肝恶性肿瘤肝动脉化疗栓塞后败血症:基于单中心的回顾性研究  

Sepsis after transarterial chemoembolization of hepatic carcinoma : A retrospective analysis from a single center

作　　者：谢迪杨[1] 乐凡[1] 张岚[1] 谢晓莺[1] 任正刚[1] 

机构地区：[1]复旦大学附属中山医院肝癌研究所,上海200032

出　　处：《肿瘤》2015年第11期1265-1270,共6页Tumor

摘　　要：目的 :分析肝恶性肿瘤经动脉化疗栓塞(transarterial chemoembolization,TACE)后发生败血症的危险因素、治疗和转归。方法 :回顾性分析2009年12月—2014年12月在复旦大学附属中山医院肝内科接受TACE后发生败血症的肝恶性肿瘤患者,从患者临床特征、肿瘤特征、实验室检查和TACE用药等方面分析相关危险因素,并总结治疗经验。结果 :在4 355例次肝恶性肿瘤TACE后,13例(0.30%)发生败血症。其中,1例继发于自发性腹膜炎,3例继发于肝脓肿,3例继发于胆汁瘤并发感染。13例败血症患者接受TACE前的平均血白细胞计数、血中性粒细胞百分比及血清降钙素原水平分别为(4.95±2.20)×109/L、(65.26±9.74)%和(0.09±0.06)ng/m L,而诊断为败血症时的平均血白细胞计数、血中性粒细胞百分比及血清降钙素原水平分别为(9.24±5.51)×109/L、(89.45±5.71)%和(5.16±6.18)ng/m L,均较TACE前显著升高(P值均<0.05)。高龄、既往有放化疗史和胆管手术史等均是发生败血症的危险因素。结论 :肝恶性肿瘤TACE后的败血症发生率较低,对高危患者可考虑预防性使用抗生素,而术后密切监测血清降钙素原有助于早期发现。Objective： To investigate risk factors, optimal treatment and prognosis of sepsis after transarterial chemoembolization （TACE） in patients with hepatic carcinoma. Methods： A retrospective study of patients treated with TACE in department of liver cancer in Zhongshan Hospital, Fudan University between December 2009 and December 2014 was performed. The risk factors of sepsis after TACE were investigated, involving clinical characteristics, tumor morphology, technical methods and laboratory results. Treatment and prognosis were also analyzed Results： There were 13 （0.30%） patients complicated with sepsis after a total of 4 355 TACE for primary and secondary hepatic cancer. Among 13 cases of sepsis, 1 case was secondary to spontaneous peritoneal infection, 3 cases due to liver abscess, and another 3 cases due to biloma. Routine blood test of patients when first diagnosed of sepsis showed significant increases in white blood cell counting, percentage of neutrophil cells and serum procalcitonin value, reaching （9.24±5.51）×10^9/L, （89.45±5.71）% and （5.16±6.18） ng/mL, respectively, as compared with those before TACE [（4.95±2.20））×10^9/L, （65.26±9.74）% and （0.09±0.06） ng/ mL, respectively] （all P 〈 0.05）. Risk factors of sepsis after TACE included elder age, previous biliary tract surgery, and history of radiotherapy and chemotherapy. Patients treated with effective antibiotics and on-time drainage of abscess had a favorable prognosis. Conclusion： The incidence rate of sepsis after TACE for patients with hepatic carcinoma is relatively low. Prophylactic antibiotics for high-risk patients and dynamic monitoring of procalcitonin are important.

关 键 词：肝肿瘤 败血症 经动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]