经皮肝穿刺胃冠状静脉栓塞术联合肝动脉化疗栓塞术治疗肝癌合并门静脉高压致上消化道出血的临床效果

Clinical Efficacy of Percutaneous Transhepatic Coronary Vein Embolization Combined with Transcatheter Arterial Chemoembolization in Treatment of Patients with Liver Cancer Complicated by Upper Gastrointestinal Bleeding Caused by Portal Hypertension

目的评价经皮肝穿刺胃冠状静脉栓塞术(PTVE)联合肝动脉化疗栓塞术(TACE)治疗肝癌合并门静脉高压致上消化道出血的安全性及有效性。方法回顾性分析2014年1月—2018年10月30例肝癌合并门静脉高压致上消化道出血的临床资料,均行PTVE联合TACE治疗。观察PTVE术后止血成功率及出血复发率,评估TACE术后不同时间的疗效、生存率及肝功能变化情况,观察PTVE和TACE术后不良反应及并发症情况。结果PTVE止血成功率100%,术后1和2年出血复发率分别为13.3%和20.0%。TACE术后1、3和6个月疾病缓解率分别为83.3%、70.0%和60.0%,疾病控制率分别为93.3%、76.7%和63.3%。随访6、12和24个月生存率分别为90.0%、67.7%和50.0%。TACE术后3 d谷氨酸转氨酶及天冬氨酸转氨酶较术前升高(P<0.05),但术后14 d逐步恢复,与术前比较差异无统计学意义(P>0.05)。TACE术前、术后3和14 d白蛋白及总胆红素比较差异无统计学意义(P>0.05)。PTVE和TACE术后无相关并发症发生,无围术期死亡;术后主要不良反应为发热、恶心呕吐和腹痛。结论PTVE可有效降低肝癌合并门静脉高压致上消化道出血的复发率,PTVE联合TACE治疗安全有效,可显著提高患者的生活质量,延长生存期。

Objective To evaluate clinical efficacy of percutaneous transhepatic coronary vein embolization(PTVE)combined with transcatheter arterial chemoembolization(TACE)in treatment of patients with liver cancer complicated by upper gastrointestinal bleeding caused by portal hypertension.Methods Clinical data of 30 patients with liver cancer complicated by upper gastrointestinal bleeding caused by portal hypertension between January 2014 and October 2018 was retrospectively analyzed,and all patients received PTVE combined with TACE.The hemostasis success rate and bleeding recurrence rate after PTVE were observed,and clinical efficacy,survival rate and liver function changes at different time points after TACE were evaluated.Adverse reactions and complications after treatment of PTVE and TACE were also observed.Results The success rate of hemostasis for PTVE was 100%,and the bleeding recurrence rates after surgery for 1 and 2 years were 13.3%and 20.0%respectively.After TACE for 1,3,and 6 months,disease remission rates were 83.3%,70.0%and 60.0%respectively,while disease control rates were 93.3%,76.7%and 63.3%respectively.The survival rates after follow-up for 6,12 and 24 months were 90.0%,67.7%and 50.0%respectively.Levels of glutamate transaminase and aspartate aminotransferase were significantly increased after TACE for 3 d compared with those before operation(P<0.05),but the levels gradually recovered after operation for 14 d,which showed no statistically significant difference as compared with those before operation(P>0.05).There were no significant differences in levels of albumin and total bilirubin before and after TACE for 3 and 14 d(P>0.05).There were no related complications and no perioperative death after PTVE and TACE.The main adverse reactions after operation were fever,nausea and vomiting,and abdominal pain.Conclusion PTVE may effectively reduce the recurrence rate of liver cancer complicated by upper gastrointestinal bleeding caused by portal hypertension.PTVE combined with TACE is safe and effective,which may significantly improve quality of life and prolong the survival period of patients.