肝癌经皮动脉化疗灌注栓塞术后栓塞综合征危险因素分析及防治措施研究  

Analysis of risk factors and prevention measures for embolism syndrome after percutaneous arterial chemotherapy infusion embolization for liver cancer

作　　者：宋凌梓 范小斌[1] SONG Lingzi;FAN Xiaobin(Interventional Surgery Department,The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院介入手术部,河南南阳473000

出　　处：《淮海医药》2023年第6期560-563,567,共5页Journal of Huaihai Medicine

基　　金：河南省医学科技攻关项目(LHGJ2021011263)。

摘　　要：目的:分析肝癌经皮动脉化疗灌注栓塞术(TACE)后发生栓塞综合征(PES)的危险因素,并探讨具体防治措施。方法:本文为回顾性研究,病例纳入南阳医学高等专科学校第一附属医院2020年1月—2022年12月收治的101例原发性肝癌患者,所有患者均接受TACE术治疗,根据术后恢复情况,将术后发生PES的40例患者列为病例组,未发生PES的61例患者列为对照组,收集并比较2组患者一般资料、临床资料,采用单因素、多因素Logistic回归模型分析影响患者TACE术后发生PES的危险因素,结合分析结果探讨具体防治措施。结果:单因素分析结果显示,女性、Child-Pugh分级B~C级、美国东部肿瘤协作组体力状况评分(ECOG-PS)≥2分、巴塞罗那临床肝癌分期(BCLC)B~C期、微球栓塞、谷草转氨酶(AST)≥60U/L、谷丙转氨酶(ALT)≥60 U/L、血清白蛋白(ALB)<40 g/L、WBC≥5.0×10^(9)/L、中性粒细胞百分比(NE)≥60%、K^(+)≤4.0 mmol/L、Na^(+)≤135 mmol/L占比均高于对照组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,女性、术前ECOG-PS≥2分、术前BCLC分期B~C期、微球栓塞、ALT≥60 U/L、ALB<40 g/L、WBC≥5.0×10^(9)/L、NE≥60%、Na^(+)≤135 mmol/L是影响患者TACE术后发生PES的危险因素。结论:女性、术前ECOG-PS≥2分、肝功能损伤、微球栓塞、ALT≥60 U/L、ALB<40 g/L、WBC≥5.0×10^(9)/L、NE≥60%、Na^(+)≤135 mmol/L是影响患者TACE术后发生PES的危险因素。完善术前检查、改善肝功能、合理控制术中载药微球应用数量、密切监测术后血液指标,以及纠正电解质紊乱为防治TACE术后发生PES的重要举措。Objective:To analyze the risk factors for post embolic syndrome(PES)after transarterial chemoembolization(TACE)for liver cancer and explore specific prevention and control measures.Methods:101 patients with primary liver cancer were included from January 2020 to December 2022,all of whom received TACE surgery.Based on the postoperative recovery,40 patients with postoperative PES were included in a case group,and 61 patients without were included in a control group.General and clinical data of the two groups were collected and compared.Univariate and multivariate Logistic regression analysis were conducted to analyze the risk factors that could lead to PES in patients after TACE surgery,and explore specific prevention and control measures based on the analysis results.Results:The results of statistical univariate analysis showed that in the case group,the proportions of females,Child-Pugh grade B-C,ECOG-PS score≥2,BCLC B-C grade,microsphere embolization,AST≥60 U/L,ALT≥60 U/L,ALB<40 g/L,WBC≥5.0×10^(9)/L,NE≥60%,K^(+)≤4.0 mmol/L,and Na^(+)≤135 mmol/L were all higher than those of the control group(P<0.05).The results of logistic multiple factor regression analysis showed that females,preoperative ECOG-PS score≥2,preoperative BCLC grade B-C,microsphere embolization,ALT≥60 U/L,ALB<40 g/L,WBC≥5.0×10^(9)/L,NE≥60%,and serum Na^(+)≤135 mmol/L were risk factors for postoperative PES in patients undergoing TACE.Conclusion:Female liver cancer patients,preoperative ECOG-PS≥2 points,liver function damage,microsphere embolization,ALT≥60 U/L,ALB<40 g/L,WBC≥5.0×10^(9)/L,NE≥60%,and serum Na^(+)≤135 mmol/L are risk factors for PES after TACE surgery.Improving preoperative examination,ameliorating liver function,rationally controlling the number of drug-loaded microspheres used during surgery,closely monitoring postoperative blood indicators,and correcting electrolyte disorders are important measures to prevent and treat PES.

关 键 词：肝肿瘤 经皮动脉化疗灌注栓塞术 栓塞综合征 危险因素 防治措施 

分 类 号：R587.1[医药卫生—内分泌]