摘要： 目的 探讨急诊经肝动脉栓塞(TEA)治疗肝细胞癌(HCC)自发性破裂出血的临床疗效及其预后的影响因素。方法 回顾性分析2015年1月至2019年6月我院急诊就诊的48例HCC自发破裂出血并接受TAE治疗患者的临床资料,采用Kaplan-Meier法统计生存率,Cox回归分析预后的影响因素。结果 48例均止血成功。术后30 d内5例死亡(3例死于肝功能衰竭,1例死于肝肾综合征,1例死于肿瘤破裂再出血)。6个月、1年和2年总生存率分别为63.0%、45.3%、20.4%。Cox回归分析显示肿瘤大小(≥ 10cm)、Child-Pugh分级(C级)、门静脉癌栓、入院时休克是预后不良的影响因素(均P<0.05)。结论 急诊TAE治疗HCC自发性破裂出血疗效显著,止血成功率高,延长了患者的生存时间,可作为首选治疗方式。肿瘤大小≥ 10 cm、Child-Pugh分级C级、门静脉癌栓、入院时休克与预后不良相关。

急诊经肝动脉栓塞治疗肝细胞癌自发性破裂出血的临床疗效及预后的影响因素

孙骏, 肖亮, 宋健博

中国医科大学附属第四医院介入科, 沈阳 110032

收稿日期:2019-12-13出版日期:2020-06-30发布日期:2020-06-15
通讯作者:宋健博E-mail:jianbosong@cmu.edu.cn
作者简介:孙骏(1990-),男,医师,硕士.
基金资助:国家自然科学基金（81471763）


关键词: 急诊, 经肝动脉栓塞, 肝细胞癌, 自发性破裂出血, 疗效, 预后
Abstract: Objective To investigate the clinical efficacy and prognostic factors of emergency transhepatic arterial embolization(TAE) in the treatment of spontaneous rupture and bleeding of hepatocellular carcinoma(HCC). Methods We conducted a retrospective analysis of the clinical data of 48 patients with spontaneous rupture and hemorrhage of HCC,who received TAE treatment from January 2015 to June 2019 in our hospital. The Kaplan-Meier estimator was used to calculate survival rate,and Cox regression was used to analyze the prognostic factors. Results All 48 patients had successful hemostasis. Within 30 days after surgery,5 died(3 of liver failure, 1 of hepatorenal syndrome,and 1 of tumor rupture followed by bleeding). The 6-month,1-year,and 2-year overall survival rates were 63.0%,45.3%,and 20.4%,respectively. Cox regression analysis showed that tumor size ≥ 10 cm,Child-Pugh grade C,portal vein tumor thrombus,and shock at admission were influential factors for poor prognosis(all P<0.05). Conclusion Emergency TAE is effective in treating spontaneous rupture and hemorrhage of HCC,and has a high success rate of hemostasis,which prolongs the survival time of patients and can be adopted as the preferred treatment. Tumor size ≥ 10 cm,Child-Pugh grade C,portal vein tumor thrombus,shock at admission were associated with poor prognosis.
Key words: emergency, transhepatic arterial embolization, hepatocellular carcinoma, spontaneous rupture and bleeding, treatment effect, prognosis
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