Primary liver cancer is one of the common malignant tumors in China with insidious onset. The mortality rate ranks the 3rd among malignant tumors of digestive system. About 110,000 people die from liver cancer in China every year. Outpatient surgical resection rate is less than 20%, and the recurrence rate of liver cancer 5 years after surgery is 70% for large liver cancer and 35% for small liver cancer, and there are a large number of patients who cannot be surgically resected waiting for non-surgical comprehensive treatment, and hepatic artery chemoembolization has become the main treatment for primary liver cancer. Other interventional methods for hepatocellular carcinoma include radiofrequency therapy, anhydrous ethanol injection, buried chemotherapy cartridges, cryotherapy, electrochemical therapy, etc. The characteristics of each of these methods will not be introduced, among which hepatic artery chemoembolization accounts for 80-90% of the total number of patients treated with interventional therapy. Interventional radiology is an emerging edge discipline developed in the last 30 years that integrates medical imaging and clinical therapeutics, the term Interventional Radiology was proposed in 1967 by Margalis, an American radiologist, Interventional radiology is guided by medical imaging methods, percutaneous puncture cannula, angiography of patients, take Under the guidance of medical imaging methods, interventional radiology is a method of diagnosing and treating diseases by using percutaneous puncture and cannulation, angiography, pathology, physiology, cytology and biochemistry, and drug perfusion, vascular embolization, dilatation, and drainage. The most important feature of interventional radiology is that it is simple, safe and effective with few complications. The blood supply of normal liver is 75% from portal vein and 25% from hepatic artery, while the blood supply of hepatocellular carcinoma is 90-99% from right hepatic artery. After embolization of hepatic artery, the blood supply of normal liver will only be reduced by 35-40%, while the hepatocellular carcinoma tissue achieves the treatment purpose due to ischemic necrosis. (a) Angiographic manifestation of hepatocellular carcinoma 1. Anatomical basis of hepatic angiography. Anatomically, the liver is composed of two lobes, and each lobe is divided into liver segments. The common hepatic artery originates from the abdominal arterial trunk and is the main artery supplying the liver. After issuing from the gastroduodenal artery, the hepatic artery divides into two branches, left and right, which supply the left and right lobes. These two hepatic arteries continue to branch, with the right branch dividing into four segmental branches and the left and right into two segmental branches. Only 50-60% of people have such a typical type. The remaining individuals have different origins of the hepatic artery. The most common ones are: right hepatic artery from the superior mesenteric artery in 14%, the collateral right hepatic artery from the superior mesenteric artery in 6%, the left hepatic artery from the left gastric artery in 10%, the collateral left hepatic artery from the left gastric artery in 8%, and the common hepatic artery from the superior mesenteric artery in the remaining 3%. It is important to be familiar with these arterial variants for hepatic artery chemoembolization. 2. Tumor vascularity and tumor staining. Typical hepatocellular carcinoma angiogram shows a vascular-rich mass with tumor neovascularization, significant tumor staining, visible dilated feeding arteries and contrast lakes. 3.Arteriovenous fistula. About 70% of cases are accompanied by portal vein and hepatic vein invasion, and the portal vein or hepatic vein is visualized in selective arteriography. It shows portal or hepatic vein pattern and may also show double track disease. 4, portal vein tumor embolus The venous phase of abdominal cavernous artery or superior mesenteric artery angiography shows filling defect in the portal vein when the returning contrast agent enters the portal vein. However, if the tumor embolus completely obstructs the portal vein, the portal vein cannot be shown. The manifestation is that the portal vein is not visualized without the sign of filling defect. (2) Commonly used chemotherapeutic drugs Arterial perfusion chemotherapy is characterized by high concentration and high dose of one-time administration, with small side effects. Interventional chemotherapy drug selection principles: 1. cell cycle non-specific killing drugs, effective for all cell division cycles; 2. drugs sensitive to specific tumors; 3. combination drug regimen, using cell cycle non-specific killing drugs and drugs sensitive to specific tumors in combination. Anthracycline glycoside antibiotic-adriamycin is the main drug of choice, which can be embedded in the double helix mechanism of DNA to block the action of RNA polymerase and inhibit the synthesis of RNA, and has a killing effect on all phases of cell division, as a broad-spectrum representative drug for arterial perfusion chemotherapy. The total amount of epoetin (EPI) does not exceed 1000 mg/m ²,beyond this dose irreversible heart rate failure will occur. Cisplatin (PDD) is a heavy metal complex with a central divalent platinum bound to 2 chlorine atoms and 2 ammonia molecules. By forming cross-links with bases on the double helix structure of DNA, it affects the template function of DNA and inhibits the synthesis of DNA and RNA, and is a non-specific drug of the cell cycle, which has effects on all phases of cell division. It is clinically effective, but its side effects of nausea and vomiting are so strong that patients often cannot tolerate it and abandon its use. Recently there is a drug that can replace cisplatin – nedaplatin, chemical name: (Z)-diamin(hydroxyacetic acid-O1,- O2,) platinum has been used clinically, this product enters the cell, the bond between alcoholic oxygen and platinum on the glycolate ligand breaks, water binds to platinum, leading to the formation of ionic substances (active substances or hydrates), the broken glycolate ligand becomes The broken glycolate ligand becomes unstable and is released, producing a variety of ionic substances and binding to DNA. It binds to DNA in the same manner as cisplatin and inhibits DNA and RNA replication, resulting in antitumor activity. After initial clinical application its side effects are significantly reduced compared to cisplatin and have overcome the original excessive side effects. Commonly used drugs and dosage: Drug name Dosage EPI 100mg/time THP 50-60mg/time HCPT 20-30mg/time 5-FU 1000mg/time CF 100 mg/time PDD 100-150mg/time MMC 20mg/time Nedaplatin 100-120 mg/time Commonly used regimen: 1. EPI 80-100mg, Tophealth 30mg 2.THP 60 mg, Tophealth 30mg 3.CDDP 150mg, 5FU 1000 mg, CF 100mg 4. THP 60 mg, nedaplatin 120 mg (c) Commonly used embolic agents 1. iodized oil. It has special guiding effect on liver cancer tissue, can selectively stay in tumor tissue, and can embolize the terminal blood vessels of tumor tissue. Liver tumor vessels have siphoning effect on it. As the permeability of tumor blood vessels increases, iodinated oil leaks out of blood vessels and accumulates in tumor tissues, while tumor tissues lack reticuloendothelial cells and lymphocytes, iodinated oil is not easily decomposed and absorbed, and stays in tumor tissues for a long time. The amount of iodized oil accumulation is proportional to the richness of tumor blood vessels, the richer the tumor blood vessels, the more iodized oil accumulation, the less the tumor blood vessels, the less iodized oil accumulation. Therefore, the role of iodized oil is limited and the therapeutic effect is not good for those who lack blood supply. 2.Gelatin sponge. Principle: Operators use gelatin sponge block to process into granules by hand with scissors, because of uneven size, irregular shape, rough granules and large friction coefficient, embolic agent often cannot fill the blood vessel completely when injecting into hepatic artery, which affects the embolization effect. Now there are gelatin particles 100-700μ different sizes of finished products, according to the need to choose. 3.Sodium alginate microspheres (KMG microspheres). It is made of seaweed as raw material into various diameters of particles, 100-700μ is the most commonly used, microscopically observed as oval, smooth edge, uniform size, and complete blood flow blockage after embolization. Another feature is that sodium alginate microspheres can be completely decomposed and excreted through urine after 2 to 3 months. There is no side effect to human body, no stimulation to the endothelium, and the artery can be repeatedly embolized without the phenomenon of arterial occlusion after gelatin sponge embolization. 4.PVA microsphere. American company production, the use of a relatively short period of time, there is not much experience in the use of. (4) Hepatic artery chemoembolization method 1. Indications The indications for interventional treatment of primary hepatocellular carcinoma are wide, and it can be used as palliative treatment for hepatocellular carcinoma that cannot be removed surgically, and also as an important method for comprehensive treatment of hepatocellular carcinoma. With the accumulation of experience and maturity of technology, the indications for interventional treatment of hepatocellular carcinoma will be further expanded. (1) Those who cannot be surgically resected due to various reasons or those who are unwilling to undergo surgical resection. (2) Before surgical resection of hepatocellular carcinoma, chemoembolization of hepatic artery can shrink the tumor and reduce the p-blood supply, which can create conditions for surgery. (3) Those whose tumor is not completely resected or recurred after surgery. (4), Rupture and bleeding caused by primary liver cancer p pain p arteriovenous fistula. (5), The volume of liver tumor is less than 70% of the liver, and the main trunk of portal vein is not completely obstructed. (6) Those with primary hepatocellular carcinoma accompanied by more severe cirrhosis or elderly patients with poor physical condition hepatic artery embolization therapy can be used as palliative treatment method. 2. Contraindications: (1) Severe jaundice, large amount of ascites. (2) Severe hepatic and renal insufficiency, Child grade C. (3) The patient’s general condition is poor and depressed or cachexia. (4) The tumor is more than 70% of the liver volume with severe liver failure. (5) Complete obstruction of portal vein aneurysm with portal hypertension. 3.Puncture and cannulation method Using Seldinger puncture and cannulation technique, the hepatic artery is routinely cannulated through the right femoral artery, abdominal arteriography is routinely performed, and the catheter is selectively inserted into the intrinsic hepatic artery or left hepatic artery or right hepatic artery to inject drugs and then inject embolic agent. If tumor vascular tumor staining is found to be incomplete continue to look for the variant blood supply artery. If hepatocellular carcinoma is accompanied by hepatic artery-portal vein fistula, conventional chemoembolization treatment is feasible. If hepatocellular carcinoma is accompanied by hepatic artery-venous fistula, the patient should be treated accordingly according to the specific situation. 4.Post-embolization reaction Post-embolization syndrome: chemotherapeutic reaction after hepatic artery chemoembolization of hepatocellular carcinoma and a series of clinical manifestations due to tumor ischemic necrosis: nausea, vomiting, fever, abdominal pain, abdominal distension, general discomfort and other symptoms. The severity of the symptoms is related to the size of the mass and the patient’s physical condition. It usually lasts for 3-5 days and gradually improves after symptomatic treatment with liver protection, anti-inflammation, antiemetic, analgesia and fever reduction. 5, complications Gastrointestinal bleeding, liver rupture, liver coma, ascites jaundice, puncture local hematoma, etc. are less common, and the chance of occurrence is related to the early and late stage of the disease. It is helpful to master the indications to reduce complications. (V), the progress of embolic agents Lipiodo utlrafluide or domestic 40% iodized oil is the most commonly used embolic agent and has been used for the longest time, with super-liquidated iodized oil being the best. Iodized oil is not effective in low blood supply lesions because of the lack of tumor blood vessels and too little iodized oil accumulation. In recent years, embolic agents have been developed, such as sodium alginate microspheres, with uniform particles and complete blood flow blockage after embolization. In clinical work, it is observed that some patients with iodinated oil embolization have achieved good efficacy in treatment, but the tumor grows while being treated, so it is difficult to completely stop the growth of the tumor. The present authors believe that iodized oil cannot completely block the blood flow because of its liquid state, and that the iodized oil already in the tumor is reduced by the constant flushing of the blood flow. Therefore, the efficacy of iodized oil embolization is largely influenced by the type and structure of tumor blood vessels, with good efficacy in lesions with abundant tumor blood vessels and poor efficacy in lesions with sparse tumor blood vessels. Its embolization time lasts for 2-3 months, during which the tumor is completely ischemic and is not affected by blood flow, thus causing the tumor tissue to be completely hypodense and necrotic. Treatment effect: The efficacy of embolization for hepatocellular carcinoma varies, but the survival rate has improved from recent literature. The PLA General Hospital summarized the data of 312 cases of primary hepatocellular carcinoma treated more than twice from January 1987 to 1996, and the survival rates at 1, 2, 3, 5, 7, and 8 years were 64.6%, 46.8%, 36.1%, 25.3%, 19.2%, and 14%, respectively.