肝硬化 Child-Pugh C 级患者的自发破裂性肝细胞癌是否适合急诊经导管肝动脉栓塞术？

Is Emergency Transcatheter Hepatic Arterial Embolization Suitable for Spontaneously Ruptured Hepatocellular Carcinoma in Child-Pugh C Cirrhosis?

机构信息

Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou 510080, People's Republic of China.

Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou 510080, People's Republic of China.

出版信息

J Vasc Interv Radiol. 2018 Mar;29(3):404-412.e3. doi: 10.1016/j.jvir.2017.09.022. Epub 2017 Dec 14.

DOI:10.1016/j.jvir.2017.09.022

PMID:29249595

Abstract

PURPOSE

To evaluate the utility of emergent transcatheter arterial embolization for spontaneously ruptured hepatocellular carcinoma (HCC) in patients with Child-Pugh class C (CPC) liver cirrhosis presenting hemorrhagic shock.

MATERIALS AND METHODS

A study of all 94 patients was retrospectively conducted from January 2006 to January 2016. Sixty patients underwent conservative treatment (control group) and 34 underwent embolization.

RESULTS

Embolization provided better stabilization of hemodynamic status than conservative treatment (91.2% vs 61.7%), with greater overall survival (OS) rates at 30, 60, and 120 days (73.5%, 52.9%, and 29.4% vs 33.3%, 13.3%, and 0%, respectively). Mean follow-up duration was 51.07 days (range, 3-237 d). Median survival time was longer for the embolization group than the control group, specifically for patients with a shock index (SI) of ≥ 0.6 to < 1 (106.0 d ± 39.4 vs 34.0 d ± 4.7) or ≥ 1 (18.0 d ± 7.5 vs 11.0 d ± 3.2), those with CPC scores 10 or 11 (88.0 d ± 29.4 vs 28.0 d ± 4.5), and those with segmental (165.0 d ± 20.6 vs 34.0 d ± 9.7) or lobar (54.0 d ± 7.9 vs 26.0 d ± 3.4) portal vein tumor thrombus (PVTT). SI ≥ 1, Child-Pugh score of 12/13, tumor size ≥ 10 cm, and PVTT were independent factors in poor prognosis for OS.

CONCLUSIONS

Emergent transcatheter arterial embolization is an effective intervention for ruptured HCC in patients with CPC liver function in hemorrhagic shock, particularly those with a SI ≥ 1, Child-Pugh scores of 10/11, and first- or lower-order PVTT.

摘要

目的

评估经导管动脉栓塞术治疗伴有 Child-Pugh 分级 C（CPC）级肝功能失代偿期的自发性破裂肝细胞癌（HCC）合并出血性休克患者的疗效。

材料与方法

回顾性分析 2006 年 1 月至 2016 年 1 月期间收治的 94 例患者的临床资料，其中 60 例患者接受保守治疗（对照组），34 例患者接受栓塞治疗。

结果

栓塞治疗在稳定患者血流动力学状态方面优于保守治疗（91.2%比 61.7%），30、60 和 120 天的总生存率（OS）更高（73.5%、52.9%和 29.4%比 33.3%、13.3%和 0%）。平均随访时间为 51.07 天（范围 3-237 天）。中位生存时间为栓塞组长于对照组，特别是休克指数（SI）≥0.6 至<1（106.0 d ± 39.4 比 34.0 d ± 4.7）或≥1（18.0 d ± 7.5 比 11.0 d ± 3.2）、CPC 评分为 10 或 11（88.0 d ± 29.4 比 28.0 d ± 4.5）、节段性（165.0 d ± 20.6 比 34.0 d ± 9.7）或叶性（54.0 d ± 7.9 比 26.0 d ± 3.4）门静脉癌栓（PVTT）患者。SI≥1、Child-Pugh 评分 12/13、肿瘤直径≥10 cm 和 PVTT 是影响 OS 预后的独立因素。