原发性肝癌患者肝动脉化疗栓塞术后肝功能失代偿的临床分析

Clinical analysis of hepatic dysfunction after transcatheter arterial chemoembolization in patients with primary liver cancer

目的分析原发性肝癌(PLC)患者行肝动脉化疗栓塞术(TACE)后肝功能失代偿的相关因素。方法回顾性分析2012年4月-2012年10月在解放军302医院住院的251例行TACE治疗的PLC患者的临床资料,应用χ2检验及Logistic回归模型分析与术后肝功能失代偿有关的相关因素。结果 251例PLC患者TACE术后40例(15.9%)发生肝功能失代偿。单因素分析结果表明,肿瘤大小、肿瘤Child-Pugh分级、血胆碱酯酶水平、有无门脉癌栓等因素与PLC患者TACE术后是否发生肝功能失代偿相关;而多因素分析结果表明,肿瘤Child-Pugh B级、肿瘤直径≥10cm及低胆碱酯酶是TACE术后发生肝功能失代偿的危险因素。结论对肿瘤直径≥10cm、Child-Pugh B级及低胆碱酯酶的PLC患者需谨慎行TACE治疗,避免术后肝功能失代偿的发生。

Objective To analyze the correlation between clinical features and hepatic dysfunction after transcatheter arterial chemoembolization （TACE） in patients with primary liver cancer （PLC）. Methods Two hundred and fifty-one PLC patients from Apr. 2012 to Oct. 2012 at 302 Hospital treated with TACE were retrospectively analyzed. x2 test and logistic regression model were used to assess the correlation between clinical features and hepatic dysfunction after TACE. Results Forty out of 251 patients （15.9%） presented with hepatic dysfunction after TACE. Univariate analysis showed that the size of tumor diameter, Child- Pugh grade, cholinesterase level and portal vein tumor thrombosis （PVTT） were associated with hepatic dysfunction after TACE in PLC patients. Multivariate analysis showed that Child-Pugh grade B, tumor diameter ≥ 10cm and low cholinesterase level were risk factors associated with hepatic dysfunction after TACE in PLC patients. Conclusion TACE should be carefully performed to avoid hepatic dysfunction in PLC patients with tumor diameter ≥ 10cm, Child-Pugh grade B and low cholinesterase level.