Clinical Application Of Gelfoam Particles With Iodine Oil Emulsion In TACE To The Treatment Of Huge Hepatic Carcinoma

Objective:To discuss the clinical application of gelfoam particles withiodine oil emulsion in TACE to the treatment of huge hepatocellular carcinomaand post-operative evaluation of MR.Methods:63cases of patients who satisfied the diagnosis of huge primaryhepatocellular carcinoma were divided to A、B group. Among them,46caseswere of male patients,17cases were of female patients, their ages were29-76years, mean age was53.95years；the liver function of41patients wereclassified as Child A,and the liver function of22patients were classified asChild B;58patients were accompanied with hepatitis B,2patients wereinfected by hepatitis B,and3patients were accompanied with hepatitis C;51cases were in the left lobes of livers,8cases were in the right lobes,4caseswere in the central region of the livers（Ⅳ、Ⅴ、Ⅷ segment）;there were21cases with portal tumor thrombi,13cases with right portal tumor thrombi,and8cases with left portal tumor thrombi；the tumor marker of32cases waspositive. Maximum diameter of the tumor were10.00～16.5cm， meanmaximum diameter was11.60cm,which was measured by CT scan or MR scan.A total of27patients in group A received the therapy of single epirubicin iodineemulsion,however,36cases in group B received the therapy of gelfoamparticles with epirubicin iodine emulsion.A group（single epirubicin iodineemulsion group）：Oxaliplatin was mixed with glucose solution，which weretransfused into proper hepatic artery.Then iodipin was mixed with epirubicin,which were transfused into tumor supply arteries until the vessels vanished, ifthe volume of hepatic carcinoma was more than60%of that of normal hepatictissues,TACE could be performed in2-3parts when conditions allowed in the near future.B group(gelfoam particles with epirubicin iodine emulsiongroup):At the base of single epirubicin iodine emulsion group, B group wasdifferent from A group,after iodipin was mixed with epirubicin, which weretransfused into tumor supply arteries.when the flow velocity of the tumorsupply arteries was slower or the iodipin was evenly distributed,then gelfoamparticles(diameter350～560μm) were mixed with contrast medium,which weretransfused into tumor supply arteries until the vessels vanished.Similarly, if thevolume of hepatic carcinoma was more than60%of that of normal hepatictissues,TACE could be performed in2-3parts when conditions allowed in thenear future. Observe the variation of signal before the surgery and after thesurgery at MR SE series T1WI and FSE series T2WI，caculating tumor necrosisrate and survey the variation of AFP、liver function、the diameter of tumor andpostoperative complication.Results:The tumor necrosis rate of A group after the operation in a monthwas35%～73%,average was53.22%,compared with57%～91%of Bgroup,average was78.53%,P<0.01. There is significant difference betweenAFP preoperation and postoperation of these two groups. There was significantdifference in tumor diameter of A group between one month after operation andpreoperation,but there was no significant difference in tumor diameter betweenthree months after operation and preopration.The diameter of tumor of B groupbetween one month after operation, three months after operation andpreoperation didn’t have significant difference.There was no significantdifference between the diameter of tumor of B group one month after operationand three months after operation. There was significant difference betweenAST、ALB and CHE of A group preoperation and postoperation,however ALTand TBIL didn’t have significant difference.AST、ALT and TBIL which wasliver function of B group didn’t have significant difference betweenpreoperation and postoperation, however ALB and CHE had significant difference.AST、TBIL、ALB and CHE postoperation between A group and Bgroup didn’t have significant difference, however ALT had significantdifference. There were no major complications after the opration. In twogroups,there were no serious complications such as Gastrointestinal Bleeding、liver abscess、 bile-duct injury and Gallbladder necrosis.There was nosignificant difference between the survival of these two groups after6months，however there was significant difference of the survival of thesetwo groups after9months and12months after surgery throughout thefollow-up period.Conclusion:Interventional therapy of these two groups has positive effects,and gelfoam particles with epirubicin iodine emulsion group could prolongsurvival period of the patient with HCC better than single epirubicin iodineemulsion group，which could prevent tumors to develop and enhance Thetumor necrosis rate.It is worth popularizing in clinical application; Theembolism of tumor vessels of gelfoam particles with epirubicin iodineemulsion group was better than that of epirubicin iodine emulsion group, but itaffect liver function of the patients after the operation.We must hold theindication strictly and pay attention to operative procedure. Liver MR SE seriesT1WI、FSE series T2WI and dynamic contrast-enhanced MRI is valuble afterafter TACE throughout the follow-up period,which could be chosen as the firstmethod to evaluate the effect of TACE.