摘要
目的探讨原发性肝癌(PHCC)破裂出血患者经肝动脉栓塞化疗术治疗的疗效。方法 PHCC破裂出血患者278例,经影像学诊断、TNM分期和Child-pugh分级确认PHCC患者肝癌类型。所有患者行栓塞术,栓塞球为以多柔吡星、表柔比星或顺铂为主的肿瘤化疗药物及可吸收性明胶海绵颗粒或以碘化油为主的栓塞剂。按照患者肿瘤情况决定使用栓塞球的大小和栓塞剂及化疗药物的剂量。栓塞术成功后,再行DSA检查,栓塞术后给予补液、抗生素、保肝及对症处理。结果栓塞术后1周患者的血压由(56.32±8.32)/(87.44±10.32)mmHg升高到(71.64±7.61)/(120.36±11.26)mmHg正常水平,血红蛋白由(53.87±12.63)g/L升高到(89.68±10.74)g/L正常水平,与治疗前比较差异有统计学意义(P<0.01),化疗2个月后患者肿瘤病灶由(18.42±2.91)cm减小到(6.56±3.10)cm,血清甲胎蛋白(AFP)水平由治疗前的(467.43±164.38)μg/mL降低到治疗后的(389.55±143.35)μg/mL,与治疗前比较差异有统计学意义(P<0.01),栓塞术后无出血死亡患者,但均有不同程度的胃肠反应、肝功能不全、外周血中白细胞减少等不良反应,经对症治疗处理后,情况均缓解。对所有患者术后随访1年,6个月的生存率为81.29%(226例),1年的生存率为56.12%(156例)。结论肝动脉栓塞化疗术治疗原发性肝癌破裂出血临床观察疗效较好,可以有效改善患者的预后。
Objective To explore the curative effect of transcatheter arterial chemoembolization （TACE） on primary hepatocellular carcinoma （PHCC） rupture hemorrhage. Methods Two hundred and seventy-eight patients with PHCC rupture hemorrhage were enrolled. Additionally, HCC types of those patients were diagnosed by imaging, tumor node metastasis （TNM） staging and Child-Pugh grades. Embolization was performed in all those patients, for which embolism mierospheres consisted of tumor chemotherapy drugs （doxorubicin, epirubicin or cisplatin） and absorbable gelatin sponge particles or predominantly iodized oil embolism agent. Size of embolism microspheres, dose of agents and chemotherapy drugs were administered on basement of tumor status. Digital subtraction angiography （DSA） were carried out after embolization. All patients received general treatment, including antibiotics, liver protection and symptomatic treatment. Results Blood pressure and hemoglobin level of postoperative patients at week 1 returned to normal, which showed statistically different （P〈0.01） from those at baseline （from 56.32 ± 8.32/87.44 ± 10.32 mmHg to 71, 64± 7.61/120.36 ±11.26 mmHg, 3.87 ±12.63 g/L to 89.68 ± 10.74 g/L, respectively）. Size of tumor and alpha fetoprotein （AFP） level were significantly lower （P〈0.01） on month 2 than those at baseline （from 18.42±2.91 cm to 6.56 ±3.10 cm, 467.43 ±164.38 tlg/mL to 389.55 ± 143.35 μg/mL, respectively）. No deaths occurred in those patients received embolization, while all patients suffered varying degrees of adverse reactions, such as gastrointestinal reaction, hepatic insufficiency, leukopenia, etc. , which could be relieved by symptomatic treatment. All patients were followed up for one year, with a 6- month survival rate of 81. 29%（226 cases） and a I-year survival rate of 56. 12% （156 cases）. Conclusion TACE might have favorable clinical curative effect and prognosis for primary HCC rupture hemorrhage.
出处
《肝脏》
2015年第10期776-778,共3页
Chinese Hepatology
关键词
原发性肝癌
自发破裂出血
经肝动脉栓塞
化疗术
Primary hepatocellular carcinoma
Spontaneous rupture
Transcatheter arterial chemoembolizaton
