CalliSpheres载药微球栓塞治疗原发性肝细胞癌自发性破裂出血的有效性及安全性

Efficacy and safety of CalliSpheres drug-eluting bead embolization for treating spontaneous rupture and hemorrhage of primary hepatocellular carcinoma

目的观察CalliSpheres载药微球治疗原发性肝细胞癌(PHC)自发性破裂出血的有效性及安全性。方法对23例PHC自发性破裂出血患者以CalliSpheres载药微球(加载表柔比星)予以栓塞,之后酌情行TACE或靶向治疗等;监测心率、血压及血红蛋白,以判断止血效果;统计术中及术后不良反应及并发症发生率;于栓塞前及栓塞后3天、1个月检测肝功能。随访12个月,绘制K-M生存曲线,统计术后1、3、6、12个月生存率。结果23例均顺利完成治疗,未见相关不良反应。栓塞后6 h心率较术前下降(P=0.001),血压及血红蛋白保持稳定未再下降,表明有效止血。栓塞后1~2天,17例出现轻微发热、恶心、呕吐、腹痛等栓塞综合征,经对症处理后均缓解;未见肝、肾衰竭及肝性脑病、胆道感染等严重并发症。栓塞后3天谷丙转氨酶(GPT)、谷草转氨酶(GOT)及总胆红素(TBil)均高于栓塞前及栓塞后1个月(P均<0.05),栓塞后1个月与栓塞前差异均无统计学意义(P均>0.05);各时间点白蛋白(ALB)差异无统计学意义(P>0.05)。栓塞后随访1~12个月,未见再次出血。栓塞后1、3、6及12个月,患者生存率为分别100%、82.61%、69.57%及56.52%。结论CalliSpheres载药微球栓塞治疗PHC自发性破裂出血的有效性及安全性均较好。

Objective To observe the efficacy and safety of CalliSpheres drug-eluting bead embolization for treating spontaneous rupture and hemorrhage of primary hepatocellular carcinoma(PHC).Methods Totally 23 PHC spontaneous rupture and hemorrhage patients underwent CalliSpheres drug-eluting bead(loaded epirubicin)embolization and TACE or targeted therapy,etc.Patient's heart rate,blood pressure and hemoglobin were monitored to judge the hemostatic effect of embolization,while the adverse reactions and complications during and after embolization were counted,and indexes of liver function were detected before,3 days and 1 month after embolization,respectively.During following-up,K-M survival curve was drawn,and the survival rate at 1,3,6 and 12 months after embolization were calculated.Results All 23 patients successfully completed embolization without adverse reaction.Six hours after embolization,the heart rate decreased compared with that before embolization(P=0.001),blood pressure and hemoglobin remained stable,indicating effective hemostasis.Mild fever,nausea,vomiting,abdominal pain and other symptoms of embolism syndrome were observed in 17 cases 1—2 days after embolization,but all relieved after symptomatic treatment.No serious complication such as liver and kidney failure,hepatic encephalopathy nor biliary tract infection occurred.The levels of glutamic-pyruvic transaminase(GPT),glutamic-oxaloacetic transaminase(GOT)and total bilirubin(TBil)3 days after embolization were higher than those before and 1 month after embolization(all P<0.05),while significant difference was found before and 1 month after embolization(all P>0.05).There was no statistical significance of albumin(ALB)between at each 2 time points(all P>0.05).The patients were follow-up of 1 to 12 months,no tumor rupture nor bleeding recurred.The 1-month,3-month,6-month and 12-month survival rate was 100%,82.61%,69.57%and 56.52%,respectively.Conclusion CalliSpheres drug-eluting bead embolization was effective and safe for treating spontaneous rupture hemorrhage of PHC.