原发性肝癌肝动脉化疗栓塞后严重肝功能失代偿的相关因素分析

Analysis of factors related to severe hepatic dysfunction after transcatheter arterial chemoembolization in patients with primary hepatic carcinoma

目的探讨原发性肝癌(PHC)患者行肝动脉化疗栓塞(TACE)后发生严重肝功能失代偿的相关因素。方法回顾性分析TACE治疗PHC 284例,总结严重肝功能失代偿与PHC患者年龄、肝硬化情况、TACE治疗次数、肿瘤类型和门静脉分支癌栓的相关性。结果284例PHC患者TACE术后发生严重肝功能失代偿者39例,其中60岁以上者占74.4%;有肝硬化或TACE治疗2次以上病例的发生率显著高于无肝硬化或TACE治疗1次病例(P<0.005),巨块型PHC患者的发生率显著高于结节型和块状型中非巨块型者(P<0.01),门静脉分支癌栓和无门静脉癌栓PHC患者经TACE治疗后严重肝功能失代偿发生率无显著性差异,而门静脉主干癌栓形成者的发生率显著高于无门静脉癌栓者(P<0.05)。结论老年、有肝硬化基础、TACE治疗2次以上、巨块型PHC和门静脉主干癌栓的PHC,TACE术后严重肝功能失代偿发生率高。

Objective To investigate the relative risk factors of severe hepatic dysfunction after transcatheter arterial chemoembolization （TACE） in patients with primary hepatic carcinoma （PHC）. Methods TACE was performed in 284 patients with PHC, the relationship between severe hepatic dysfunction after TACE and clinicopathological characteristics including age, accompanied with the basic of liver cirrhosis, number of TACE courses,tumor type and portal vein tumor thrombosis, were summarized. Results Among the 284 patients with PHC after TACE ,39 cases presented severe hepatic dysfunction,and 74.4% were older than 60 years of age. The incidence of severe hepatic dysfunction was significantly higher in the patients with the basis of liver cirrhosis and after more than two times of TACE than that without the basis of liver cirrhosis and two or less than two times of TACE（P 〈 0. 005 ）. The incidence of severe hepatic dysfunction in huge massive type of PHC was significantly higher than nodular and not huge massive type （P 〈 0.01 ）. There was no significant difference in the PHC with the portal vein branch tumor thrombosis and that without the portal vein branch tumor thrombosis, whereas the incidence of severe hepatic dysfunction was significantly higher in the patients with the main portal vein tumor thrombosis （P 〈 0.05 ）. Conclusion The incidence of severe hepatic dysfunction for PHC after TACE occurrs more commonly in the elder patients, accompanied with the basis of liver cirrhosis, more than two times treatments, huge massive type of PHC and the main portal vein thrombosis.