Comparative Analysis Of Microspheres And Lipiodol Embolization In The Treatment Of Large Hepatocellular Carcinoma

Objective:To compare the clinical efficacy of lipiodol and microspheres in the embolization of large hepatocellular carcinoma?HCC?,and to discuss the factors that affect the prognosis.Method:In our hospital from 2012 November to 2017 January,32patients with primary liver cancer?tumor diameter range 5¹8.5cm?without other treatment of patients,the lipiodol group?group A?,15 cases of hepatic artery chemoembolization using lipiodol+chemotherapy.Microsphere group?group B?17 cases:Chemotherapeutic drugs plus simple microspheres were used for hepatic arterial chemoembolization.Cisplatin,doxorubicin and mitomycin were used for chemotherapeutic drugs in embolization.As embolism agent Lipiodol,sodium alginate?100³00um?.The efficacy of two kinds of embolic agents was evaluated before AFP,1 months after operation AFP,postoperative complications and survival.Short term efficacy using mRECIST criteria:evaluation of target focus:?1?complete remission?CR?,the arterial phase of all target lesions disappeared;?2?partial remission?PR?,the maximum diameter of all target targets was compared with the baseline state,at least 30%;?3?the progression of lesions?PD?,the sum of the longest diameter of target lesion increased by 20%compared with the minimum target lesion recorded after treatment,and the absolute value of total length and increase in length was above 5mm,or one or more new lesions appeared;?4?stability of the lesion?SD?,between partial remission and disease progression^[1].One month after operation,the tumor necrosis range was based on the imaging criteria of residual tumor:CT was based on dynamic enhanced scan,and the lesions were significantly enhanced in arterial phase.There was no significant enhancement in the arterial phase.Even if CT plain scan suggested that the iodide oil was inhomogeneous,it was also a non tumor remnant.DSA was a standard^[2]with tumor vessels,dyed or arteriovenous fistula.Tumor necrosis rate<20%for mild necrosis,aged 20%and<50%,<90%and 50%moderate necrosis,severe necrosis,more than 90%close to 100%for complete necrosis.Result:The clinical data of the two groups were not statistically significant.In this experiment,mild and moderate necrosis group lipiodol group 33.3%and 29.4%microsphere group was statistically significant?P<0.05?;there was statistical significance of severe necrosis group lipiodol group 46.7%and 35.3%microsphere group?P<0.05?;there was statistical significance completely necrotic group lipiodol group 20%and 35.3%microsphere group?P<0.05?.Preoperative and postoperative biochemical indexes:preoperative ALT:iodide oil group 45.86+15.54U/L,microsphere group:47.89+13.12 U/L;no statistical significance?P>0.05?;Preoperative AST:iodide oil group 40.78+18.64U/L,microsphere group:42.13+14.32 U/L;no statistical significance?P>0.05?;Preoperative TBLL:iodide oil group23.98+17.22u/mmol,microsphere group:28.9+15.2 U/L,no statistical significance?P>0.05?;Preoperative ALB:iodide oil group 36.87+15.07g/l,microsphere group:37.48+11.68 g/l,no statistical significance?P>0.05?;Preoperative AFP value:iodide oil group 1918.18+1081.82ng/ml,microsphere group:1735.36+1264.64 ng/ml,no statistical significance?P>0.05?;One month after the operation,the iodide oil group was ALT:44.33+8.17U/L,and the microsphere group ALT:36.55+6.05 U/L had statistical significance?P<0.05?.AST:41.92+6.47U/L in lipiodol group and AST:33.89+2.66U/L in microsphere group were statistically significant?P<0.05?.TBIL:24.63+10.44u/mmol in lipiodol group and micromicrosphere group TBIL:22.56+6.74u/mmol had no statistical significance?P>0.05?.ALB:37.68+6.33g/l in lipiodol group and ALB:45.85+8.45g/L in microsphere group were statistically significant?P<0.05?.AFP value of lipiodol group:844.32+338.48 ng/ml,microsphere group AFP value:506.67+298.56 ng/ml has statistical signif-icance?P<0.05?.Postoperative complications:abdominal pain:11 cases?73%?in lipiodol group,12 cases?70.5%?in microsphere group,9 cases?60%?in high temperature>38.5 degrees:lipiodol group,10 cases?58.5%?in microsphere group.The leucocyte decreased:3 cases?20%?in the lipiodol group,4 cases?23.5%?in the microsphere group,5 cases?33.3%?in the lipiodol group,and 6 cases?35.3%?in the microsphere group had no statistical significance?P>0.05?.The survival rate:3 months of iodized oil in 13 cases?87%?,microsphere Group 15 cases?88%?,the short-term survival rate was not statistically significant?P>0.05?.6 months of iodized oil group?60%?,microsphere group 13 cases?76%?,the survival rate was statistically significant?P<0.05?.12 months of iodized oil group?27%?,microsphere Group 8 cases?47%?,the survival rate was statistically significant?P<0.05?.18 months of iodized oil group?0%?,microsphere group 3 cases?18%?,the survival rate was statistically significant?P<0.05?.3 months after the operation,there were 2 cases of extrahepatic metastasis:2 cases in iodide oil group?13%?,2 cases in microsphere group?12%?,and no statistical significance?P>0.05?for 3 months.In 6 months,the new extrahepatic metastasis was found in 4 cases?27%?in iodide oil group and 3 in microsphere group?18%??P<0.05?.In 12 months,the new extrahepatic metastasis was found in 6 cases?40%?in iodide oil group and 4 in microsphere group?24%??P<0.05?.Conclusion:1.As a solid embolic agent for large liver cancer,the effect is clear,the effect is lasting,and the rate of tumor embolism and inactivation can be improved.To improve the long-term survival rate,reduce the number of interventional therapy and reduce the cost of treatment,the alginate micros-phere embolization is better than the simple lipiodol embolization.2.postoperative complications:abdominal pain,high fever,leukocyte reduction,nausea and vomiting and other symptoms of iodized oil group and sodium alginate microsphere group have no significant difference.