To investigate the application and significance of percutaneous puncture anhydrous ethanol ablation in the treatment of primary hepatocellular carcinoma and its extrahepatic metastases. Methods Retrospective analysis of the clinical data of 67 patients with primary hepatocellular carcinoma and some with pulmonary metastases and abdominal lymph node metastases. 83 intrahepatic lesions; 53 pulmonary metastases (31 cases); and 22 abdominal lymph node metastases (16 cases) were found among the 67 cases. The intrahepatic lesions were treated with percutaneous hepatic artery chemoembolization and/or anhydrous ethanol ablation, and the extrahepatic metastases were treated with anhydrous ethanol ablation alone. The results showed that the efficiency of the whole group was 65.8% for tumor lesions, 67.5% for intrahepatic lesions, 60.4% for pulmonary metastases and 72.7% for abdominal lymph node metastases, and the survival rates of six months and one year were 83.5% and 59.7%, respectively. Conclusion Anhydrous ethanol ablation has good clinical application value in the treatment of primary liver cancer and extrahepatic metastases. 1. Data and methods 1.1 General data Sixty-seven patients with PHC and partially combined extrahepatic metastases were collected, 47 males and 20 females; age ranged from 37 to 83 years old, with an average of 57±2.1 years. Among the 83 intrahepatic lesions in 67 patients, all of them were treated with TACE combined with PEI, except for 6 cases with 8 intrahepatic lesions without obvious tumor staining on the first hepatic arteriogram (23 cases with 34 intrahepatic lesions showed occlusion of the tumor supply artery or the presence of unembolizable collateral supply arteries on the hepatic arteriogram after multiple TACE treatments). Thirty-one cases of combined pulmonary metastases (53 lesions in total, none of which had more than three metastases) and 16 cases of abdominal lymph node metastases (22 lesions in total) were treated with PEI under CT guidance. 1.2 Materials and equipment The guiding equipment was GE Light Speed 16-row spiral CT with scanning conditions of layer thickness 2.5~5 mm and layer spacing 2~3 mm; the puncture needle was selected from Japanese Happo PEI alcohol needle with specifications of 21G×150mm/200mm; anhydrous ethanol was 99.9% medical ethanol in purity; and French Guerbet 48% super liquid iodized oil. 1.3 Treatment method Preoperatively, patients were given morphine hydrochloride 10mg intramuscularly, and Valium 10mg intramuscularly for patients with mental tension. Patients were placed in supine or lateral position, firstly, CT scan was performed to select the largest level of the tumor, and homemade catheter fenestrations were used to mark and locate the puncture point, needle direction and depth, then the skin was routinely disinfected and sterile treatment wipes were laid. The patient was asked to breathe calmly before the operation, and was anesthetized with local infiltration of 2% lidocaine hydrochloride. The alcohol needle was punctured percutaneously to the deepest surface of the tumor (i.e., about 0.5 cm from the junction between the distal side of the tumor and normal tissue) under CT guidance in steps. The ratio is 1:9) and mitomycin 5~10mg, and rotate the puncture needle while backing up to the superficial surface of the tumor. The multi-point injection method and split injection were adopted, and the ethanol injection volume was decided according to the patient’s tolerance level and the formula [2] V=4/3π(r+0.5)3 (V is the ethanol dosage ml, r is the tumor radius cm ). The calculated dosage can sometimes be moderately exceeded in order to make the lesion flush the lesion as much as possible. After the injection, the needle was kept for 3~5 min and then withdrawn. After the operation, monitor the patient’s blood pressure, respiration and other vital signs, and provide hemostasis and anti-infection treatment. CT examinations were repeated at intervals of 3~4 weeks, and the need for repeat treatment was evaluated according to the size of the lesion and the iodine oil deposition. 1.4 Efficacy evaluation criteria The CT scan or enhanced scan of the lesion at 3 months after the first treatment was completed was used as the imaging evaluation basis, and the extent of ethanol ablation was judged according to the deposition of iodized oil in the lesion. Due to the special nature of tumor ablation treatment, the efficacy was evaluated only with reference to RECIST, the standard for evaluating the efficacy of solid tumors. Complete remission (CR): complete ablation of tumor tissue with only residual iodinated oil images; ‘partial remission (PR): tumor ablation of more than 30% and above; ƒ stable (SD): tumor ablation of less than 30% or volume increase of less than 20%; lesion progression (PD): tumor volume increase of more than 20% or appearance of new lesions. The patients were also followed up continuously for 6~12 months to evaluate the mean survival. 2. Results 2.1 Treatment effect The survival rates at six months and one year were 83.5% and 59.7%, respectively. The specific efficacy is shown in Table 1 Table 1 Treatment results of 67 patients Lesions Complete remission Partial remission Stable Progressive Effective Intrahepatic lesions 83 42 14 12 15 67.5% Pulmonary metastases 53 19 13 11 10 60.4% Abdominal lymph node metastases 22 11 5 3 3 72.7% Total 158 72 32 26 28 65.8%