Interventional therapy comes from interventional radiology. Interventional radiology is a new sub-discipline in the field of radiology, and many of its techniques are derived from surgical procedures that have been adopted and modified by radiologists. The use of X-ray fluoroscopy, CT positioning, B-type ultrasonograph and other medical imaging equipment as a guide, the special catheter or instrument through the human arteries, veins, the digestive system of the natural pipeline, the bile ducts or post-surgical drainage pipe to arrive at the diseased area in the body, to obtain tissue cells, bacteria or biochemical information, but also can be carried out to obtain imaging imaging data, so as to achieve the purpose of diagnosis of the disease, and at the same time, can also be performed A variety of specialized treatments can also be performed. Interventionalists have been able to "intervene" with catheters or instruments in almost all branches of blood vessels, the digestive tract, and other specific areas of the body to treat disease. Most interventional procedures are performed inside blood vessels. Some diseases are treated with interventions that do not require an incision, but only a small incision less than the size of a grain of rice, where a thin tube is inserted into a blood vessel.
CharacteristicsInterventional therapy is characterized by:
① small injury, safe and easy to implement;
② accurate positioning, the efficacy of the occurrence of fast and sure;
③ few side effects and complications. The minimally invasive treatment is actually called interventional therapy.
Indications Cardiovascular disease
For cardiovascular disease can also be treated with interventional therapy. For example, balloon dilatation technology is used to improve mitral stenosis, and stent implantation technology is used to relieve thoracic aortic stenosis, etc. This kind of therapy, including turning, blocking, thrombolysis, stenting, etc., has been recognized as a new and reliable therapy for the treatment of cardiovascular diseases.
TumorTumor vascular intervention therapy is divided into two types of intravascular intervention and extravascular intervention according to the site of device introduction. Ar-He knife cryotherapy is the extravascular intervention; intravascular intervention refers to inserting the catheter into the blood vessel that governs the tumor, injecting chemotherapeutic drugs, "concentrating force", playing "annihilation", or blocking the blood vessel (embolization), cutting off its blood supply, and "starving" the tumor to death. Almost all substantial cancer tumors can be treated with vascular intervention. For example, for lung cancer, catheter can be inserted into bronchial artery and its branch that governs the cancer, and for uterine cancer, catheter can be inserted into pelvic artery or uterine artery. The most successful clinical application is hepatic artery chemoembolization therapy for liver cancer.
Introduction to the method Origin of the methodNormal liver receives dual blood supply from the hepatic artery and portal vein, with the hepatic artery accounting for 20% of the blood supply and the portal vein accounting for 80% of the blood supply; whereas 95-99% of the blood supply of hepatocellular carcinoma comes from the hepatic artery. In other words, hepatic artery is not too important for normal liver, but it is vital for liver cancer. If the hepatic artery is blocked, the blood supply of normal liver will be reduced by only 20%, and this reduction will be replaced by the increase of portal vein blood supply; while the blood supply of liver cancer will be reduced by more than 90%, and the cancer cells will not be supplied with blood, i.e., no nutritional oxygen supply, and they will die.
According to this principle, a special liver cancer treatment method is designed clinically, i.e. hepatic artery chemoembolization
UsageThe method is: generally at the root of the thigh, puncture the skin, insert a special catheter into the femoral artery, then into the abdominal aorta, and finally into the hepatic artery, and as far as possible, insert into the arterial branches supplying blood to the liver cancer tissues. Embolic agents and chemotherapeutic agents are then injected into the hepatic artery. There are terminal embolic agents, commonly used iodine oil, which will completely block the small arteries; there are also proximal embolic agents, commonly used gelatin sponge, stainless steel rolls, etc. Gelatin sponge is most commonly used to block the trunk of hepatic artery. Can be infused at the same time chemotherapeutic drugs, such as fluorouracil, mitomycin, cisplatin, doxorubicin or epidoxorubicin, etc., these drugs will be pre-mixed with iodized oil sufficiently, and injected into the hepatic artery, so that it is slowly released, which can play a more durable anticancer effect.
All middle and advanced liver cancers that cannot be treated surgically are suitable for transhepatic artery chemoembolization
Value of useIts main value lies in:
(1) To make the tumor shrink, so that the original non-surgically resectable liver cancer can become resectable or to create conditions for other treatments, such as argon-helium knife freezing;
(2) After the resection of the liver cancer or freezing treatment, the method can help to prevent recurrence. helps to prevent recurrence. Some people have studied 139 cases of hepatocellular carcinoma patients who had undergone radical resection, and those who had chemoembolization after operation, the survival rate of 1, 3 and 5 years after operation was 89.1%, 61.2% and 53.7% respectively, while those who had not chemoembolization had an intrahepatic recurrence rate as high as 56.3%, and the survival rate of 1, 3 and 5 years after operation was 75.4%, 42.4% and 30.5% respectively.
Reasons for failure to cureHowever, in the vast majority of cases, this method cannot cure hepatocellular carcinoma because:
(1) blood supply to the peripheral part of the cancer often comes from the portal vein;
(2) after embolization of the hepatic artery, there is compensatory increase in the blood supply of the portal vein to the cancer, or collateral circulation occurs;
(3) in the case of the blood supply to the small arteries of the sub-nodules around the large tumor mass, this method can not be easily blocked. This method is not easy to block.
After chemoembolization of hepatocellular carcinoma, it should be timely transferred to other treatments. For some liver cancers that cannot be surgically resected, we often use chemoembolization-percutaneous cold ablation sequential treatment. ***There were 360 patients treated. All intrahepatic tumor masses were larger than 5 cm. Chemoembolization was performed first, and CT was performed 2 weeks later to observe the effect of embolization. If the tumor had been completely filled with iodine oil, cold ablation treatment with argon helium knife was given; otherwise, chemoembolization was performed again, but not more than 3 times. If necessary, chemoembolization was performed 1-2 times 1 month after cold ablation treatment. As a result, 8.3% of the patients' tumors disappeared completely, 63.3% of the patients' tumors shrunk significantly, 18.3% of the tumors were stable and did not increase further, and only 15.9% of the tumors recurred at the original frozen site. 90.6% of the patients survived for more than half a year, 70.0% survived for 1 year, 52.1% survived for 2 years, and 41.1% survived for more than 3 years. This result is equivalent to that of surgical treatment. It is worth pointing out that most of these patients we treated could not be surgically resected, and some had already failed other treatments, and the tumor size was more than 5 cm, and a considerable number of lumps were more than 10 cm, so it should be satisfactory to achieve such results.