合并糖尿病对转移性肝癌介入治疗安全性及疗效的影响  

The Influence of Combined Diabetes on Security and Curative Effect of Interventional Therapy of Liver Metastatic Cancer

作　　者：李国平[1] 王小林[1] 王建华[1] 颜志平[1] 龚高全[1] 陈颐[1] 程洁敏[1] 李长煜[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032

出　　处：《中国临床医学》2010年第2期205-207,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:评估糖尿病对转移性肝癌患者行经动脉化疗栓塞(transarterial chemoembolization,TACE)的安全性及疗效的影响。方法:对临床诊断明确的54例转移性肝癌合并糖尿病患者(A组)及62例转移性肝癌无糖尿病患者(B组)的术前空腹血糖(其中A组每天术前均检测3餐前血糖,并通过口服降糖药、皮下注射或静脉滴注胰岛素将血糖控制在安全范围)、术后严重的并发症(包括肝脓肿、肝性脑病、糖尿病酮症酸中毒、低血糖等)发生情况、平均介入治疗次数、住院时间、平均可介入治疗期进行比较分析。结果:A组术前空腹血糖均值为(8.2±3.1)mmol·L-1,B组术前空腹血糖均值(4.5±1.4)mmol·L-1(P<0.001)。平均介入治疗次数A组(6.3±2.1)次,B组为(9.5±2.8)次(P<0.05)。平均住院时间A组为(11.2±3.5)d,B组为(7.8±2.6)d(P<0.05)。平均可介入治疗期A组为(18.6±6.2)个月,B组为(23.5±4.5)个月(P<0.05)。肝脓肿发生率A组为5.6%,B组为1.6%,经穿刺引流及抗感染药物治疗后好转。A组发生低血糖2例,肝性脑病2例,经积极治疗后好转。结论:糖尿病是影响转移性肝癌安全性及治疗疗效的一个重要因素。如果将血糖控制至安全范围内,预先去除糖尿病相关危险因素,结合血糖情况调整介入化疗栓塞方案,转移性肝癌合并糖尿病患者行TACE治疗是安全可行的。Objective：To evaluate the influence of combined diabetes on security and curative effect of transarterial chemoembolization （TACE） in metastatic liver. Methods：Fifty-four patients with metastatic cancer of liver companied with diabetes（Group A） and 62 metastatic cancer of liver patients without diabetes（Group B） who were clinically diagnosed were retrospectively analysed. The indicatrixes including preoperative blood-fasting sugar,postoperative severe complications（including hepatic abscess,hepatic encephalopathy,diabetic ketoacidosis,hypoglycaemia and so on）,mean times of interventional therapy,mean length of stay,average time of available for interventional therapy were analysed and the statistical differences between the two groups were also compared. Results：The mean preoperative blood-fasting sugar of Group A was 8.2±3.1mmol/L and that of Group B was 4.5±1.4 mmol/L（P0.001）. Mean times of interventional therapy of Group A was 6.3±2.1,Group B was 9.5±2.8,P0.05.Mean length of stay of Group A was 11.2±3.5 days and that in Group B was 7.8±2.6 days（P0.05）.The average time of available for interventional therapy of Group A was 18.6±6.2 months and that in Group B was 23.5±4.5 months（P0.05）. Incidence rate of hepatic abscess in Group A was 5.6% and that of Group B was 1.6%.The hepatic abscess were all cured after drainage and by antvbiotics. Hypoglycaemia occurred in 2 patients in Group A and none in Group B. Two patients of Group A developed hepatic encephalopathy. All these complications were cured after active treatment. Conclusion：Diabetes is an important factor that affects the security and curative effect of interventional therapy of metastatic cancer liver. It is feasible and safe for patients who had metastatic liver cancer companied with diabetes if blood glucoses are controlled in safety range,latent factors of risk are eliminated,and the plans of TACE are adjusted according to blood glucose of patients.

关 键 词：转移性肝癌 介入治疗 糖尿病 化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]