Study On Traditional Chinese Medicine Intervention After Common Complications Of Minimally Invasive Surgery In Hepatocellular Carcinoma Based On Literature And Case Investigation

BackgroundThe liver is the largest digestive gland of the human body, which performs a variety of physiological functions. The liver may arise Cancerous changes itself, and it may also arise metastatic carcinoma. The liver cancer has High incidence and high mortality. Due to the particularity of anatomical and physiological function, there is a lot of clinical researches, new treatments and new technologies. Minimally invasive treatment is one of the important means of treatment. There are many means of minimally invasive treatment. Such as vascular interventional therapy, argon-helium cryoablation therapy, radiofrequency ablation, microwave treatment, etc. compared with the traditional laparotomy surgery treatment, minimally invasive treatment has wider Indications, less complications and low damage on the liver. It is widely considered to be one of the preferred treatment on middle-late primary liver cancer and hepatic metastatic carcinoma. The latest update in 2015 of NCCN issued that, for the liver function reserve (Child-Pugh score) insufficient or the unrespectable liver cancer, we should Consider the liver transplantation first, Not suitable for liver transplantations should consider the minimally invasive treatment for first choice. Liver transplantation is expensive, Lack of donors and High risk. As a result, minimally invasive treatment is preferred by many early HCC patients, and widely used in the treatment of liver cancer.There are a lot of different means for minimally invasive treatment of the liver cancer, generally including vascular interventional treatment and non-vascular interventional treatment. The related Complications is similar. Serious complications are uncommon, such as severe infection, liver and kidney function failure, biliary fistula, liver rupture bleeding, etc. The common complications include pain, fever, liver function damage, gastrointestinal bleeding, abdominal cavity effusion, Pleural effusion, etc.ObjectivesComplications of liver cancer minimally invasive treatment is the target of the research. The objective of this study is tend To explore the different minimally invasive treatments prone complications and morbidity, To explore the influence factors of complications and TCM intervention method. Dongfang hospital oncology department Long-term apply minimally invasive treatment for hepatocellular carcinoma combined with traditional Chinese medicine. This study trying to find the influence of TCM intervention method on complications. Analyzing the possible reasons, the study would like to provide reference for treatment of postoperative complications of liver cancer minimally invasive treatment.MethodsThe study is divided into three parts.The first part is the literature research. The study selective analysis transcatheter arterial chemoembolization, argon-helium cryotherapy, radiofrequency ablation and six complications, including Pain, fever, liver function damage, bleeding, gastrointestinal reaction, abdominal cavity effusion and Pleural effusion. The study has summarized the three kinds of common complications from incidence, influence factors and intervention method of traditional Chinese medicine.The second part is clinical observation. The study retrospectively analyzed 50 cases of Dongfang hospital, who accept minimally invasive treatment combined with traditional Chinese medicine. Based on the statistic on vital signs, symptoms, physical and radiographic examination before and after the treatment, we emphasize to summarize the complications, and explore the effect of intervention of traditional Chinese medicine, explore the advantage of treatment Combined traditional Chinese medicine on minimally invasive surgery complications. The third part summarizes the clinical experiences of Professor Hu Kaiwen in the treatment on minimally invasive surgery complications, and interpret the academic value of experience and theory on minimally invasive surgery of liver cancer.ResultsThe literature research part1. Common complications are as follows:The vascular interventional treatment:pain(48-97%), fever(51-88%), gastrointestinal reactions(45-84%), liver function damage(28-89%) myelosuppression(15-50%), argon-helium cryotherapy:pain(45-80%), fever(25-93%),, radiofrequency ablation:pain(34-100%), fever(63-100%).2. There are many influence factors of complications, mainly includes:hepatic function reserve, preoperative liver cirrhosis and portal vein tumor emboli, collateral circulation, location, dose and delivery way in the vascular interventional treatment, the volume of frozen tissue, the number of freeze-thaw cycle and the number of argon-helium knife in argon-helium cryoablation, the basis of disease such as diabetes, the auxiliary drugs using in minimally invasive treatment, the operation of the performer, intraoperative imaging support.3. Western medicine symptomatic treatment is mainly used, traditional Chinese medicine intervention is less reported. The therapeutic may be concluded as follows:’Jianpi’,’Yiqi’and ’Qinggan’in syndrome after ablation or embolism,’Jianpiyiqi’,’Huoxueyangyin’and ’Huoxuejiedu’in myelosuppression,’Qinggan’,’Jianpi’and’liqi’in protecting liver function.The clinical observation part1. Complications after minimally invasive treatments are as follows, fever (4.5%), liver area pain (25.4%), gastrointestinal reaction (29.9%), liver function injury (10.4%), gastro-intestinal bleeding (1.5%) and ascites (1.5%). The total incidence was 43.2%. No serious complications lead to death appear.2. Common complications after minimally invasive treatments are fever, pain, gastrointestinal reaction and liver function injury. The incidence is lower than the literature reports of merely vascular interventional therapy or argon-helium cryoablation therapy.3. There is a statistical difference on NRS score between preoperative and the day7, day 14, day30 after the minimally invasive treatment (F< 0.05). NRS score as a whole is on the decline, express that pain situation gradually improved after the treatment. There are no statistical differences on NRS score before and day7 after the minimally invasive treatment (P> 0.05). It expresses that minimally invasive treatment will not cause significant pain.4. There is no statistical difference on ALT and AST level between preoperative and the day7, dayl4, day30 after the minimally invasive treatment (P> 0.05). It expresses that minimally invasive treatment will not cause significant transaminase lifts.5. In accepted’Dingxiangzhitonggao’topical treatment people, there is a statistical difference on NRS score between the day7 and the day14, day30 after the minimally invasive treatment (P<0.05).6.12 nausea or vomiting patients accept traditional Chinese medicine topical treatmenton the umbilical,11 of them nausea and vomiting ease in 7days, all of them ease in 30 days7. Preoperative TCM tongue and pulse summarizes that, dark tongue and pulse string thin are the most.’Ganyupixu’,’Tan’,’Yu’ is the most Syndrome differentiation. Aidi,Kanglaite,Xiaoaiping and Huachnasu are the most using proprietary Chinese medicine.Conclusions1. Literature research partDifferent kinds of minimally invasive means are similar with common complications, but different on incidence.The selection of operation and preoperative evaluation arethe most important factors on complications.Western medicine symptomatic treatment is mainly used, traditional Chinese medicine interv-ention is useful but less reported. Traditional Chinese medicine is useful for ablation or embo-lism syndrome treatment, myelosuppressiontreatmentand protecting liver function. The ther-apeutics are different,’Jianpiyiqi’ is the mainly used.2. Clinical observation partComplications after minimally invasive treatments include, fever, liver area pain, gastrointestinal reactions, liver function injury, gastro-intestinal bleeding, and ascites.The common complications incidence after minimally invasive treatments is lower than the literature reports of merely vascular interventional therapy or argon-helium cryoablation therapy, as a result of combining traditional Chinese medicine.There is no statistical increase on pain or transaminase level after the therapy combining traditional Chinese medicine.Postoperative gastrointestinal reaction mainly appear in the vascular interventional treatment, the possible reason may be using chemotherapy drugs.It is effective for pain after the therapy by using’Dingxiangzhitonggao’. It is effective for nausea or vomiting after the therapy by using’Wenzhongzhiou’therapeutictraditional Chinese medicine topical treatment on the umbilical.’Ganyupixu’,’Tanyin’,’Yuxue’are the most common type before minimally invasive surgery.Chinese medicine intervention has positive significance on prevention and cure of common complications of liver cancer minimally invasive surgery3. Clinical experiences of Professor Hu KaiwenSummarize the Traditional Chinese Medicine treatment experience of Professor Hu Kaiwen,includingidentify ’Cold’ and ’Heat’, focus on’Yangqi’.’Green Treatment’ concept, ’Huchang’ concept and ’Shuaiqidabanerzhi’ concept are useful for liver cancer minimally invasive treatments.