the center of tumor. Observation with light microscope showed that the tumor cells’ nucleoplasm proportion was great, tumor cells arranged irregularly, and the tumors displayed invasive growth and no obvious envelope around them. Animals’ spontaneous survival time was 40-53 days. The cause for their death was multiple system organ failure. Conclusion In pathological morphology, pathological process and prognosis, the hepaticVX2 tumors in rabbits are similar to human hepatocarcinoma. It has such characteristics as easy reproduction, short growth period, high success rate, high stability and so on. The model is an ideal hepatoma model in animals.
Objective To investigate the impact of injection of acetic acid hypertonic saline solution (AHS) in dog liver during radiofrequency ablation (RFA) on its destructive zone. Methods RFAs were performed in dog livers by using LDRF-120S mutiple probe ablation system combining 50% acetic acid 5% hypertonic saline solution injection. Thirty healthy adult hybrid dogs were randomly divided into 5 groups (n=6). Group A: RFA was performed immediately after injection of 2 ml AHS; Group B: RFA was performed 5 min after injection of 2 ml AHS; Group C: RFA was performed immediately after injection of 4 ml AHS; Group D: RFA was performed 5 min after injection of 4 ml AHS; Group E: RFA was performed immediately after injection of 6 ml AHS. Results There were no significant differences in the mean initial impedance within 5 groups. The mean ablation times were different significantly among 5 groups (F=83.831, P＜0.001). The mean ablation time was different significantly between any two groups by LSD-t analysis (P＜0.001). The mean coagulation diameters were different significantly among 5 groups （F=53.488, P＜0.001）. The mean coagulation diameter of group E was the largest among 5 groups. Besides mean coagulation diameter was no significant difference between group D and E (Pgt;0.05), the mean coagulation diameter was different significantly between any two groups by LSD-t analysis (P＜0.001). Obviously thrombus were shown in coagulation necrosis zone and nearly normal tissue with gordon amp; sweet. AHS spillage from the injection site occurred in group E. Four dogs died in group E within 14 d but no dog died in the other groups. Conclusion RFA is performed 5 min after injection of 4 ml AHS in dog liver produces the ideal ablation destructive zone.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.
ObjectiveTo establish a model for predicting microvascular invasion (MVI) of hepatocellular carcinoma based on magnetic resonance imaging (MRI) radiomics features.MethodsThe clinical and pathological datas of 190 patients with hepatocellular carcinoma who received surgical treatment in our hospital from September 2017 to May 2020 were prospectively collected. The patients were randomly divided into training group (n=158) and test group (n=32) with a ratio of 5∶1. Gadoxetate disodium (Gd-EOB-DTPA) -enhanced MR images of arterial phase and hepatobiliary phase were used to select radiomics features through the region of interest (ROI). The ROI included the tumor lesions and the area dilating to 2 cm from the margin of the tumor. Based on a machine learning algorithm logistic, a radiomics model for predicting MVI of hepatocellular carcinoma was established in the training group, and the model was evaluated in the test group.ResultsSeven radiomics features were obtained. The area under the receiver operating characteristic curve (AUC) of the training group and the test group were 0.830 [95%CI (0.669, 0.811)] and 0.734 [95%CI (0.600, 0.936)], respectively.ConclusionThe model based on MRI radiomics features seems to be a promising approach for predicting the microvascular invasion of hepatocellular carcinoma, which is of clinical significance for the management of hepatocellular carcinoma treatment.