Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Oncologist. 2012;17(5):725-31. doi: 10.1634/theoncologist.2011-0372. Epub 2012 Apr 17.
There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors.
Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging.
In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins.
The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patients could exclusively receive oral analgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.
目前针对肝动脉栓塞（HAE）治疗后患者的管理缺乏循证医学证据。我们研究了转移性神经内分泌肿瘤患者接受 HAE 治疗后住院时间（LOS）、实验室指标、药物使用、发病率和死亡率。
我们回顾性地从电子病历中提取 LOS、肝功能检查（LFTs）、静脉用抗生素、镇痛药、峰值体温、菌血症、肝脓肿形成、类癌危象和影像学上转移瘤负荷等数据。
2005 年至 2009 年，72 例患者接受了 174 次 HAE 治疗类癌和胰岛细胞瘤。中位 LOS 为 4 天（范围 1-8 天）。峰值 LFTs 与肿瘤负荷之间无相关性。出院前 LFTs 的下降并不均匀；25%、37%、30%、53%和 67%的患者分别在其天冬氨酸转氨酶、丙氨酸转氨酶、碱性磷酸酶和总胆红素及直接胆红素水平开始下降之前出院，没有因急性肝衰竭再入院。静脉用阿片类镇痛药的中位剂量为 60mg 口服吗啡当量（范围 3-1961mg）。99%的患者在 HAE 前使用静脉用抗生素；37%的患者在 HAE 后出现发热，无明确的菌血症。1 例患者在 HAE 后发生肝脓肿。发生了 2 例类癌危象。唯一的院内死亡与门静脉积气有关。
HAE 后住院治疗的持续时间和强度应根据个体情况进行管理。在出院前不需要出现 LFTs 的下降趋势。静脉用镇痛药的使用量适中，表明许多患者可以单独使用口服镇痛药。鉴于严重并发症罕见，住院时间可以缩短，从而降低成本和医院感染风险。
