纤维蛋白原联合血管介入技术治疗肝癌破裂出血的临床研究

Clinical study of fibrinogen combined with vascular interventional technique in the treatment of rupture and hemorrhage of liver cancer

目的探讨采用介入治疗联合纤维蛋白原治疗肝癌破裂出血的止血效果.方法收集2015年3月~2018年5月在本院诊断为肝癌破裂出血且接受介入治疗的原发性肝癌破裂出血患者49例,将其分为实验组(纤维蛋白原+明胶海绵栓塞)26例和对照组(单纯碘油栓塞)23例;分析其止血效果、实验室检查及转归情况.结果实验组和对照组即时止血率均为100.0%;实验组术后1周内再次出血率为3.8%(1/26),对照组术后1周内再次出血率为13.0%(3/23);两组患者均有心率加快,血压下降,血红蛋白降低等表现,但两组间无明显差异(P>0.05);两组患者瘤体直径大小无明显统计学差异(P>0.05);两组患者术前肝功能相关指标无显著性差异(均P>0.05),术后比较,实验组ALT、AST和TBIL明显低于对照组(均P<0.05),而ALB的变化与对照组无显著性差异(P>0.05).结论与传统单纯碘油栓塞相比,纤维蛋白原联合明胶海绵颗粒介入治疗肝癌破裂出血的再次出血发生率低,对患者肝功能影响较小,临床疗效显著,值得临床推广.

Objective To explore the hemostasis effect of interventional therapy combined with fibrinogen for hemorrhage of liver cancer. Methods 49 patients with primary liver cancer rupture and hemorrhage diagnosed in our hospital from March 2015 to May 2018 were collected and divided into experimental group (fibrinogen+gelatin sponge embolization) of 26 cases, and control group (lipiodol embolization) of 23 cases;the hemostasis effect, laboratory examination results and patients' outcome were analyzed. Results The immediate hemostasis rate of the experimental group and the control group was 100.0%;the rebleeding rate was 3.8%(1/26) in the experimental group within 1 week after operation, and the rebleeding rate was 13.0%(3/23) in the control group within 1 week after operation. Both groups had higher heart rate, lower blood pressure, and decreased hemoglobin, but there was no significant difference between the two groups(P>0.05). There was no significant difference in tumor diameter between the two groups(P>0.05). There were no significant differences in preoperative liver function related indexes(P>0.05). After operation, ALT, AST and TBIL in the experimental group were significantly lower than those in the control group(both P<0.05), but the change of ALB was not significant compared with that of the control group (P>0.05). Conclusion Compared with the traditional simple lipiodol embolization, fibrinogen combined with gelatin sponge particles for the treatment of hepatocellular carcinoma rupture and bleeding has a low incidence of rebleeding, has little effect on liver function, and has significant clinical efficacy, which is worthy of clinical promotion.