[en] Objective: To investigate the feasibility and safety of the X-ray guided obstructive double J tube replacement in ureter. Methods: The clinical data of 44 patients with double J tube obstruction who underwent double J tube replacement from April 2016 to August 2019 were analyzed retrospectively. Among the 44 cases, there were 3 males and 41 females, aged from 27.0 to 70.0 (54.6 ± 11.2) years. The time since last double J tube placement, the method of transurethral remove of double J tube, the method of double J tube replacement, the location of double J tube obstruction and postoperative complications were collected, and the success rate of operation was calculated. According to the different positions of calcium salt deposition in double J tubes, the obstructive double J tubes were divided into bladder end type, renal pelvis end type, two-end type and whole partial type. The replacement method was differentiated according to different types of double J tube obstruction. The cut-off end method was to cut off the obstructed bladder end of double J tube by scissors, and the internal unobstructed double J tube could be seen. The guide wire could be introduced into the renal pelvis through the double J tube, and the new double J tube could be replaced. This method was only used for bladder end type double J tube obstruction. The thine guide wire method was to replace the common guide wire which could not pass through the renal pelvis end obstruction with the microguide wire, so that it could pass through the end of the double J tube of the renal pelvis end obstruction or through the side hole, enter into the renal pelvis, withdraw the original double J tube, and then replace the new double J tube. This method was suitable for renal pelvis end type double J tube obstruction, or combined with cut-off end method for two-end type double J tube obstruction. In the auxiliary sheath method, the obstructed double J tube was used as the support, the vascular sheath tube was sent into the ureter, and the guide wire was sent to the renal pelvis through the sheath tube to replace the new double J tube. This method was suitable for all types of double J tube obstruction. Results: A total of 47 X-ray-guided double J tube replacements were performed in 44 patients. In the removal of double J tube, 37 cases of direct method and 10 cases of indirect method were used, and the overall success rate of double J tube removal was 100% (47/47). The time from the last double J tube placement was (4.2 ± 1.3) months. There were 23 cases of bladder end type obstruction, 8 cases of renal pelvis end obstruction, 5 cases of two-end type obstruction, and 11 cases of whole partial type obstruction. The success rate of replacing double J tubes by cut-off end method, thin guide wire method and auxiliary sheath method was 76.0% (19/25), 50.0% (2/4) and 77.8% (14/18), respectively. After the failure of the cut-off end method or the thin guide wire method, 4 cases were further replaced by the thin guide wire method or auxiliary sheath method, and 3 cases were successful. Therefore, the overall success rate of double J tube replacement was 80.9% (38/47). The double J tubes were inserted by percutanous pyelostomy in 9 patients who failed to replace double J tube successfully. Among the 44 cases, there were 4 cases of urethral orifice pain and discomfort, and 2 cases of gross hematuria, all of which relieved spontaneously. Conclusion: It is feasible and safe to replace the obstructive double J tube in ureter under X-ray guidance. (authors)

[en] Objective: To assess the therapeutic outcomes of transcatheter arterial chemoembolization combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis for primary hepatic carcinoma accompanied by portal vein tumor thrombus. Methods: Thirty patients with primary hepatic carcinoma accompanied by portal vein tumor thrombosis of type II and type III were randomly divided into two groups. The Child-Pugh ratings (class A and B) of group A and B were 9 vs 9 (class A) and 5 vs 7 (class B) respectively (χ²=0.201, P>0.05). The constitution of Type II and type III portal vein tumor thrombus in group A and B were 8 vs 9 and 6 vs 7 respectively (χ²= 0.002, P>0.05). The median values of ALT, TBIL, ALB and AFP in group A and B were 58.7U/L vs 70.5 U/L (W=191.5, P>0.05), 21.4 μmol/L vs 21.7 μmol/L (W=203, P>0.05), 35.3 g/L vs 37.5 g/L (W=214,P>0.05) and 680 μg/L vs 873 μg/L (W=179.00, P>0.05) respectively. Group A was treated with transcatheter arterial chemoembolization (TACE) using emulsion made up of adriamycin, cisplatin, mitomycin and ultraliquidlipiodol plus percutaneous injection of chemoembolization agent intra- portal vein tumor thrombosis using emulsion consisted of cisplatin and ultraliquidlipiodol, while group B was treated with TACE only as a control group. Survival analyses were performed via the Kaplan-Meier test in SPSS11.5 with the log-rank tests with an threshold of 0.05. Results: The 3, 6 and 12 months survival cases of group A and B were 11 vs 10, 10 vs 3, and 7 vs 0 respectively. The median survival time of group A and group B were 14.0 months and 4.0 months respectively. The difference of the two groups was significantly (χ²=11.728, P<0.01). There was no severe side-effect related to therapy in both groups. Conclusion: Comparing with the control group, TACE combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma accompanied by type II and type III portal vein tumor thrombosis. (authors)

[en] Objective: To assess the therapeutic effect of hyperthermochemotherapy by using heated gemcitabine perfusion combined with transcatheter arterial chemoembolization of carboplatin in treating primary liver carcinomas. Methods: 96 patients with primary liver carcinoma were randomly divided into two groups: group A and group B. The patients in group A received hyperthermochemotherapy by using heated gemcitabine perfusion combined with transcatheter arterial chemoembolization of carboplatin, while the patients in group B received transcatheter arterial chemoembolization under room temperature. The hepatic and renal functions as well as the immune function were determined before and at 3, and 30 days after the treatment. Both plain and multi-stage enhanced CT or MRI scanning were carried out at 30 days after the treatment. Based on RECIST standard, the total effectiveness was compared between the two groups. The therapeutic procedure was repeated every 4-6 weeks. After the third time of the treatment, the patient was followed up. The total survival times of the two groups were separately calculated and the results were compared between the two groups. Results: In both groups the serum levels of ALT and AST were significantly elevated at 3 days after the treatment (P < 0.05), which were much higher in group B than those in group A (P < 0.01). Postoperative serum levels of ALT and AST determined at 30 days after the treatment were not different from the preoperative ones in both groups. Postoperative renal functions were not significantly different from the preoperative ones. The short-tenn evaluation of the clinical results showed that the total efficiency in group A and group B was 75.00% and 39.58% respectively, and the difference between the two groups was statistically significant (P < 0.01). After the treatment the percentages of CD3 and activated T lymphocyte in the peripheral blood in the patients of group A were increased, which were higher than their preoperative ones as well as than those in the patients of group B, while the percentages of CD8 were decreased and became lower than their preoperative ones as well as than those in the patients of group B. After the treatment no obvious changes in the immune function were observed in patients of group B when compared to the preoperative data. The median survival times of group A and group B were 24.0 months and 18.9 months respectively, the difference between the two groups was statistically significant (P < 0.01). Conclusion: For the treatment of primary liver carcinomas hyperthermochemotherapy by using heated gemcitabine perfusion combined with transcatheter arterial chemoembolization of carboplatin is safe and effective with fewer side effects. This therapy can improve patient's immune function and prolong the survival time as well. (authors)

[en] Objective: To discuss the clinical application of C-arm CT in performing percutaneous transhepatic cholangiopancreatic drainage (PTCD) for obstructive jaundice. Methods: The clinical data of 82 patients with obstructive jaundice were retrospectively analyzed. The patients were divided into study group (n = 43) and control group (n = 39). C-arm CT guided PTCD was performed for patients of the study group, while under fluoroscopic guidance PTCD was carried out for patients of the control group. The end point of the study was the successful puncture, i.e. a safe procedure course from the correct puncturing to the safe placement of a guide-wire into a proper bile duct. The times of puncturing, the fluoroscopy time for the procedure, the total puncturing time, the exposure radiation dose, and the occurrence of complications such as hemobilia, biliary peritonitis, etc. were recorded. The results were analyzed. Results: The number of puncturing in the study group was (1.1 ± 0.3) times, while it was (2.8 ± 0.6) times in the control group, the difference between the two groups was significant. The fluoroscopy time and the total puncturing time of the study group were (13.1 ± 2.7) sec and (46.9 ± 9.7) sec respectively, while those of the control group were (33.7 ± 6.2) sec and (90.7 ± 17.2) sec respectively. The fluoroscopy time and the total puncturing time of the study group were much shorter than those of the control group. The exposure radiation dose of the study group was (2.61 ± 0.53) mGy, while the exposure radiation dose of the control group was (6.75 ± 1.23) mGy. The exposure radiation dose of the study group was lower than that of the control group. Hemobilia occurred in 6 patients of the control group. Conclusion: In treating obstructive jaundice with PTCD, the use of C-arm CT can reduce the fluoroscopy time and the total puncturing times. (authors)

[en] Objective: To investigate the safety of CT-guided percutaneous gastrostomy in treating dysphagia caused by amyotrophic lateral sclerosis. Methods: The clinical data of 24 patients with amyotrophic lateral sclerosis were retrospectively analyzed. All patients presented as varying degrees of dyspnea, and simple non-invasive ventilator was employed to assist respiration. The patients also had dysphagia and couldn't normally take food, and CT-guided percutaneous gastrostomy was carried out. During and after operation, the respiratory function and complications were recorded. Results: Successful CT-guided percutaneous gastrostomy was accomplished in all patients, the technical success rate was 100%. During operation and one day, 3 days after operation, the non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation of blood (SpO₂) were not significantly different from the preoperative ones (P > 0.05 in all). The patients were followed up for more than 3 months, one patient developed gastrostomy exudate and the exudate disappeared after replacement of a 16 F gastrostomy tube;another patient developed gastrostomy infection and the infection was cured after anti-inflammatory therapy. Gastrostomy tube was slipped and shifted in one patient two months after treatment, and replacement of gastrostomy tube had to be carried out. No serious complications or treatment-related death occurred. Conclusion: CT-guided percutaneous gastrostomy does not affect the respiratory function in patients with amyotrophic lateral sclerosis, besides, it carries less procedure-related complications. Therefore, this technique is worthy of clinical popularization. (authors)

[en] Objective: To discuss the application of preoperative temporary internal carotid balloon occlusion test in treating head and neck tumors with surgery. Methods: The temporary balloon occlusion test of the tumor-side internal carotid artery was carried out in 32 patients with head and neck tumors before surgery. The balloon occlusion lasted for 30 minutes. After the balloon occlusion started, the changes in nervous system were recorded and the pressure at the arterial stump was monitored. The ratio of arterial pressure at the arterial stump to the general mean arterial pressure was calculated. The test was considered to be negative if no neurologic symptoms appeared after the balloon occlusion or the pressure at the arterial stump was ≥ 50% of the base line, otherwise the test would be regarded as positive. Results: Of the 32 patients, negative balloon occlusion test was seen in 30 and positive in 2. Among the two patients with positive balloon occlusion test, one developed neurologic symptoms during the test, which disappeared after the test was ceased. In another patient no test-related neurologic symptoms occurred although the pressure at the arterial stump was 40 mmHg. Among the 30 patients, partial resection of internal carotid was performed in 2, surgical ligation of internal carotid was adopted in 7, and entire resection of the tumor with reservation of the tumor-side internal carotid was carried out in 21. After the surgery, no neurologic complications occurred. Both two patients with positive balloon occlusion test gave up surgery. One patient received seed implantation combined with arterial drug infusion, and the other patient underwent argon-helium knife cryoablation together with arterial drug infusion. Conclusion: The temporary internal carotid balloon occlusion test is simple and safe. This test is very helpful in selecting effective therapeutic scheme for head and neck tumors to avoid the occurrence of neurologic complications. (authors)

[en] Objective: To investigate the clinical application of C arm CT imaging technique in diagnosing and treating of hypo-vascular primary hepatic carcinomas. Methods: Forty-three patients with hypo-vascular primary hepatic carcinomas were enrolled in this study. All the patients underwent DSA and C arm CT imaging (Philips dual x-ray flat-panel digital imaging system) before transcatheter arterial chemoembolization (TACE). The imaging findings were retrospectively analyzed. The detection rate of hepatic tumors estimated before TACE were compared among CT/MRI, DSA and C arm CT imaging. Results: After TACE a total of 97 hypo-vascular tumors were found on CT scanning. The detection rates of hepatic tumors on CT/MRI, DSA and C arm CT imaging were 71.1% (69/97), 78.4% (76/97) and 89.7% (87/97), respectively, with P<0.05. Thirty-nine lesions had a diameter < 10 mm, and the detection rates for them on CT/MRI, DSA and C arm CT imaging were 61.5% (24/39), 76.9% (30/39) and 87.2% (34/39), respectively, with P<0.05. Fifty-eight lesions had a diameter ≥10 mm, and the detection rates for them on CT/MRI, DSA and C arm CT imaging were 77.6% (45/58), 79.3% (46/58) and 87.9% (51/58), respectively, with P>0.05. Conclusion: C arm CT imaging technique is superior to CT/MRI and DSA in detecting the hypo-vascular hepatic tumors. This technique can more precisely and more sensitively demonstrate the hepatic lesions, especially for the tumors with a diameter smaller than 10 mm. Therefore, this technique has great clinical value in treating hepatocellular carcinomas. (authors)

[en] Objective: To investigate the clinical effect and safety of fluoroscopy-guided percutaneous gastrostomy and nasogastric feeding tube placement. Methods: The clinical data of sixty-seven patients with dysphagia were retrospectively analyzed. The primary diseases included laryngocarcinoma (n = 14), esophagomediastinal fistul a (n = 18) and cervical esophageal carcinoma ( n = 35 ). Twenty-two patients underwent fluoroscopy-guided percutaneous gastrostomy (group G) and forty-five patients received fluoroscopy-guided nasogastric feeding tube placement (group N). The results were analyzed and compared between the two methods. Results: The interventional therapy was successfully accomplished in all patients with a technical success rate of 100%. In both groups, the levels of the serum albumin (ALB), prealbumin (PA) and total lymphocyte count (TLC) determined at 8 days and one month after the procedure were significantly higher than those determined before the therapy (P < 0.05). One and three months after the treatment, the patient's body weight was significantly increased and the living quality was significantly improved when compared to those evaluated before the treatment (P < 0.05). One month after the operation, The level of the ALB and the quality of life of the patients in group G were significantly better than those of the patients in group N (P < 0.05). No statistically significant difference in the incidence of postoperative complications existed between the two groups (P > 0.05). The medical expense of percutaneous gastrostomy was about 2.6 times of that of nasogastric feeding tube placement. Conclusion: Both percutaneous gastrostomy and nasogastric feeding tube placement, which are performed under fluoroscopic guidance, are clinically safe and effective, both of them can improve patient's nutrition state. However, the gastrostomy is superior to nasogastric feeding tube placement in clinical effectiveness, although the expense of gastrostomy is higher than that of nasogastric feeding tube placement. (authors)

[en] Objective: To evaluate the clinical value of CT-guided ¹²⁵I particle implantation combined with iliac artery infusion chemotherapy in treating refractory and recurrent pelvic malignant tumors. Methods: A total of 35 patients with refractory and recurrent pelvic malignant tumor, who were admitted to authors' hospital during the period from January 2013 to January 2016 to receive CT-guided ¹²⁵I particle implantation combined with iliac artery infusion chemotherapy, were selected and used as the study group, while other 39 patients with refractory and recurrent pelvic malignant tumor received simple ¹²⁵I particle implantation and were used as the control group. The short-term and long- term curative effect, as well as the improvement of clinical symptoms, were compared between the two groups. Results: The objective effective rate and the benefit rate in the study group were 60.0% (21/35) and 85.7% (30/35) respectively, while those in the control group were 53.8% (21/39) and 84.6% (33/39) respectively, the differences between the two groups were not statistically significant (P = 0.594 and P = 0.894 respectively). In the study group the mean disease progression-free period was 12.2 months, which was 3.6 months longer than that of 8.6 months in the control group, the difference between the two groups was statistically significant (P = 0.002). The recurrence rates in the study group and the control group were 40.0%(12/30) and 57.6%(19/33) respectively, the difference between the two groups was statistically significant (P = 0.018). The mean preoperative and postoperative KPS values in the study group were 72.4 points and 82.7 points respectively, which in the control group were 68.9 points and 79.1 points respectively; in each group statistically significant difference existed between the preoperative KPS value and the postoperative one (P = 0.043 and P = 0.039 respectively), however, no statistically significant difference in postoperative KPS value existed between the study group and the control group (P = 0.745). Conclusion: For the treatment of refractory and recurrent pelvic malignant tumors, CT-guided ¹²⁵I particle implantation is an effective therapy, however, combination use of iliac artery infusion chemotherapy can reduce the incidence of tumor recurrence and prolong the disease progression-free period. (authors)

[en] Objective: To assess the therapeutic value of transcatheter arterial chemoembolization combined "1"2"5iodine seed implantation for primary hepatic carcinoma with portal vein tumor thrombus. Methods: The data of 23 patients ranging from 34 to 70 years old [average age ( 56 ± 8) years] with primary hepatic carcinoma with portal vein tumor thrombosis of type Ⅱ and type Ⅲ were retrospectively collected. The tumor number of liver parenchyma ranged from 1 to 15 (median number 4). The average diameter of tumor thrombus was (20.5 ± 1.5) mm and average length was (37.4 ± 2.6) mm. All of the tumors of liver parenchyma in 23 patients were treated by transcatheter arterial chemoembolization (TACE) and tumor thrombus were treated with "1"2"5iodine seed implantation. Before the "1"2"5iodine seed implantation, the formula dosage, the number, the spatial distribution, the intensity of radioactivity and the matched peripheral dosage of seed were calculated by treatment planning system (TPS). Then the "1"2"5iodine seeds were implanted in different levels and locations of port vein thrombosis under CT guided. Results: The follow-up period ranged from 1 to 26 months. The times of transcatheter arterial chemoembolization were 1 to six times (median time 3.1±0.4) and the "1"2"5iodine seed implantation in the port vein thrombosis were 1 to 2 times (median time 1.4 ± 0.5). The numbers of implanted "1"2"5iodine seeds were 4 to 17 (median number 7.0 ± 1.0). The median survival time was 18.0 months (3-24 months). The 3,6 and 12 months survival rates were 91.3% (21/23), 69.6% (16/23), and 60.9% (14/23). There was no severe side-effect related to therapy. Conclusions: Transcatheter arterial chemoembolization combined "1"2"5iodine seed implantation for portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma with portal vein tumor thrombosis. (authors)