巨块型肝细胞癌c-TACE术后并发肿瘤溶解综合征早期诊断及其策略研究

Early diagnosis and operational reserarch of tumor lysis syndrome after c-TACE operation for massive hepatocellular carcinoma

目的:探讨肿瘤溶解综合征(tumor lysis syndrome,TLS)在原发性巨块型肝细胞癌患者传统肝动脉栓塞化疗术(conventional transcatheter hepatic arterial chemoembolization,c-TACE)手术后临床特点、早期诊断及其治疗策略。方法:收集2016年8月―2021年5月收治的11例原发性巨块型肝细胞癌c-TACE术后并发肿瘤溶解综合征患者的临床资料并作回顾性分析。结果:11例患者均于手术开始72 h内发生TLS,出现高尿酸血症11例(100%)、高钾血症9例(81.8%)、高磷血症8例(72.7%)、低钙血症4例(36.3%)、肌酐升高4例(36.3%),11例乳酸脱氢酶均升高,主要临床表现有恶心呕吐、胸闷喘憋、尿量减少、水肿、手足抽搐,多数患者经过及时补液水化、降尿酸、纠正电解质紊乱及血液透析等治疗后,异常指标大多在1周内恢复正常范围;1例未经治疗死亡;1例因并发急性肾功能衰竭、凝血功能异常、颅内出血死亡。结论:原发性肝癌患者c-TACE术后初期容易并发TLS,TLS是一种高度致死性疾病,治疗过程中需严密监测血电解质、尿酸、肾功能等实验室指标,如果能及时诊断并采取有效的治疗措施,可减少TLS发生并降低其死亡率。

Objective To investigate the clinical early diagnosis and operational reserarch of tumor lysis syndrome(TLS)after c-TACE operation on patients with primary massive hepatocellular carcinoma.Methods The clinical data of 11 patients with primary massive hepatocellular carcinoma c-TACE complicated by tumor lysis syndrome operation from August 2016 to May 2021 were collected for retrospective analysis.Results All the 11 patients developed TLS within 72h after operation,accompanied by hyperuricemia in 11 cases(100%),hyperkalemia in 9 cases(81.8%),hyperphosphatemia in 8 cases(72.7%),hypocalcaemia in 4 cases(36.3%),increased creatinine in 4 cases(36.3%),and elevated lactate dehydrogenase in 11 cases.The main clinical manifestations are nausea,vomiting,chest tightness,wheezing,reduced urine volume,edema,tetany,most patients after timely replenishing hydration,correcting electrolyte disorders,reducing uric acid,hemodialysis and other treatment,abnormal indicators are most restored to the normal range within 1 week;One case died without treatment;One case died of acute renal failure,abnormal coagulation function and intracranial hemorrhage.Conclusion Patients with massive hepatocellular carcinomar are prone to TLS in the early postoperative period of c-TACE,TLS is a highly fatal disease,and laboratory indicators such as blood electrolytes,uric acid,renal function and urine output should be closely monitored during treatment.If diagnosed in time and effective therapeutic measures are implemented,the incidence of TLS and mortality can be reduced.