肝癌热消融出血并发症的多因素分析

发布时间：2018-05-28 21:55

  本文选题：肝癌 + 热消融　； 参考：《天津医科大学》2016年硕士论文

【摘要】：研究背景和目的:近些年,在影像引导下局部热消融治疗原发性肝癌(Primary liver carcinoma,PLC)及继发性肝癌(Metastatic liver carcinoma,MLC)已在全球范围内得到广泛的应用。肝癌的热消融是一种安全、微创、有效的方法,是肿瘤非手术医治的重要突破,已变为继肝移植和肝切除后第三种能达到根治性治疗原发性肝癌的方法,而且对于手术无法切除的中晚期肝癌患者,局部热消融也可成为一种重要的保守性治疗方法。术后出血是肝癌热消融治疗的主要并发症之一,本研究旨在对肝癌热消融治疗出血并发症的相关因素进行多因素分析,并进一步探讨防治措施。资料和方法:2002年1月至2014年12月,天津市第三中心医院对1797例病人实施了2356例次热消融治疗,其中男性1362例,女性435例,年龄24-91岁,平均(58.9±9.7)岁,其中PLC 1614例、MLC 183例。PLC由病理和(或)临床确定诊断,诊断标准满足我国卫生部PLC诊疗规范(2011年版);MLC有确切的原发病灶,由两种或以上的强化影像学方法及肿瘤标志物诊断。入选标准:肿瘤最大直径≤6.0 cm,数量≤5个,无肝内主干胆道、主干血管及下腔血管浸润为原则。本研究回顾性总结病人相关的临床信息,对发生出血并发症的相关因素作多因素分析并总结防治措施。本研究采用SPSS 20.0统计工具,应用单因素分析对可能导致热消融出血的相关因素:性别、年龄、病灶类别、病灶数目、病灶直径、病灶位置、热消融次数、术前是否行TACE、血小板数值、凝血酶原时间、肝功能Child-Pugh分级、肝周腹水进行统计学分析,有统计学意义者进行多因素分析,从而选出导致热消融出血并发症的高危因素。P0.05为差异有统计学意义。结果:1797例患者共3200个肿瘤行2356例次热消融治疗,射频消融(Radiofrequency ablation,RFA)治疗547例次,微波消融(Microwave ablation,MWA)治疗1809例次。治疗后共有18例患者出现了出血,发生率为0.76%,严重出血6例,发生率0.25%(6/2356);轻微出血12例,发生率0.51%(12/2356)。多因素Logistic回归分析结果显示:凝血功能障碍(PLT50×109/L、PT18s)、肿瘤邻近血管以及肝功能Child B级可导致出血的风险增加。结论肝癌热消融出血并发症发生率低,但大量出血非常凶险,处理不当可危及生命。当患者具有凝血功能障碍(PLT50×109/L、PT18s)、肿瘤邻近血管以及肝功能Child-Pugh B级高危因素时应做好预防措施,有助于加强热消融治疗的安全系数。
[Abstract]:Background and objective: in recent years, primary liver carcinoma (PLCs) and secondary hepatocellular carcinoma (HCC) have been widely used in the treatment of primary liver carcinoma under the guidance of local thermal ablation. Thermal ablation of liver cancer is a safe, minimally invasive and effective method. It is an important breakthrough in non-surgical treatment of tumor. It has become the third method to achieve radical treatment of primary liver cancer after liver transplantation and hepatectomy. Local thermal ablation may also be an important conservative treatment for patients with advanced liver cancer who can not be resected surgically. Postoperative hemorrhage is one of the main complications in the treatment of liver cancer by thermal ablation. The purpose of this study was to analyze the factors related to the complications of heat ablation for liver cancer and to further explore the preventive and therapeutic measures. Materials and methods: from January 2002 to December 2014, 2356 patients (1362 male and 435 female, aged 24-91 years, mean 58.9 卤9.7 years) were treated with thermal ablation in Tianjin third Central Hospital. 1614 cases of PLC were confirmed by pathology and / or clinical diagnosis. The diagnostic standard met the standard of PLC diagnosis and treatment of Ministry of Health of our country. (2011 edition of PLC has definite primary lesion, diagnosed by two or more enhanced imaging methods and tumor markers. Inclusion criteria: the maximum diameter of tumor 鈮，

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