肝脏
肝髒
간장
Chinese Hepatology
2015年
10期
776-778
,共3页
原发性肝癌%自发破裂出血%经肝动脉栓塞%化疗术
原髮性肝癌%自髮破裂齣血%經肝動脈栓塞%化療術
원발성간암%자발파렬출혈%경간동맥전새%화료술
Primary hepatocellular carcinoma%Spontaneous rupture%Transcatheter arterial chemoembolizaton
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。
目的：探討原髮性肝癌（PHCC）破裂齣血患者經肝動脈栓塞化療術治療的療效。方法 PHCC 破裂齣血患者278例，經影像學診斷、TNM 分期和 Child-pugh 分級確認 PHCC 患者肝癌類型。所有患者行栓塞術，栓塞毬為以多柔吡星、錶柔比星或順鉑為主的腫瘤化療藥物及可吸收性明膠海綿顆粒或以碘化油為主的栓塞劑。按照患者腫瘤情況決定使用栓塞毬的大小和栓塞劑及化療藥物的劑量。栓塞術成功後，再行 DSA 檢查，栓塞術後給予補液、抗生素、保肝及對癥處理。結果栓塞術後1週患者的血壓由（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，血紅蛋白由（53．87±12．63）g／L 升高到（89．68±10．74）g／L 正常水平，與治療前比較差異有統計學意義（P ＜0．01），化療2箇月後患者腫瘤病竈由（18．42±2．91）cm 減小到（6．56±3．10）cm，血清甲胎蛋白（AFP）水平由治療前的（467．43±164．38）μg／mL 降低到治療後的（389．55±143．35）μg／mL，與治療前比較差異有統計學意義（P ＜0．01），栓塞術後無齣血死亡患者，但均有不同程度的胃腸反應、肝功能不全、外週血中白細胞減少等不良反應，經對癥治療處理後，情況均緩解。對所有患者術後隨訪1年，6箇月的生存率為81．29％（226例），1年的生存率為56．12％（156例）。結論肝動脈栓塞化療術治療原髮性肝癌破裂齣血臨床觀察療效較好，可以有效改善患者的預後。
목적：탐토원발성간암（PHCC）파렬출혈환자경간동맥전새화료술치료적료효。방법 PHCC 파렬출혈환자278례，경영상학진단、TNM 분기화 Child-pugh 분급학인 PHCC 환자간암류형。소유환자행전새술，전새구위이다유필성、표유비성혹순박위주적종류화료약물급가흡수성명효해면과립혹이전화유위주적전새제。안조환자종류정황결정사용전새구적대소화전새제급화료약물적제량。전새술성공후，재행 DSA 검사，전새술후급여보액、항생소、보간급대증처리。결과전새술후1주환자적혈압유（56．32±8．32）／（87．44±10．32）mmHg 승고도（71．64±7．61）／（120．36±11．26）mmHg 정상수평，혈홍단백유（53．87±12．63）g／L 승고도（89．68±10．74）g／L 정상수평，여치료전비교차이유통계학의의（P ＜0．01），화료2개월후환자종류병조유（18．42±2．91）cm 감소도（6．56±3．10）cm，혈청갑태단백（AFP）수평유치료전적（467．43±164．38）μg／mL 강저도치료후적（389．55±143．35）μg／mL，여치료전비교차이유통계학의의（P ＜0．01），전새술후무출혈사망환자，단균유불동정도적위장반응、간공능불전、외주혈중백세포감소등불량반응，경대증치료처리후，정황균완해。대소유환자술후수방1년，6개월적생존솔위81．29％（226례），1년적생존솔위56．12％（156례）。결론간동맥전새화료술치료원발성간암파렬출혈림상관찰료효교호，가이유효개선환자적예후。
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 microspheres 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 μg/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 1-year survival rate of 56.12% (156 cases).Conclusion TACE might have favorable clinical curative effect and prognosis for primary HCC rupture hemorrhage.
