明胶海绵与Embosphere栓塞微球在介入治疗肝癌破裂出血有效性及安全性的对比分析

Comparative analysis of efficacy and safety of gelatin sponge particle and Embosphere microsphere in interventional treatment of rupture and hemorrhage of hepatocellular carcinoma

目的对比分析碘化油+明胶海绵颗粒与碘化油+Embosphere栓塞微球在介入治疗肝癌破裂出血临床有效性及安全性。方法收集2016年5月至2019年5月对56例肝癌破裂出血患者采用Seldinger技术穿刺股动脉行肝动脉超选择性栓塞止血。其中34例采用碘化油+明胶海绵颗粒栓塞(明胶海绵组),22例采用碘化油+Embosphere栓塞微球栓塞(微球组),术后结合患者心率、血压、血红蛋白判断止血疗效;监测肝功能评估栓塞止血安全性。结果56例肝癌破裂出血患者行急诊肝动脉栓塞后,术后心率较前下降,血压得到控制,动态复查血红蛋白未再下降,止血成功率100%。明胶海绵组中,2例(占5.88%)栓塞术后1周内再次复发活动性出血(经再次造影使用Embosphere栓塞微球出血得以控制);微球组未见复发出血。与术前相比,明胶海绵组栓塞术后谷丙转氨酶、胆红素均有不同程度升高(6例胆红素升至51μmol/L以上),差异有统计学意义(t=2.689,P<0.05;t=3.976,P<0.05);微球组中,术后肝功能与术前比较差异无统计学意义(P>0.05)。两组之间术后谷丙转氨酶、总胆红素差异有统计学意义(t=3.368,P<0.05;t=4.133,P<0.05),白蛋白差异无统计学意义。结论肝癌破裂出血使用碘化油+明胶海绵颗粒和碘化油+Embosphere栓塞微球作为栓塞剂具有同等的即时止血效果,但Embosphere栓塞微球与明胶海绵颗粒相比,再次出血风险相对低,且安全性较高,值得临床应用。

Objective To compare the efficacy and safety of iodinated oil plus gelatin sponge particle and iodinated oil plus Embosphere microsphere embolization in treatment of patients with spontaneous rupture and hemorrhage of hepatocellular carcinoma.Methods The Seldinger technique was used to puncture femoral artery and super-selective embolization was performed in 56 patients with rupture and hemorrhage of hepatocellular carcinoma.Thirty-four cases were embolized by iodized oil plus gelatin sponge particles(gelatin sponge group)and 22 cases were embolized by iodized oil plus Embosphere microsphere(microsphere group).The effect of hemostasis was judged by assessing the patient’s heart rate,blood pressure and hemoglobin.Liver function was monitored to evaluate the safety of hemostasis by embolization.Results After emergency hepatic artery embolization for 56 patients with rupture and hemorrhage of hepatocellular carcinoma,the heart rate decreased and blood pressure was controlled after the operation,and the hemostatic success rate was 100%.In the gelsponge group,2 cases(5.88%)had recurrent active bleeding within 1 week after embolization(the bleeding was controlled by microsphere embolization).No recurrent bleeding was observed in the embolization group.Compared with pre-operation,transaminase and bilirubin increased after embolization in gelfoam group(bilirubin increased to more than 51μmol/L in 6 cases),and the difference was statistically significant(P<0.05).There was no statistically significant difference in liver function postoperatively in microsphere group(P>0.05).There were statistically significant differences in ALT and TBil after operation(P<0.05),but no statistically significant differences were found in albumin between the two groups.Conclusion Oil iodide plus gelatin sponge particles and oil iodide plus Embosphere microspheres can be used as embolization agents for hepatocellular carcinoma rupture and hemorrhage with the same immediate hemostasis effect.However,compared with gelatin sponge particles,Embosphere microspheres have a relatively low risk of re-bleeding and a relatively high safety,so it is worthy of clinical application.