Experimental And Clinical Study Of Granular Embolization Materials In The Treatment Of Primary Hepatic Carcinoma

Part One:Experimental study on the effects of granular embolization materials for embolization of hepatic artery Objective:To investigate the most proper size and type of granular embolic material for hepatic artery embolization.Methods:40 New Zealand white rabbits were randomly divided into 8 groups,5rabbits in each group.The hepatic arteries were embolized with different sizes of granular embolic agents.Group Ⅰ was treated with 0.9% normal saline as control,40-120μm Embosphere microspheres was applied in Group II,100-300μm Embosphere microspheres in Group III,150-350μm PVA particles in Group IV,150-350μm gelatin sponge particles in Group V,300-500μm Embosphere microspheres in Group VI,350-560μm PVA particles in Group Ⅶ,and 350-560μm gelatin sponge particles was in Group Ⅷ.The hepatic artery distal vessels disapper in dendritic pattern selected as the point of embolization.All the rabbits were sacrificed 7 days after operation and the liver was samplied to observe the morphological changes of the hepatocelluls.The pathological sections and HE staining were performed to evaluate the degree of liver and biliary tract necrosis,and the diameter of hepatic vessels embolized with agents were recorded.Results:Hepatic artery embolization was successfully performed in 40 rabbits with a technical success rate of 100%.The liver suface and edge of Group Ⅱ to Ⅷ were showed different degrees of patchy necrosis.The liver severe necrosis was occurred in 80% of Group Ⅱ,there were 20% of moderate and 40% of bile duct necrosis.60% rabbits suffered with severe necrosis,and the rest was showed a moderate necrosis In Group Ⅲ.The incidence of severe necrosis,moderate necrosis were 60% and 40% In Group Ⅳ and Ⅴ.The liver moderate severe necrosis was occurred in 60% and mild necrosis 40% In Group Ⅳ.The incidence of moderate necrosis was 40% and mild necrosis 60% in Group Ⅶ and Ⅷ.The diameter of hepatic artery embolized in GroupⅡ was 75 ±29.14 μm.202±33.65μm,309±51.76μm,266±29.66μm in Group Ⅲ、Ⅳand Ⅴ.402±17.18μm、496±30.08μm、471±23.29μm were embolized in Group Ⅵ、Ⅶ and Ⅷ.The diameter of Group Ⅲ was smaller than Group Ⅳ and Ⅴ,Group Ⅵwas smaller than Ⅶ and Ⅷ,the difference was statistically significant(P<0.05),but it was failed to reach the statistical significant difference between Group Ⅳ and Ⅴ,Ⅶand Ⅷ(P>0.05).Conclusion : 1.100-300μm Embosphere microspheres,150-350μm PVA particles,gelatin sponge particle embolization rabbit hapatic artery showed moderate and severe necrosis,not biliary necrosis,hepatic artery embolization effective and safe,meet the requirement of transarterial chemoembolization embolization.2.The Embosphere microspheres,PVA particles,gelatin sponge particles shared a similar size,and the Embosphere microspheres presented the smaller diameter of hepatic vessels embolization,and the liver necrosis was more severe.Part Two: Clinical Application Study on Granular Embolization material in the Treatment of Primary hepatic carcinomaObjective:To explore the optimum granular embolization material in transcatheter arterial chemoembolizatonMethods:97 patients with primary hepatic carcinoma were collected from June 2016 to june 2018.All patients whom met the admission criteria were divided into three groups according to the type of granular embolization agents:the 100-300μm Embosphere microspheres group(Group EM),the 150-350μm PVA particles group(Group PVA),and the 150-350μm gelatin sponge particles group(Group GSP).There were 35 patients in Group EM,32 in Group PVA and 30 patients in Group GSP.40%lipiodol(5ml)and epirubicin hydrochloride(20mg)were used to infuse the vessels and embolized by the three kinds of granular embolic materials.3 to 5 cardiac cycle contrast medium emptying was marked as the end points of embolization.The objective remission rate(ORR),disease control rate(DCR)in patients at 1,3 and 6 months,time to progression(TTP),post-embolization syndrome(PES)and liver function impairment were followed up to evalue the effects of the operation.Result:The objective remission rate of disease in patients at 1,3 and 6 months were82.86%、77.14%、71.42% in Group EM,50%、43.75%、37.5% In Group PVA,and56.67%、50%、46.67% in Group GSP.The time to progression was 16(95%CI 10-21)month in group EM,8(95%CI 6-9)month in group PVA and 9(95%CI 5-12)months in Group GSP.The rate of postoperative abdominal pain and fever were 45.71%、88.57% in Group EM,75% 、56.25%in Group PVA and 80% 、 56.67% in Group GSP.The ORR in Group EM higher than Group PVA and Group GSP,the TTP longer than Group PVA and Group GSP,the rate of postoperative abdominal pain less than Group PVA and Group GSP,the rate of fever higher than Group PVA and Group GSP,were statistically signigicant(P<0.0167)between Group EM and Group PVA、Group GSP,but not statistically signigicant(P > 0.0167)between Group PVA and Group GSP.There were not statistically signigicant(P>0.0167)of DCR、OS、nausea and vomiting 、 liver function impairment among Groups.Severe complications such as liver failure,liver abscess,gastrointestinal hemorrhage,bile duct injury,gallbladder necrosis and theraputical related death were not observed.Conclusion:100-300μm Embosphere microspheres,150-350μm PVA particles and gelatin sponge particles were safe and effective for embolizing the target vessels of primary hepatic carcinoma,Compared with 150-350μm PVA particles and gelatin sponge particles,the 100-300μm Embosphere microspheres exhibited its advantage in the recent curative effect of transcatheter arterial chemoembolizaton,which was more proper for interventional embolization of primary hepatic carcinoma.