选择性动脉栓塞治疗原发性肝癌自发破裂出血的疗效及预后分析  

Selective arterial embolization for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma:analysis of curative effect and prognosis

作　　者：周春[1] 刘圣[1] 祖庆泉[1] 王斌[1] 王绍显 施海彬[1] ZHOU Chun;LIU Sheng;ZU Qingquan;WANG Bin;WANG Shaoxian;Sill Haibin(Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, China)

机构地区：[1]南京医科大学第一附属医院介入放射科,210029

出　　处：《介入放射学杂志》2017年第12期1093-1097,共5页Journal of Interventional Radiology

摘　　要：目的探讨初诊行选择性动脉栓塞(TACE)治疗原发性肝癌自发破裂出血的疗效及预后相关因素。方法回顾性分析2012年6月至2016年6月,初诊接受选择性TACE治疗的57例原发性肝癌自发破裂出血的患者。末次随访时间为2016年10月。采用Kaplan-Meier法计算累积生存率,Cox回归模型分析生存预后因素。结果 57例患者,中位生存期为208 d,6个月、1年、2年累积生存率分别为50.3%、35.9%、14.7%。多因素Cox回归分析显示:肿瘤直径、Child-Pugh分级、休克病史以及栓塞材料是患者预后的独立相关因素。结论初诊行选择性TACE治疗肝癌自发破裂出血安全、有效。本研究显示,较大的肿瘤直径,Child-Pugh分级不佳,休克病史与患者预后不良有关。同时,碘油联合明胶海绵颗粒TACE治疗患者可以获得比单纯PVA颗粒栓塞更好的预后。Objective To investigate the curative effect of transarterial embolization （TAE） for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma （HCC）, and to discuss the factors influencing prognosis. Methods A total of 57 patients with HCC complicated by spontaneous rupture and bleeding, who received initial TAE during the period from June 2012 and June 2016, were enrolled in this study. The last follow-up visit was in October 2016. Kaplan-Meier method was used to calculate the cumulative survival rate, and Cox regression model was adopted to analyze prognostic factors. Results In this series of 57 patients, the median survival time was 208 days. The 6- month, 1- year and 2- year cumulative survival rates were 50.3%, 35.9% and 14.7%, respectively. Multivariate Cox regression analysis indicated that tumor size, Child-Pugh classification, history of shock, and the used embolization materials were the independent prognostic faators. Conclusion The use of selective TAE, as an initial therapy, for HCC complicated by spontaneous rupture and bleeding is safe and effective. This study reveals that larger diameter of the tumor, poor Child-Pugh classification, the presence of shock history indicate a poor prognosis. TACE using lipiodol combined with gelatin sponge particles can expect a better prognosis than TACE using PVA particles alone.

关 键 词：肝细胞癌 自发破裂 动脉栓塞 有效性 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]