Hepatic Artery Embolism Chemotherapy Combined Microwave Ablation Sequential Added Anhydrous Ethanol Injection On The Clinical Effect Of The Treatment Of Primary Large Hepatocellular Carcinoma

Objective:On the basis of isolated bovine liver experiment,to explore the clinical efficacy of sequential therapy of transarterial chemoembolization(TACE)combined with microwave ablation(MWA)and percutaneous ethanol injection(PEI)in the treatment of primary hepatocellular carcinoma(PHC).Methods:The experiment of microwave ablation combined with percutaneous ethanol injection was carried out on fresh bovine liver in vitro.To observe the difference of three-dimensional thermal field characteristics and the range of coagulation incomplete area between two adjacent coagulation areas.Then the ethanol was injected into the residual incomplete solidification area,the amount and effect of ethanol injected for supplementary coagulation were recorded.The clinical data of 60 patients with unresectable primary hepatocellular carcinoma treated in our hospital from January 2013 to December 2019 were analyzed retrospectively.Patients in the observation group(n=30)received sequential TACE combined with MWA and PEI,while patients in the control group(n=30)received only TACE treatment.The clinical therapeutic effects and adverse reactions of the two groups were compared.Kaplan-Meier method and Log-rank test were used for survival analysis,and Cox regression model was used to analyze the factors affecting survival and prognosis.Results:fresh bovine liver in vitro,the ablation range was observed in the longitudinal and transverse section of the thermal coagulation area.The longitudinal section of the single needle coagulation zone is in the shape of a long 3.4cm with a width in the middle and a tapering ellipsoid at both ends of the 2.6cm.The larger transverse and longitudinal diameter of ablation can be obtained by double-layer multi-needle thermocoagulation,but the superposition of the thermal coagulation zone is not strict when the two needles are apart from 2.5cm,and there is a polygonal solidification incomplete zone in the upper and lower parts of the two coagulation zones,which were used as ethanol injection points to supplement the range of complete microwave ablation.After ethanol 2ml/point injection,the area was ablated completely.In the clinical study,the times of TACE treatment in the observation group was significantly less than that in the control group(t=5.40,p<0.001).After 1 month treatment,the ORR and DCR of the observation group were significantly higher than those of the control group.(χ~2=9.64,p<0.001),(χ~2=16.67,p=0.001).The median OS of the observation group was significantly longer than that of the control group(x2=7.82,p=0.005).The OS rates of 1-year,3year and 5-year in the observation group were significantly higher than those in the control group(χ~2=12.50,11.29,10.89(p=0.000,0.001,0.001,respectively).The median PFS of the observation group was significantly longer than that of the control group(χ~2=9.70,p=0.002).The PFS rate of the observation group was significantly higher than that in the control group(χ~2=10.90,14.17,13.90 p=0.001,0.000,0.000,respectively).There was no significant difference in adverse reactions between the two groups(p>0.05).Multivariate analysis showed that liver cirrhosis(RR=7.780),maximum tumor diameter(RR=2.241)and BCLC stage(RR=7.024)were independent factors affecting OS and PFS.Conclusions:The therapeutic effect of TACE combined with MWA and PEI in the treatment of large primary hepatocellular carcinoma was significantly better than that of TACE alone,which was worthy of further clinical application.