急诊肝动脉栓塞治疗肝癌自发性破裂出血42例病例分析

Analysis of 42 cases of emergency transcatheter arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma

目的探讨急诊肝动脉栓塞治疗肝癌自发性破裂出血的安全性及可行性。方法回顾性分析重庆市急救医疗中心肝胆外科在2015年1月—2018年12月行急诊肝动脉栓塞止血治疗42例肝癌自发性破裂出血患者的病例资料,其中男性35例,女性7例,年龄28~78岁,平均年龄51岁。分析其治疗过程,观察插管成功率、术后死亡情况及术后并发症。结果所有患者术中均成功插管,术后好转出院40例,术后1个月内死亡1例(出血量大),1个月后死亡1例(弥漫性肝癌、肝功能衰竭),并发肝肾功能衰竭3例,其中2例积极治疗后好转。结论急诊肝动脉栓塞具有创伤小、手术时间短、术后并发症少、止血效果好等优点,在急诊条件下增加了患者的生存率,为后续肿瘤治疗奠定了基础,在临床工作中应该值得推广。

Objective To investigate the safety and feasibility of emergency transcatheter arterial embolization in the treatment with spontaneous rupture of hepatocellular carcinoma. Methods The data of 42 patients with spontaneous rupture of hepatocellular carcinoma who were treated by emergency transcatheter arterial embolization from January 2015 to December 2018 in Department of Hepatobiliary Surgery of Chongqing Emergency Medical Center were collected. There were 35 males and 7 females, aged 28-78 years, with an average age of 51 years. The success rate of intubation, postoperative mortality and postoperative complications were observed. Results All patients were successfully intubated, 40 cases improved and discharged, 1case died within 1 month after operation, who with large amount of bleeding, 1 case died after 1 month, who with diffused liver cancer and liver failure, 3 cases were complicated liver or kidney failure, in whom 2 cases improved after active treatment. Conclusion Emergency transcatheter arterial embolization has the advantages of less trauma, short operation time, less postoperative complications and good hemostatic effect, which can increase the survival rate of patients under emergency conditions and lay a foundation for subsequent tumor treatment, it should be popularized in clinical work.