The Observation Of Therapeutic Effect And Evolution Of Traditional Chinese Medicine Syndrome Types Of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Transcatheter Arterial Chemoembolization

Objectives: The incidence of hepatocellular carcinoma (HCC) with portalvein tumor thrombus(PVTT) is high. PVTT always causes acute portalhypertension and alimentary tracthemorrhea, even refractory ascites and leadsto liver function failure. So many patients of HCC with PVTT will die in shortperiod without treatment. Because of inducing liver function failure, TACEis considered a taboo to patients of HCC with PVTT, absolutely with PVTT inmain portal vein before. After majority hakeems sample TACE to treat patientsof HCC with PVTT and get invariably therapeutic effect, TACE isn't consideredas taboo to patients of HCC with PVTT now. But because of the weak hepaticfunction, the dosage limitation of chems medicine and embolism agent in TACEand the damage of hepatic function post-TACE, the prostecdtive efficacy ofTACE is not satisfaction. We discovered it can improve clinical symptom,protect liver function, antagonize side effect after TACE, lessen immunesuppression and takes an important part in treatingtumor and precluding tumorpalindromia to use chinese medicine as assisting treatment pro-and post-TACE.We study the temporary therapy effect of TACE in six month. The TraditionalChinese Medicine syndrome types pre-and post-TACE of HCC with PVTT were alsostudied to sum up the characteristic of it.It can guide clinical treatmentof TCM pre-and post-TACE better and improve therapeutic efficacy.Methods: From Jan. 2005 to Jan. 2007, 62 patients of HCC with PVTT in thefirst affliliated Hospital of Guangzhou University of TCM were selected tostudy. To observe the temporary therapy effect and traditional ChineseMedicine syndrome types pre-TACE and 3 days, 7 days, 14 days and 21 days post-TACE and the change of clinical symptom. Results:1. HCC with PVTT belongs to advanced stage hepatoma. Yin deficiency ofliver and kidney and accumulated dampness-heat account highest percentage,are 40.3% and 27.4%. Second is qi stagnation and blood tasis(21.0%). Lowestis stagnation of liver qi and splenic deficiency (11.3%).2. Stagnation of liver qi and splenic deficiency, qi stagnation and bloodtasis and accumulated dampness-heat change greater post-TACE. Stagnation ofliver qi and splenic deficiency reduces 14.29%, 42.86%, 28.57% and 14.29% on 3 days, 7 days, 14 days and 21 days post- TACE than pre-TACE andaccumulated dampness-best reduces 23.53%, 29.41%, 11.76% and 17.65% thanpre-TACE. Qi stagnation and blood tasis increases 30.77% and 38.46% on 3days and 7 days post- TACE than pre-TACE. Yin deficiency of liver and kidneychanges slower, but it occupies biggest percentage in all period. Lowest ispre-TACE(40.3%), higest is 21 days post-TACE(46.78%).3. Compared with pre-TACE there are macro-improvement of symptom on 14 daysand 21 days post- TACE for stagnation of liver qi and splenic deficiency, qistagnation and blood tasis and accumulated dampness-heat. There arestatistically difference. Compared with pre-TACE there was no obviousimprovement on 21 days post- TACE for Yin deficiency of liver and kidney. Thereis no statistically difference. We concluded TACE didn't have obviousimprovement in clinic syndrome of TCM to Yin deficiency of liver and kidney.Compared pre-TACE with 3 days post-TACE, there are no obvious difference insymptom for all syndrome types.4. The integration of symptom increases one by one to stagnation of liverqi and splenic deficiency, qi stagnation and blood tasis, accumulateddampness-hest and Yin deficiency of liver and kidney in any period. We canconclud they become aggravation one by one.5. Evaluation on therapeutic effect: on size of tumor, the effective powerof stagnation of liver qi and splenic deficiency, qi stagnation and blood tasis.accumulated dampness-heat and Yin deficiency of liver and kidney is 42.86%, 38.46%, 29.41% and 28%. There is no statistically significant differenceon effective power. On change of PVTT post-TACE, CR is 2 patients(3.23%), PRis 13 patients(20.97%),NC is 33 patients(53.23%), PD is 14 patients(22.58%). OnQOL scale, QOL scale is raised one month after TACE, compared to the QOL scalepre-TACE, there is statistically significant difference(P＜0.01); compared with QOL pre- TACE there is no obvious change of QOL three month post-TACE;QOL scale is decreased six month after TACE, compared to the QOL scale pre-TACE,there is statistically significant difference(P＜0.01). The survival rates of1 month, 3 month and 6 month after TACE are 100%, 83% and 63.6%.Conclusion:1. Yin deficiency of liver and kidney accounts the biggest percentage inall periods pre-and post- TACE to patients with HCC with PVTT. So it is thebasic pathogenesis, and it is important to invigoration liver and kidney intreatment.2. The Traditional Chinese Medicine syndrome types mainly changes to qistagnation and blood tasis in 7 days post-TACE, and mainly changes toaccumulated dampness-hest and Yin deficiency of liver and kidney after 7 dayspost-TACE.3. There. are obvious temporary therapy effect of TACE in controlling thesize of tumor and PVTT and improving QOL scale and raising survival rate. TACEhas better improvement in clinic syndrome of TCM in stagnation of liver qiand splenic deficiency, qi stagnation and blood tasis, accumulateddampness-hest than Yin deficiency of liver and kidney.