| Objective: kidney cancer(RCC) accounts for 3-4% of the total incidence of all solid tumors, in the past the treatment of kidney cancer mainly rely on surgical resection,about 25% of patients at diagnosis have lost the chance of operation because of the insidious onset of kidney cancer.As well as the limitation treatment of conventional radiotherapy, chemotherapy and targeted therapy for renal cell carcinoma, more than 100,000 patients died of kidney cancer every year.To ease the clinical symptoms of kidney cancer and prolong the survival period of paients who unable to underwent surgical treatment,this study analyzed retrospectively to evaluate the impact of transcatheter chemoembolization(TACE) combined with percutaneous ethanol ablation(PEI) related factors in patients with advanced kidney cancer efficacy through 58 cases of kidney cancer patients.Methods:Choose 58 cases of kidney cancer patients of metting the inclusion criteria who operate on chemoembolization combined with percutaneous ethanol ablation in our hospital wards intervention line, 32 cases were male and 26 females, aged 40 to 66 years old The average age of 58 years old. Tumor diameter 4.5cm ~ 10 cm. Chronic kidney disease(CKD) stage 1for 35 cases,stage 2 for 15 cases,stage 3 for 8 cases. 17 cases of gross hematuria. 21 cases of kidney pain, digital score(VAS) score of 3 to 6 points. Robson staging 37 cases of stage II, IIIa of the three cases, IIIb 18 cases retrospectively analyzed clinical data. 58 patients were first transcatheter chemoembolization, 5F pigtail catheter abdominal aorta to the overall distribution of tumor feeding arteries clear, according to the contrast, the use of a catheter 5F Siommons, 4F Super Cobra slip to the tumor feeding artery catheterization, After the blood supply angiographic lesions observed, clear whether the renal arteriovenous fistula, ultra-election tumor feeding artery, using micro-catheters, infusion fluorouracil and carboplatin 0.3g + 1g + mitomycin 10 mg, bleach injection of iodized oil and gelatin sponge particles, if necessary(350-500μm) embolization of tumor blood vessels, iodized oil dose based on patient tumor size, blood supply is abundant, with or without arteriovenous fistula, whether solitary kidney cancer, the patient’s age and renal function was determined in peripheral artery embolization for tumor purpose, and should pay attention to retain the target artery, in order to minimize tumor formation of collateral circulation, which will help in the future to repeat embolization of the tumor blood vessels. Patients with postoperative abdominal CT, understand iodized oil deposition, and tumor necrosis, as there is still residual tumor tissue, the patient’s response until after chemoembolization remission underwent percutaneous ethanol injection ablation, combined with CT fluoroscopy under DSA determine the puncture point, 21 G Chiba needle lesions, Withdrawing without urine and blood after the ethanol and iodized oil in a 2: 1 ratio of iodized oil injected into ethanol and iodized oil emulsion, fluoroscopy defect, determined in accordance with the scope of iodized oil defect and patient tolerance of ethanol iodized oil emulsion dose, if necessary, multi-point puncture, note ethanol injection of iodized oil emulsion Do pelvis, retroperitoneal space. Depending on the patient’s condition can be repeated after chemotherapy embolism or ethanol ablation, each treatment interval of 4 to 6 weeks. All patients abdominal CT examination, review liver and kidney function, blood coagulation, blood, urine, according to a recent World Health Organization Response Evaluation Criteria in Solid Tumors, complete remission(CR), partial response( PR), stable disease(SD) and progressive disease(PD), the control rate(DCR) =(CR + PR + SD) / total cases × 100% at fouth and sixth weeks. Follow-up of survival, survival time in months. A total of 58 patients received chemotherapy embolization 175 times, 96 times ethanol ablation. Results: among 58 patients of transcatheter chemoembolization combined with percutaneous ethanol ablation,10 cases of CR,35 cases of PR,12 cases of SD,1case of PD, the tumor control rate was 98.3%. 17 cases of patients with gross hematuria before and disappearance of gross hematuria after. 21 cases of patients with kidney pain, postoperative VAS score of 1 to 3 points. 2,58 advanced kidney cancer patients survived 5 ~ 18(13 ± 0.7) months, 6M, 12 M,18M survival rates were 98.3%(57/58), 91.4%(53/58), 86.2%(50/58) after the treatment. As of the end of follow-up, eight patients died, survived 50 cases. Through the influence of catheter chemoembolization combined with percutaneous ethanol ablation of 10 factors were univariate Kaplan-Meier analysis, Log-rank test and Cox regression timing multivariate analysis to determine the nine factors that affect kidney cancer survival, namely: age, tumor size, vein thrombosis, arteriovenous fistula, Robson stage, lymph node metastasis, tumor blood supply is abundant, CKD stage, whether solitary kidney. Conclusions: 1.Transcatheter chemoembolization combined with percutaneous ethanol ablation for renal cancer patients have a better therapeutic effect; 2. Age, tumor size, vein thrombosis, arteriovenous fistula, lymph node metastasis, Robson stage, tumor blood supply, CKD stage, nine factors that influence whether solitary kidney as the transcatheter chemoembolization and ethanol independent risk factors for ablation efficacy of advanced renal cell carcinoma; 3. Younger than 50 years of age, tumor diameter less than 7cm, no vein thrombosis, no arteriovenous fistula, without lymph node metastasis, tumor blood supply, CKD stage is low, non-solitary kidney Robson staging of patients with renal cell carcinoma and early good effect. |
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