Transcatheter arterial chemoembolization combined with microwave coagulation therapy and the perioperative care for patients with hepatocellural carcinoma.

PURPOSE: To explore the value of artificial hydrothorax microwave coagulation combined with transcatheter arterial chemoembolization (TACE) therapy in the treatment of ultrasound-invisible malignant tumors in the hepatic dome (mainly hepatocellular carcinoma/HCC) and the perioperative care for the patients. METHODS: Sixty-eight patients with malignant liver tumors in the hepatic dome were treated with a combination therapy of TACE and microwave coagulation via an artificially induced hydrothorax. Their perioperative condition was under close observation and the nursing care was intensified. Paracentesis of the chest was successfully carried out via the positioning of ultrasound and guidance of microwave to the tumor site, so that the tumor could be treated with cold cycle microwave coagulation therapy. RESULTS: After treatment, 3/68 patients (4.4%) achieved complete tumor ablation, while 59/68 (86.8%) achieved tumor ablation >50% or tumor shrinkage >30%. Another 6/68 patients (8.8%) achieved tumor ablation <50% or tumor shrinkage <30%. Of 45 patients, 42 (93.3%) obtained a reduction of AFP level >50% post-therapy, 28/37 patients (75.7%) achieved a reduction of CEA level >50%, 23/29 patients (79.3%) achieved a reduction of CA19-9 level> 50%; 3/68 patients (4.4%) survived for 4 to 6 months, 31/68 (45.6%) survived >6 months and 34/68 (50%) survived >12 months. No bleeding, liver failure, infection or needle tract seeding occurred after the operation, and no treatment-related deaths occurred. CONCLUSION: Microwave coagulation combined with TACE for HCC in the hepatic dome is safe and effective. Perioperative observation and nursing care can not only reduce the complications but also improve the therapeutic effect and the patient quality of life.