肝癌冻融治疗后并发出血的防治  

Prevention and Treatment of Hemorrhage after Hepatocarcinoma Cryoablation

作　　者：易峰涛[1] 卢绮萍[2] 

机构地区：[1]广州军区武汉总医院放射治疗科,湖北武汉430070 [2]广州军区武汉总医院普通外科,湖北武汉430070

出　　处：《华南国防医学杂志》2015年第12期892-895,共4页Military Medical Journal of South China

基　　金：湖北省自然科学基金项目(2011CDB016);中国博士后自然科学基金资助项目(2013M542581)

摘　　要：目的分析冷刀治疗后出血的原因,探索出血防治方法。方法 1999-10/2014-12月487例肝脏肿瘤患者完成术前检查后接受了冻融治疗,损伤到较大的血管或冰球破裂,并出现出汗,心慌,血压下降等临床症状和体征,计为冷刀治疗并发出血。考虑并发出血时,完成超声、计算机断层扫描(computed tomography,CT)或数字减影血管造影(digital subtracion angiography,DSA)检查进一步明确诊断;并给予局部压迫、静脉止血药物应用及输注冷沉淀、红细胞等处理,效果不佳时及时给与肝动脉栓塞治疗或手术治疗。结果 487例肝癌患者冷刀治疗中或治疗后发现有出血征象并诊断为出血者共51例(10.5%),死亡2例。单因素分析提示:患者不同性别、年龄、肿瘤来源及肿瘤大小对出血影响无统计学差异(P>0.05);但是患者是否存在肝硬化(P=0.03)、凝血功能是否异常(P=0.03)、血小板是否明显减少(P=0.024)、肿瘤在肝内不同位置(P=0.043)、使用不同直径的冷刀(P=0.003)以及冷冻时穿刺次数(P=0.025)对出血的影响有统计学差异。结论氩氦冷冻消融治疗肿瘤比较安全,但在选择患者或治疗前、治疗中及治疗后有出血倾向时,必须作出准确判断,采取合适的治疗方法,积极治疗。Objective To research the cause and prevention and treatment method of hemorrhage after hepatocarci- noma cryoablation.Methods Four hundred and eighty-seven patients with liver tumor accepted cryoablation from October 1999 to January 2014. Major blood vessels damage or ruptured ice hockey, and sweating, flustering, descended blood pres- sure,and other signs and symptoms could be in statistics for cryoablation complicating hemorrhage. When considering hemorrhage, clear diagnosis could be obtained with ultrasound or computed tomography （CT） or digital subtraction angi- ography.And vein local oppression, intravenous hemostatic drugs, cryoprecipitate, red blood cells were given, if the effect not beautiful when giving hepatic artery embolization or surgery timely.Results Four hundred and eighty-seven patients were given cryoablation therapy, 51 patients had hemorrhage signs during or after treatment and were diagnosed as hem- orrhage,and the incidence rate was 10.5%.Univariate analysis showed that the hemorrhage was significantly correlated with hepatic cirrhosis （P = 0.03）,coagulation disorders（P = 0.03）,platelets significantly reduced （P = 0.024）, tumor lo- cation （P = 0.043） ,type of cryoprobe （P = 0.003）and puncture times （P = 0.025）.Conclusion The risk of hemorrhage complicated with hepatocarcinoma cryoablation can be prevented and treated.Cryoablation is safe,but in the choice of pa- tients or the treatment before and after treatment in patients with hemorrhagic tendency, must take right judgment and take suitable therapy for hemorrhage actively.

关 键 词：冻融治疗 肝癌 出血 

分 类 号：R735.7[医药卫生—肿瘤]