Primary Clinical Study Of 100-300?m Diameter Polyvinyl Alcohol Microspheres Combined With Iodized Oil Emulsion Embolization For Primary Hepatic Carcinoma

Objective: To evaluate the clinical efficacy and postoperative adverse reactions of 100-300?m diameter polyvinyl alcohol microspheres combined with iodized oil emulsion in the treatment of primary hepatic carcinoma.Methods: A retrospective study was used to analyze 132 patients with liver cancer who underwent interventional treatment in the interventional department,the Department of Hepatobiliary Surgery,and Hepatobiliary Surgery of the Affiliated TCM Hospital of Southwestern Medical University from March 2016--February 2017.34 cases were lost to follow-up.Among them,85 were males and 13 were females,aged 36-76 years and mean age(51.91±1.52 years).All patients enrolled were primary hepatic carcinoma patients and a liver function grade Child-Pugh A or B or who refused to undergo surgical resection.The patients were randomly divided into A and B groups.According to the different tumor vascular embolization materials in the operation,100-300 ?m diameter polyvinyl alcohol microspheres + iodized oil emulsion group(group A)48 cases and gelatin sponge particles + iodized oil emulsion Group(B)50 cases.In both groups,60 mg of cisplatin solution was slowly infused into the peritoneal cavity after tumor vascular embolization.Postoperatively,adverse reactions and complications were observed in both A and B groups.The two groups were routinely given symptomatic and supportive treatments such as hepatoprotection,gastric protection,fever reduction,and analgesia.The second TACE treatment time was determined 6-7 weeks after the first treatment in both groups according to the reexamination of liver and kidney function,blood routine,coagulation function,alpha-fetoprotein(AFP),and imaging examination.Afterwards,the patient will visit the hospital regularly every two months to review the blood routine,liver and kidney function,AFP and enhanced liver CT or MR examinations,and then determine the time interval for the next TACE treatment.By observing the incidences of postoperative adverse reactions,liver and kidney function,survival time,disease progression time(FPS),overall survival(OS),clinical effectiveness,and disease control rate in the two groups of patients A and B,Determine the treatment effect.All patients receiving treatment A and B were followed up for more than 1 year.Result: 1 ? 100-300?m polyvinyl alcohol microspheres + iodized oil emulsion group(group A),gelatin sponge particles + iodized oil emulsion group(group B),A,B group CR rates were 22.9%,16% There was a clear trend of remission after treatment in group A.The incidence of PR in group A and B was 52.1% and 38.0%,respectively;the incidence of SD in group A and B was 18.8% and 32.0%,respectively;the incidence of PD in groups A and B was significant.They were 6.3% and 14% respectively.The clinical efficacy rates of A and B groups were 83.3% and 54.0%,respectively.P values equal to 0.031 were statistically significant(P<0.05).The disease control rates of A and B groups were 93.8% and 86.0%,respectively.The disease control rates of A and B groups were equal to 0.871,with no statistically significant difference(P>0.05).2.There were significant differences between the A and B groups in the use of intraoperative chemotherapy doxorubicin and iodized oil(P<0.001)3.There was significant difference in serum AFP between group A and group B before and after treatment(P<0.001),and the difference was statistically significant(P<0.05).Serum AFP between group A and B had no difference after treatment.Significant difference(P=0.383),the difference was not statistically significant(P>0.05).4.Gastrointestinal adverse reactions after TACE in both groups were mainly nausea,vomiting,abdominal pain,persistent fever,and liver function impairment.All patients were relieved or disappeared to varying degrees after active symptomatic treatment.There was no irreversible toxicity and serious complications in both A and B groups.The incidence of nausea,vomiting,pain,and fever after A and B comparison was observed in group A was 25.0%,20.8% and 41.7,respectively.%,37.5%,group B was 60.0%,52.0% and 28.0%,38.0%.In this study,there was a statistically significant difference in postoperative nausea and vomiting between group A and B(P<0.05).5,A,B two groups after TACE 6-7 weeks after liver function reexamination,in which there is a difference between the two groups of AST(P = 0.026),the difference between the two groups(P = 0.042)were statistically significant(P<0.05).6.The median postoperative survival of patients A and B was 24 months and 19 months,respectively.The survival rates of patients in group A were less than 6 months,12 months,and 18 months were 89.6%,66.7%,22.9,respectively.The survival rates in group B were less than 6 months,12 months,and 18 months were 86.0%,54.0%,and 24.0%.The median survival time and survival curve between group A and group B were statistically significant.Significance(P < 0.05).The disease progression time of A and B patients was 16 months and 9 months respectively(P<0.05).The difference was statistically significant.The overall survival of patients with A and B groups without portal vein tumor embolization before treatment was significantly lower(P<0.05),and the difference was statistically significant.Conclusion: The clinical efficacy of 100-300?m diameter polyvinyl alcohol microspheres combined with iodized oil emulsion embolization for primary hepatocellular carcinoma is stable,safe and effective,clinical control rate is high,adverse reactions are few and there is no obvious heart and liver and kidney function toxicity Side effects and serious complications are excellent tumor embolization agents,which can significantly improve the 1-year and 2-year survival rates of patients with advanced primary liver cancer,prolong survival time,and improve the quality of life of patients.