【摘要】 目的分析急诊肝动脉化疗栓塞术(TACE)介入治疗肝癌破裂出血的效果及安全性。方法回顾性分析39例肝癌破裂出血患者的临床资料,分析患者的治疗方法、效果及血红蛋白水平,并分析患者的影响因素。结果 39例肝癌破裂患者中30例经急诊TACE介入治疗,止血效果良好,并未出现任何并发症,经30 d治疗后TACE治疗者存活率为90.00%(27/30);随访180 d,其生存率为43.33%(13/30)。其余9例给予保守治疗方案,经30 d治疗后存活率为33.33%(3/9),随访180 d存活率为22.22%(2/9)。TACE介入治疗患者的存活率及血红蛋白水平均高于保守治疗方案患者,差异具有统计学意义(P<0.05)。经TACE介入治疗患者30 d后存活情况与其血红蛋白浓度、肌酸酐浓度、ChildPugh分级结果以及TACE方式有一定的关联,经回归分析显示,肝癌破裂出血患者接受TACE介入治疗(OR=0.077,P=0.0201<0.05)以及血红蛋白维持在较高水平均可促使生存率提高;血红蛋白高浓度是经TACE介入治疗患者30 d存活的独立影响因素(OR=0.610,P=0.0362<0.05)。结论急诊TACE介入治疗肝癌破裂出血具有较好的临床效果,不良反应率较低,提高30 d生存率。更多还原

【Abstract】 Objective To analyze the effect and safety of emergency transcatheter arterial chemoembolization(TACE) intervention in the treatment of rupture and bleeding of liver cancer. Methods The clinical data of 39 patients with rupture and bleeding of liver cancer were retrospectively analyzed. Analysis were made on treatment methods, effects and hemoglobin levels and its influencing factors. Results Of the 39 patients with ruptured liver cancer, 30 cases were treated by emergency TACE intervention. Their effect of hemostasis was good and no complications were found. After 30 d of treatment, the survival rate of the patients with TACE was 90%(27/30); After 180 d of follow-up, the survival rate was 43.33%(13/39). The remaining 9 patients were given conservative treatment. The survival rate after 30 d of treatment was 33.33%(3/9) and the survival rate after 180 d of follow-up was 22.22%(2/9). The survival rate and hemoglobin level of patients with TACE intervention were higher than those in conservative treatment, and the difference was statistically significant(P<0.05). The survival of 30 d patients after TACE intervention was correlated with hemoglobin concentration, creatinine concentration, Child-Pugh grading results and TACE pattern. Regression analysis showed that TACE intervention(OR=0.077, P=0.0201<0.05) and high hemoglobin levels in patients with ruptured liver cancer could promote the survival rate. High concentration of hemoglobin is an independent factor(OR=0.610, P=0.0362<0.05) for 30 d survival patients with TACE intervention. Conclusion Emergency TACE intervention therapy shows good clinical effect in treating rupture and bleeding of liver cancer with low adverse reactions rate, and it can improve the 30 d survival rate.更多还原