1, liver function is damaged
Liver function damage is the main side effect of interventional therapy for liver cancer, mainly manifested as alanine aminotransferase ***ALT***, with an incidence of 7% ~ 100%, mostly due to the cytotoxicity of chemotherapy drugs and embolic agents and the absorption of necrotic tissues after treatment.
2. Gastrointestinal reaction
The incidence of gastrointestinal reactions is as high as 44.8% ~ 83%, most of which are digestive system reactions caused by interventional drugs, such as nausea, vomiting, loss of appetite or not thinking about diet.
3. Decreased hemogram
The incidence of white blood cells decreased from 30% to 25%, mainly due to bone marrow suppression of chemotherapy drugs, which usually occurred 2 weeks after operation.
Step 4: Pain
Mainly upper abdominal pain, the incidence rate is 30%- 100%, mostly due to hepatic ischemia after embolization, which leads to swelling of local blood vessels in the liver capsule or direct contrast agent and embolic agent, usually within 24 hours after operation.
5. Have a fever
The incidence rate varies from 10% to 100%, which is mostly caused by acute ischemia, necrosis, shedding and absorption of tumor tissue. It usually appears on the second day after interventional therapy for liver cancer, with a body temperature of 37.5-38℃ for 5-7 days. However, some patients have body temperature above 38.5℃ for 9-60 days.
6, puncture site injury
The incidence rate is between 2%- 13%, which is manifested as local bleeding, hematoma, arteriovenous spasm or thrombosis. Most of them are caused by disorder of coagulation mechanism, application of heparin during operation or excessive hemostasis after operation.
In hepatocellular carcinoma, vascular interventional therapy is the most widely used type in the treatment of hepatocellular carcinoma. Selective hepatic artery embolization, selective hepatic artery embolization, selective hepatic artery embolization. Its main physiological basis is normal liver cells of hepatic artery, hepatic artery 25% ~ 75%, portal vein 85% ~ 20%. 90% ~ 95% blood supply of primary liver cancer provides anatomical basis for vascular interventional therapy of liver cancer.
The specific technical methods of the three methods are the same, all of which are to puncture a small hole of about 3-5mm on the panel, insert a catheter from the artery to the blood supply artery of liver cancer, and then administer drugs through the catheter, but the difference is that the drugs administered are different. Selective hepatic arterial infusion therapy is intra-arterial infusion of drugs through catheter at a dose equal to or less than intravenous administration.
This can increase the local drug concentration of target cells, prolong the contact time between drugs and lesions, and reduce the total dose of drugs in the whole body, thus improving the curative effect and reducing side effects. Chemotherapy drugs are commonly used, and the curative effect of chemotherapy drugs is positively related to the effective blood concentration of drugs in tumor site and the contact time between drugs and tumors. In addition, traditional Chinese medicine preparations and CIK cell adoptive immunotherapy can also be infused.
Selective hepatic artery embolization (TAE) is to selectively inject embolic agents into tumor blood vessels and tumor blood supply arteries through catheters, blocking tumor blood supply and sealing tumor blood vessel beds, thus inhibiting tumor growth. This is equivalent to starving the tumor. Commonly used embolic agents include gelatin sponge, ultra-liquefied lipiodol, sodium alginate microspheres and so on.
Selective arterial chemoembolization (TACE) is the simultaneous administration of chemotherapeutic drugs and embolic agents through a catheter. Eliminate tumors in two ways.
Indications of interventional therapy for hepatocellular carcinoma
According to NCCN American cancer treatment guidelines, interventional therapy has been recognized as the first choice for advanced liver cancer. Regional targeted drug perfusion, tumor vascular embolization, argon-helium knife cryoablation and other methods are used to kill tumor cells in a concentrated way, so as to minimize the tumor load and reduce the number and volume of malignant tumors. Combined with CIK cell adoptive immunotherapy and anti-angiogenesis drugs, it has achieved good therapeutic effect in clinic, effectively improved the quality of life of patients and prolonged the survival period. It can also reverse the staging of liver cancer in some patients and transform unresectable liver cancer cases into resectable liver cancer cases.
Symptomatic management of interventional therapy for liver cancer
1. Small liver cancer jaundice: In the theory of traditional Chinese medicine, the symptom of small liver cancer is often caused by damp-heat in the liver and gallbladder, but jaundice is not limited to the liver and gallbladder, and the spleen and stomach can especially cause jaundice. In addition, the synopsis of the golden chamber clarifies the important pathogenesis of jaundice, "Huang's income comes from dampness." Spleen is vulnerable to external attack of dampness, spleen is prone to internal dampness, dampness blocks middle energizer, spleen and stomach are out of balance, and liver is out of drainage, which leads to bile not following the normal way, infiltrating into blood and overflowing into skin, resulting in jaundice. These are the theoretical basis of symptomatic treatment of small hepatocellular carcinoma in traditional Chinese medicine. At the same time, Chinese medicine believes that yang and yellow are mostly caused by damp-heat stagnation and steaming, yin and yellow are mostly inhibited by cold and dampness, and spleen and yang are weak. For treating jaundice caused by small liver cancer, Herba Artemisiae Scopariae, Fructus Gardeniae and Radix Curcumae can be added.
2. Pain of small liver cancer: Pain is the main content of treatment of small liver cancer. Pathogenic stagnation, qi stagnation and blood stasis, phlegm coagulation and toxin accumulation, and mutual struggle are the theoretical basis of TCM treatment of small liver cancer pain. It can be seen that phlegm, blood stasis, dampness and toxin can all cause the pain of small liver cancer. These four aspects are closely related, mutually causal and harmful. Different patients will have different emphases in different periods, which makes the clinical manifestations varied. Semen Persicae, Carthami Flos, Saviae Miltiorrhizae Radix, Radix Paeoniae Rubra and Radix Curcumae can be added for blood stasis syndrome of small hepatocellular carcinoma.
3. Fever of small liver cancer: Cancer fever is one of the common symptoms in the treatment of small liver cancer. Traditional Chinese medicine believes that spleen deficiency leads to deficiency of qi and blood biochemistry, deficiency of middle qi and endogenous yin fire, which can cause fever. At the same time, it is believed that qi deficiency, blood deficiency, yin and yang, qi and blood, phlegm dampness and food stagnation can all lead to fever, and the clinical manifestations are also varied, such as those with normal body temperature but patients feel internal heat or liver area heat, those with elevated body temperature, burning hands and body, and those with cold and heat, which are the theoretical basis of TCM treatment of small liver cancer. Herba Artemisiae Scopariae, Rhizoma Coptidis, Cortex Phellodendri and Radix Gentianae can be added to treat small liver cancer.
Advantages and disadvantages of interventional therapy for liver cancer
Therapeutic advantage
Liver cancer has become one of the main diseases that endanger society and human health, and has brought great pain and trouble to human beings. In order to reduce the incidence of liver cancer, interventional therapy of liver cancer is very necessary. The advantages of interventional therapy for liver cancer are as follows:
1, the curative effect is exact. After successful treatment, AFP can be rapidly decreased, the tumor shrinks and the pain is relieved.
2. Scientific mechanism: The regional drug concentration of interventional therapy is dozens of times higher than that of systemic chemotherapy, which blocks the blood supply of tumor. The two-pronged approach has good curative effect and less toxicity than systemic chemotherapy;
3. Interventional therapy for liver cancer is simple, safe and reliable;
4, the elderly and the infirm and those suffering from certain diseases can also be performed without general anesthesia and stay awake;
5. The diagnostic radiography is clear and repeatable, which is convenient for multiple comparisons;
6. Some liver cancers can be reduced in size before two-step resection;
7. It can be used as one of the important methods for comprehensive treatment of advanced tumors;
8. The cost of interventional therapy for liver cancer is relatively low.
Treat shortcomings
1, although it is superselective, it still has obvious side effects, and the digestive tract reaction is the most, which brings discomfort to human body.
2. Liver cancer mainly relies on hepatic artery for blood supply, but there is portal vein around the cancer block for blood supply, so that cancer cells can survive secretly.
3, the operation is difficult, the catheter should enter the blood supply artery superselective, but sometimes it is difficult to enter the hepatic artery. Some liver cancers can be supplied by multiple blood vessels.