原发性肝癌TACE术后严重并发症原因及预防

Causes and prevention of serious complication after transcatheter arterial chemoembolization for primary hepatic carcinoma

目的探讨原发性肝癌行经导管肝动脉化疗栓塞术后严重并发症的原因及预防。方法2005年1月-2007年7月,573例原发性肝癌患者行1252次肝动脉化疗栓塞术,术后针对发生的并发症,给予积极治疗,同时结合生化及影像学检查,探讨严重并发症出现的原因及预防措施。结果并发症有上消化道出血3例、急性肝功能衰竭6例(死亡1例)、肺栓塞1例、胆汁瘤2例、胆囊炎4例、胃穿孔并死亡1例。结论经导管肝动脉化疗栓塞术治疗原发性肝癌出现的严重并发症与术前肝功能较差、门静脉高压、化疗栓塞药物剂量过大、药物反流及异位栓塞等有关。重视TACE术时机的选择,采用规范化的介入治疗措施,可以避免或减少严重并发症。

Objective To analyze the etiological factors and prevention of serious complications after transcatheter arterial chemoembolization （TACE） for primary hepatic carcinoma（PHC）. Methods A consecutive group of 573 patients with PHC received a total of 1252 TACE procedures form January 2005 to July 2007. All patients with complication were treated intensively together with imaging and biochemical examinations, in order to study the causes and preventive measures of the serious complications. Results After all, the record revealed 3 cases of upper gastrointestival hemorrhage, 6 cases of acute hepatic failure with one death, 1 case of pulmonary embolism, 4 cases of cholecystitis; 2 cases of intrahepatic biloma and one died for gastric perforation. Conclusions Severe complication with TACE for PHC might be caused by existed poor liver function, portal hypertension, high dose of the chemotherapeutic agent, drug reflux or ectopic embolism etc. So to comply with evidence-based medicine priciples, select the appropriate period for TACE, and use of standardized measures of intervention therapy are essential for preventing and reducing the occurrence of the serious complications.