| Objective：To observe the efficacy of individual differences in treatment withtranscatheter arterial chemoembolization (TACE) on primary hepatocellularcarcinoma(PHC) with leukopenia, ascites, and portal vein tumor thrombus, lack ofblood supply of tumors, cirrhosis; To observe the efficacy by superselectivecatheterization in TACE; To investigate the efficacy and safety of three acrylicmicrospheres in TACE.Methods：1. Through the retrospective cohort study, we analysised the time toprogression(TTP) and survival status of the201cases of PHC received TACEtreatment in First Affiliated Hospital of Nanchang University during June2009toJune2011. The patients with neutropenia or ascites were only given the embolizationof tumor feeding arteries, not used chemotherapy drugs. The treatment ofimmunomodulatory therapy had been used after TACE in patients with portal veintumor thrombus. The changes of liver function and white blood cells and short-termeffects were observed for a month before and after TACE. The patients whose tumorslack of blood supply only were given chemotherapy instead of undergoneembolization. The patients with cirrhosis just were given embolization instead ofundergone chemotherapy. The patients with arteriovenous fistula were plugged thearteriovenous fistula with PVA before TACE. The short-term effects of all the abovepatients were observed. Comparative the lipiodol deposition rate, TTP, the survivalfunction and complications between the patients with superselective catheterization oftumor feeding artery proximal or not in TACE.2. By prospective controlled study,26patients were divided into the lipiodolembolization groups (lipiodol used alone as an embolic agent) and unitedembolization group (joint use of three acrylic microspheres and lipiodol as an embolicagent). Comparatived the TTP; median survival time;6,9,12,18-month survival rate;survival curves and complications between the two groups patients.Results：1: The efficacy of TACE1.1A total of201cases of PHC received the TACE treatment, of which16caseswere lost.185patients had received a total of611times of TACE. Average dosage oflipiodol was12.73±3.62ml; there were147patients had good lipiodol deposition and38cases were poor. The average of TTP was4.38±2.68months; mediansurvival time was10.37months;6months survival rate:69%;9months survival rate:52%;12months survival rate:41%;18months survival rate:18%;24monthssurvival rate:4.3%.1.2A total of32cases in the initial treatment of patients with WBC <3.0x10^9/L,There was no significant difference in the changes of WBC and liver functionbefore and after treatment (P>0.05).The median of TTP was2.88months;3monthssurvival rate was78%;6months survival rate:50%;9months survival rate:22%;12months survival rate:13%; median survival time was6months.1.3A total of16cases was associated with ascites, No statistic difference werefound between liver function changes before and after treatment (P>0.05).Themedian of TTP was2.67months;3months survival rate was81%;6months survivalrate:31%;9months survival rate:25%;12months survival rate:13%; mediansurvival time was5.25months.1.4A total of17patients by DSA angiography showed the tumor lacking bloodsupply, poor lipiodol deposition, were given chemotherapy treatment, The median ofTTP was3months;3months survival rate was100%;6months survival rate:71%;9months survival rate:28%;12months survival rate:12%; median survival time was7.75months.1.5A total of30patients by DSA angiography showed AV fistula, were givenPVA particles re-plug the AV fistula, chemoembolization, The median of TTP was4.63months;3months survival rate was77%;6months survival rate:57%;9monthssurvival rate:23%;12months survival rate:17%; median survival time was7months.1.6There were no significant differences in liver function changes from a totalof65patients with portal vein tumor thrombus before and after treatment. Themedian of TTP was2.67months;3months survival rate was80%;6months survivalrate:43%;9months survival rate:2%;12months survival rate:0%; median survivaltime was5.59months. of which40patients received chemoembolization,25patientsreceived embolization, No statistic difference were found between the two groups ofaverage of TTP, median survival and survival curves (P>0.05).1.7A total of81cases of patients with cirrhosis of the liver basis, of which39patients received chemoembolization, the median survival was4.08months,42patients received embolization, the median survival of3.5months. No statisticdifference were found between the two groups of average of TTP, median survival and survival curves (P>0.05).1.8A total of108patients underwent superselective catheterization, Lipiodoldeposition conditions, TTP, median survival time and survival time were better thanthe non-superselective intubation group. Average iodized oil consumption,intrahepatic ectopic embolism and postoperative pain was less thannon-superselective intubation group. Differences were statistically significant (P<0.05).2. The relationship between microspheres embolization and prognosis of TACE2.1The TTP in lipiodol embolization group was4.92±2.87months and jointgroup was5.69±5.04months, No statistic difference were found between the twogroups (P>0.05).2.2No statistic difference were found between the two groups of6,9,12,18-month survival rate (P>0.05).2.3No statistic difference were found between the two groups of patientssurvival curve (P>0.05).2.4No statistic difference were found between the two groups of patientscomplications after TACE (P>0.05).Conclusion：1. There is a good short-term effect in individual differencestreatment of TACE for primary hepatocellular carcinoma associated with ascites,leukopenia, and portal vein tumor thrombus, liver cirrhosis and hepatic artery andportal vein fistula.2. Superselective catheterization can improve the efficacy of TACE and reduce thecomplications.3. The efficacy of three acrylic microspheres with TACE is safe.4. The efficacy of three acrylic microspheres with TACE need to be confirmed byfurther studies. |
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