Analysizing The Vascular Alteration And Parts Of Factors Of Recurrence And Metastasis Of Primary Hepatic Carcinoma After TACE

Objective: Analysizing the vascular alteration after TACE and parts of factors of recurrence and metastasis of primary hepatic carcinoma, to instruct the therapy of primary hepatic carcinoma.Methods: By retrospectively researching 98 patients of PHC of our hospital who have accepted more than twice TACE during 1997-2007 years, to observe the relation between collateral circulation and the position of tumor , the times of cure, to observe the conditions of hepatic artery' s stenosis and obstruction after many times therapys, to observe the effect of using different embolism methods to embolism blood-supply' s vascular, and to observe the relations between recurrence and metastasis of humor and Hepatic functional classification, HBsAg, tumor type, portal vein carcinoma epistom, arterio-venous fistula(AVF).Results:1. The number of collateral circulation are 45, among the total hepatic lateral branch are 31, hepatic medial branch are 14 (between leafs collateral circulation are 8 , inside leafs collateral circulation are 6), parasitism blood-supply are 16 and collateral blood-supply are 29.2. Being the increasing of interventional therapy times, the incidence rate of hepatic lateral branch is raising, the incidence rate are respectively 10. 2%(the first time), 13. 7%(the second time), 24.1%(the third time), 35. 7%(the quart time), 75. 0%(above the quart time). Using Spearman rank correlation to analysiz the relation between interventional therapy times and the incidence rate of hepatic lateral branch, the result is that rs=l, p<0. 01. Demonstrating the relation between them is positive correlation, and there is statistical significance.3. The hepatic lateral branch is related with the position of tumor. The collateral circulation of liver' s 5 and(or) 6 segment are respectively right gastroepiploic artery(RGEA)(6 strips), right inferior phrenic artery(RPA)(3 strips), superior mesenteric artery (SMA) (2 strips), cystic artery (CA) (1 strip), gastroduodenal artery (GDA) (1 strip), left gastric artery (LGA) (1 strip), right aortic suprarenal artery(1 strip). The collateral circulation of liver' s 7 and(or) 8 segment are respectively right inferior phrnic artery(RPA)(7 strips), superior mesenteric artery (SMA)(4 strips), right gastroepiploic artery (RGEA)(3 strips), left gastric artery (LGA)(3 strips), gastroduodenal artery (GDA)(1 strip), intercostal artery(1 strip). The collateral circulation of liver' s left lobe are respectively superior mesenteric artery (SMA) (3 strips), left gastric artery (LGA) (2 strips), right gastroepiploic artery (RGEA)(1 strip), gastroduodenal artery (GDA)(1 strip), short gastric artery(1 strip).4. The number of the stegnosis and(or) obstruction of hepatic artery are 19 examples. The incidence rate are respectively 11. 8%(the second time), 20. 7%(the third time), 35. 7%(the quart time), 50. 0%(above the quart time). Using Spearman rank correlation to analysiz the relation between interventional therapy times and the incidence rate of stegnosis and (or) obstruction of hepatic artery, the result is that rs=l,p<0.01. Demonstrating the relation between them is positive correlation, and there is statistical significance.5. We separate embolism methods from three groups, and analysizing the effect of different embolism methods on revascularization by using chi square test .The result is no-recanalization rate of group 2 and group 3 is obviously more than that of group 1, and part-recanalization and all-recanalization rate of group 2 and group 3 obviously is obviously less than that of group 1.6. We analysize the risk factors of recurrence and metastasis of PHC after TACE, the result is that AVF, bad hepatic function , HBsAg(+) are risk factors of recurrence after TACE of hepatoma, portal vein carcinoma epistom, bad hepatic function ,HBsAg(+) are risk factors of metastasis after TACE of hepatoma.Conclusions: The emergence of collateral circulation and revascularization are precipitating cause of hepatoma' s recurrence and metastasis after TACE. The emergence of collateral circulation is related with the position of tumor and the times of cure. Tumor revascularization is related with embolism methods. Otherwise, AVF, bad hepatic function , HBsAg(+) are risk factors of recurrence after TACE of hepatoma, portal vein carcinoma epistom, bad hepatic function , HBsAg(+) are risk factors of metastasis after TACE of hepatoma.