Patient Wang, male, 9 years old. 2007 November school physical examination revealed: hepatitis B surface antigen (+), hepatitis B surface antibody (-), hepatitis B e antigen (+), hepatitis B e antibody (-), hepatitis B core antibody (+), HBV-DNA 1.06×105cp/ml, AFP 1210ug/ l; B ultrasound examination showed: diffuse hepatocellular carcinoma, splenomegaly. On November 19, 2007, CT examination of the upper abdomen showed diffuse hepatocellular carcinoma and splenomegaly, and on November 26, 2007, biopsy of the liver showed hepatocellular carcinoma, excluding hepatoblastoma, and on February 18, 2008, angiography was performed under a vascular digital subtraction machine (DSA), which showed abnormal nodular staining in the left and right lobes of the liver, A 2.8F microcatheter was used to superselect to the right anterior inferior hepatic artery, right anterior superior hepatic artery, left hepatic artery and gastroduodenal artery, and slowly injected super liquid iodine oil 20ml + epi-amycin 20mg suspension of 5ml, 3ml, 3ml and 9ml, respectively. The body temperature rose to 39.2℃ on the 3rd day after surgery, and gradually returned to normal on the 6th day without obvious symptoms of nausea, vomiting and abdominal pain. The abdominal CT on the 7th postoperative day showed good iodine oil deposition in the intrahepatic lesion. The preoperative and postoperative CT and intraoperative DSA performance are shown below. The preoperative CT showed the occupying foci in S5 segment, and the postoperative CT showed the occupying foci in S5 segment with iodine oil deposition, and the intraoperative TACE film showed the tumor with iodine oil deposition. Among them, hepatoblastoma is the most common. Although the incidence of hepatocellular liver cancer is less than 0.5% of pediatric tumors, it is the second most common primary liver cancer after hepatoblastoma, accounting for 25% of primary liver cancers in children. The ratio of male to female is about 1.7:1; the occurrence of hepatocellular carcinoma in children is closely related to HBV infection, the incidence of cirrhosis is much lower than that in adults (20C25% compared to 60C70%), the tumors grow rapidly, mostly of giant type, pathological grading is mostly grade III and IV, and AFP positive rate is 79.1%. Mother-to-child vertical infection is still the main route of HBV infection in children. Primary liver cancer is mainly related to the presence of HBV-DNA sequences, and the low accuracy of reverse transcription activity in the key steps of HBV replication often leads to integration site mutations, and mutant strains appear in large numbers during chronic infection. Overexpression of liver tissue proto-oncogenes (mainly N-ras, Cmyc, C-ets-2) and integration of HBV genes may lead to the development of hepatocellular carcinoma. The main clinical manifestations are loss of appetite, right upper abdominal pain, epigastric mass, occasional back pain, and weight loss. Most children are at advanced stages at the time of presentation, and therefore have a poor prognosis with a long-term survival rate of less than 30%. Primary hepatocellular liver cancer is one of the most common tumors resistant to chemotherapy, and although some studies of beat chemotherapy and adjuvant therapy against tumor neovascularization have been conducted recently, the chemotherapy cure rate is still less than 15%. Complete surgical resection or liver transplantation is usually the only hope of cure for limited hepatocellular carcinoma, yet less than 25% of nodules are surgically resectable. For inoperable or recurrent hepatocellular carcinoma, transcatheter arterial chemoembolization (TACE) remains one of the most effective methods. Because of the low clinical incidence of primary liver cancer in children and its own characteristics different from those of adults, there are few reports in the literature on TACE for primary liver cancer in children. However, the relationship between TACE treatment and patient prognosis is influenced by many factors. First, patients with tumors <5.0 cm have significantly higher survival rates at 1, 2, and 3 years than patients with tumors >5.0 cm. Second, recent clinical studies have confirmed that the formation of portal vein cancer thrombus is a slow process, and when the portal vein is completely blocked, small peripheral side branch veins have long been formed, which will not lead to liver ischemia, so portal vein cancer thrombus is not an absolute contraindication to TACE, and the portal vein cancer thrombus itself also forms the blood supply artery. Thirdly, the efficacy of TACE also depends on the degree of tumor vessels embolized by iodine oil or gelatin sponge particles, and complete embolization can lead to complete tumor necrosis. Super-selection of the tumor supply artery not only maximizes embolization of the tumor vessels, but also minimizes damage to normal liver tissue. Although angiography revealed three nodules in the patient’s liver, the envelope was relatively intact. 2.8F microcatheters were used to superselect to the right anterior inferior hepatic artery, right anterior superior hepatic artery, left hepatic artery and gastroduodenal artery respectively to instill appropriate amounts of superfluid iodine oil + epi-amycin suspension and gelatin sponge particles to embolize as completely as possible, in order to achieve the best treatment effect and reduce liver function damage. The prognosis of primary hepatocellular carcinoma in children is poor, and most of them are already in advanced stage when diagnosed. The occurrence of hepatocellular carcinoma in children in China is closely related to HBV infection, so we should pay attention to the close follow-up of children with HBV infection, early detection, early diagnosis and early treatment in order to achieve better results. For children with primary liver cancer that cannot be surgically resected or liver transplanted, TACE is an effective and important treatment tool.