The patient was 37 years old, and he was found to have hepatic occupancy on physical examination, and CT suggested multiple small hepatocellular carcinomas in the right liver. The patient had a history of hepatitis B and grade A liver function.
TACE was performed first, and liver tumor staining was seen, and the lesion was well deposited with iodized oil after injection of iodinated oil chemotherapy drug emulsion.
August 2014.
In October 2014, partial iodine oil deposition was seen in the lesion on CT.
The lesion was immediately adjacent to the right branch of the portal vein.
The lower edge of the lesion was between the right branch of the portal vein and the hepatic vein, no iodine oil deposition was seen and it was hypodense.
The lower edge of the lesion was immediately adjacent to the right branch of the portal vein.
Four argon helium knife cryoablation needles were used to puncture around the lesion and surround the lesion, followed by cryotherapy, and the ice ball was seen to completely encircle the tumor.
Ice sphere encircling the tumor
Ice sphere encircling the tumor
The ice sphere wraps around the tumor in a low density during the freezing process.
Cryosphere, level of the lower edge of the lesion
Cryopin at the lower edge of the lesion.
Review of the upper level of the lesion in December 2014
Ablation extent wrapping around the tumor.
Extent of ablation encircling the tumor
Portal vein intact
Re-review, complete local tumor inactivation. The extent of ablation was reduced, suggesting good regeneration of the surrounding liver.
The tumor is completely inactivated.
The portal vein and its branches are intact.
In the right liver, small dotted iodine oil deposits were seen, which were micro foci.
The left inner lobe also shows iodine oil deposition as a micro foci.
Comments:
Radiofrequency microwave ablation was an option for the patient with small hepatocellular carcinoma, but because the lesion was located next to the portal vein, the patient was more painful and prone to damage to the portal vein and bile ducts during thermal ablation, so the cryoablation with argon helium knife, which is smaller to the vessels and bile ducts, was chosen.
Fortunately, the tumor was completely inactivated after the procedure and the portal bile ducts were not damaged.
My opinion is that the first TACE is very necessary for any liver cancer. Like this case, TACE not only allows good iodine oil deposition of the parapapapillary tumor, but also the very small lesions in the lower right liver and left inner lobe are detected and treated in time due to TACE. If TACE is not performed first, many microscopic lesions will not be detected and treated in time, which may eventually affect the prognosis. However, we currently do not support the so-called infusion chemotherapy and repeated interventions.