Clinical Research On Ultrasound-guided Percutaneous Ethanol Injection Therapy Of Small Liver Cancer

Purpose: In this clinical trial, we aimed to explore the effect of therapy of percutaneous ethanol injection(PEI) of small liver cancer under color Doppler ultrasound guidance on alpha fetoprotein(AFP) as well as the imageological change, to make statistic analysis of survival time and survival rate of patients with PEI, to evaluate PEI therapeutic effect, to discuss the effect of PEI therapy on liver biochemical index and the occurrence rate of associated complications, and to assess the safety of PEI therapy of small liver cancer.Method: The present study involved 68 patients(without gender or age requirement) with PEI who have single or multiple small liver cancers between October 2010 and December 2014 in our hospital. PEI therapy is conducted under color Doppler ultrasound guidance, where three side opening 21 GPEIT needles are applied and 99.7% analytically pure medicinal alcohol is intratumorally injected. The anhydrous ethanol injection volume at the focus is 2~8ml once, with treatment frequency of 2~4 times and treatment interval of 5~7 days. The accumulative treated focuses is 118(including single or multiple focuses), the diameter of tumor is 0.7~3cm and the total of treated cases is 277. Before and after the treatment, all the patients go through the liver function test, AFP test, ultrasonic examination and CT or MRI enhancement examination. During the follow-up visit, no patient quits, with the duration of follow-up visit being more than one year. In order to evaluate PEI treatment effect and the effect of PEI therapy on liver function of patients, SPSS20.0 Software is applied to conduct paired T test of AFP index, focus diameter change and liver function change before and after the PEI therapy. The descriptive statistics of adverse reaction and complication occurrence rate after PEI therapy is used to evaluate safety of PEI therapy. With the initial date of receiving PEI therapy as the starting point of survival time and the deadline of follow-up visit or death or tumor recurrence receiving other methods of treatment(including surgery or RFA or MWA or TACE) as the terminal point of the event, the life table method is used to calculate accumulative survival rate of patient and compare with operative treatment effect based on medical literature.Result: In 6 months after PEI treatment, the imaging examination shows that 118 focuses shrinks as a whole, the focuses which completely disappear or are seen indistinctly account for 7.6%, the focuses with shrinkage rate of no less than 50% account for 37.3%, the focuses with shrinkage rate of less than 50% account for 45.8%, the focuses without obvious change account for 6.8%, and the focuses which enlarge or where new focuses are found near the treated site account for 2.5%. After single therapy, AFP drops by 87.1%, with negative conversion ratio of 15.5%. The pathological examination of the focuses of 9 patients with PEI therapy is made and all treated focuses have no residual tumor cell. PEI therapy causes increase in ALT and AST, which recover to the levels before the therapy with a short time after the therapy. Adverse reactions after single therapy mainly occur at the epigastric region. The patients with shoulder and back pain(discomfort) account for 13.7%, with fever(body temperature!38.5℃) for 11.9%, with nausea and vomiting for 7.2%, with drunk reaction for 5.7%,and the patients with dizziness, chest distress or palpitation for 2.2%. However, all the symptoms above can remit in a short time. In terms of complications, there are 2 cases with abdominal wall implantation metastasis while no bleeding, bile leakage, hepatophyma liver abscess and tumor ruptures occur after PEI therapy. In this study, the survival time after PEI therapy of small liver cancer is 10~46 months and the accumulative survival rate in 1, 2 and 3 years after the operation is 97%, 82% and 68% respectively.Conclusion: Under ultrasonic guidance, PEI therapy of small liver cancer is simple, safe, effective, inexpensive and minimally invasive, and there is no statistical differences between PEI therapy and surgical excision in the study of the survival rate 3 years after the operation. PEI therapy has slight effect on liver function, with little postoperative adverse reactions and complications. PEI therapy can be clinically taken as an effective measure for small liver cancer treatment and this therapy is worth of being popularized and generalized.