肝癌TAE治疗后上消化道出血的预防

The prevention of gastroduoduenal bleeding caused by transcatheter hepatic artery chemoembolization for patient with primary liver carcinoma

目的：探讨肝癌病人TAE治疗后上消化道出血的主要原因和预防方法。方法：73例肝癌患者行首次TAE治疗，观察TAE治疗后10天内上消化道出血的发生情况。治疗组33例，TAE术后持续用奥美拉唑（洛赛克）5天。对照组40例，不用奥美拉唑等抗酸剂。结果：73例TAE后共8例出现上消化道出血（11．0％），其中治疗组1例（3．0％）；对照组7例（15．9％），差异有显著性。TAE术中，有13例Lipiodol反流至胃十二指肠，其中3例出现胃十二指肠出血，发生率23．1％，60例无Lipiodol反流至胃十二指肠，其中5例出现胃十二指肠出血，发生率仅8．3％。结论：TAE时尽量避免化疗栓塞物质返流至胃十二指肠营养血管，TAE后按常规使用奥美拉唑，可以减少上消化道出血的发生。

Objective: TO study how to prevent gastroduodenal bleeding caused by transcatheter hepatic artery c hemoemboli zation (TA E ) for pat ie ms wit h pri mary live carcinoma. Methods: The patient swith TA E traetment in this study was divided into two coups. There was 33 cases in group A, in which hosec(omeprazole －－ Astra) was given for 5 deys after TAE. There was 40 cases in group B, in which tosec was not given after TAE. Results: 8 cases was noticed with gastroduodenal bleeding resulted from TAE (8/73, 11. 0% ), in which 3 cases was in group A (3. 0% )and 7 in group B(15. 9% ). The difference Of the incidences between group A and group B was significant different During TAE, llpiodol was found to enter the gastroduodenal artey and/or right gastric artery in 13 cases(group C), in which 3 cases were noticed with gastrodudenal bleeding with the incidence rate of 23. 1%. In remaining 60 cases with no Lipiodol entering these arteries(group D), only 5 cases were associated with gastroduodenal bleeding with the incidence rate of only 8. 3%. Conclusions: In order to prevent the gastnducxlenal bleeding resulted rfom TAE, we should avoid Lipiodol entering the gastroduodenal artery and/or right gaStric artery and to give tosec to patients after TAE for 5 consecutive days.