肝癌切除术围术期脑梗死患者的临床特点分析  

Clinical features of ischemic stroke patients undergoing perioperative hepatectomy for hepatic cancer

作　　者：程道宾[1] 秦超[1] 梁志坚[1] 韦馨娴 谢兴锐 虞丽霞[2] 蔺心敬[3] 何宁宇[4] 

机构地区：[1]广西医科大学第一附属医院神经内科,南宁530021 [2]广西医科大学第一附属医院病案信息科,南宁530021 [3]广西壮族自治区人民医院神经内科 [4]南宁市第二人民医院神经内科

出　　处：《中华老年心脑血管病杂志》2015年第2期154-157,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(30860088;81260186);广西自然科学基金(0832134;0991149);广西教育厅科研项目(200710LX060);广西医科大学博士启动基金(304214)

摘　　要：目的探讨肝癌切除术围术期脑梗死患者的临床特点及可能发病机制。方法选择接受肝癌切除术患者4437例,符合肝癌切除围术期脑梗死患者7例,回顾性分析患者的临床资料。结果 4437例患者中符合肝癌切除术围术期脑梗死患者7例,占所住院接受肝癌切除术患者的0.16%。3例存在1种或多种高血压、高脂血症等传统的脑卒中危险因素,4例无脑卒中危险因素。所有患者均为早期肝癌,4例(57.14%)患者脑内出现单一病灶,3例(42.86%)患者均出现非单一动脉供血区的2个及以上病灶。癌细胞抗原(cancer antigen,CA)125升高6例(85.71%),CA199升高4例(57.14%),D-二聚体升高5例(71.43%),甲胎蛋白升高6例(85.71%)。结论肝癌切除术围术期脑梗死多发生在术后的前3d,多数患者肝癌相关的血液生化指标异常、部分患者脑内出现分布于多个血管供血区的多发性梗死灶等明显的临床特点,其发病机制可能与血液的凝固性升高有关。Objective To study the clinical features of ischemie stroke patients undergoing periop erative hepatectomy for hepatic cancer and its pathogenesis. Methods The clinical data about 4473 hepatic cancer patients who underwent hepateetomy for hepatic cancer （including 7 ischemic stroke patients） were retrospectively analyzed. Results Seven out of the 4473 hepatic cancer patients were diagnosed with ischemic stroke in perioperative hepatectomy for hepatic cancer, accounting for 0.16% of the total patients who underwent hepatectomy for hepatic cancer. Of the 7 ischemic stroke patients,3 were found to have one or more risk factors for ischemic stroke （such as hypertension and hyperlipidemia） ,4 were found to have no risk factor for ischemic stroke. The 7 patients were diagnosed with early hepatic cancer, single lesion was found in 4 patients （57.14%） and 2 or rnre lesions were found in 3 patients （42.86%）. The serum levels of CA125, CA199,D dimer,and alpha fetal protein were elevated in 6 （85.71%）,4 （57. 14%）,5 （71.43%） and 6 patients （85. 71%）, respectively. Conclusion Ischemic stroke usually occurs in hepatic cancer patients 3 days before perioperative hepatectomy. The biochemical test is abnormal in most hepatic cancer patients, and multiple lesions can be found in different blood supply regions of some hepatic cancer patients,which may be related with their elevated blood coagulability.

关 键 词：肝肿瘤 手术期间 脑梗死 血液凝固 癌胚抗原 甲胎蛋白类 

分 类 号：R735.7[医药卫生—肿瘤]