实用肝脏病杂志 ›› 2015, Vol. 18 ›› Issue (2): 124-127.doi: 10.3969/j.issn.1672-5069.2015.02.005

• 肝癌 • 上一篇    下一篇

微粒型栓塞剂在肝癌自发性破裂出血中的临床应用

吴普照, 张跃伟, 周军, 赵广生, 刘影, 李闯, 唐顺雄, 赵旭   

  1. 563000贵州省遵义市 遵义医学院(吴普照); 大连大学附属中山医院介入治疗科(张跃伟,周军,赵广生,刘影,李闯,唐顺雄,赵旭)
  • 收稿日期:2014-08-05 出版日期:2015-03-10 发布日期:2016-02-19
  • 通讯作者: 张跃伟 E-mail:zhangyuewei1121@sina.com
  • 作者简介:吴普照,男,40岁,医学硕士,副主任医师。主要从事肿瘤及外周血管介入治疗学研究。E-mail:604003776@qq.com

Urgent hemostasis by GSMs-TACE in patients with spontaneous rupture of hepatocellular carcinoma

Wu Puzhao, Zhang Yuewei, Zhou Jun, et al.   

  1. Zunyi Medical College,Zunyi 563000,Guizhou Province,China
  • Received:2014-08-05 Online:2015-03-10 Published:2016-02-19

摘要: 目的 回顾性分析应用不同直径明胶海绵微粒(GSMs)作为栓塞剂,经导管肝动脉化疗栓塞(TACE)治疗肝癌破裂出血患者的疗效及安全性。方法 收集2010年8月~2013年12月期间,我院11例经GSMs-TACE治疗的肝癌自发性破裂出血患者的临床资料;分别于GSMs-TACE治疗后1、3和6 m复查CT和甲胎蛋白(AFP),按照改良实体瘤疗效评价标准(mRECIST 1.1)和AFP水平评价治疗反应。结果 随访1~6 m(平均5 m),所有GSMs-TACE治疗患者均得以成功止血,无因技术原因所致相关并发症发生;术后1、3和6 m生存率分别为90.9%(10/11)、72.7%(8/11)和63.6%(7/11);客观有效率(ORR)分别为70%、75%和71.4%;术后并发症主要有疼痛(100%)、恶心呕吐(73%)和发热(54.5%),其中2例分别于GSMs-TACE术后第10 d和30 d行外科手术切除肿瘤。结论 GSMs-TACE治疗肝癌自发性破裂出血安全有效,即能达到立即有效止血的目的,还能够提高患者近期生存率,为后续治疗创造有利条件。

关键词: 肝细胞癌, 经导管肝动脉化疗栓塞, 明胶海绵微粒, 自发性破裂, 止血

Abstract: Objective To retrospectively analyze the safety and efficacy of transarterial chemoembolization (TACE) by using gelatin sponge microparticles(GSMs) in different diameters in patients with spontaneous rupture of hepatocellular carcinoma(HCC). Methods From August 2010 to December 2013,11 patients with spontaneous rupture of HCC received GSMs-TACE in Zhongshan Hospital Affiliated to Dalian University. CT scanning and determination of serum AFP levels were performed 1,3 and 6 months after initial GSMs-TACE,and tumor response was evaluated according to mRECIST 1.1 criteria and AFP levels. Results The 11 patients after GSMs-TACE were Followed-up for 1 to 6 months with a mean range of 5 months. 11 patients receiving GSMs-TACE achieved successful rapid hemostasis without technique-related complications;the survival rates at 1,3 and 6 month(s) were 90.9% (10/11),72.7% (8/11) and 63.6% (7/11),respectively,and the Objective effective rates were 70.0%,75.0%,71.4%,respectively;the postoperative complications mainly included local pain(100%),nausea and vomiting (73.0%),fever(54.5%);two patient received hepatectomy 10 days and 30 days after GSMs-TACE,respectively. Conclusion TACE using GSMs of different diameters is safe and effective for patients with spontaneous rupture of HCC in the purpose of achieving hemostasis,improving survival rates and even getting the subsequent surgical operation.

Key words: Hepatocellular carcinoma, TACE, Gelatin sponge microparticles, Spontaneous rupture, Hemostasis