Nykänen Taina, Peltola Erno, Sallinen Ville, Mäkisalo Heikki, Nordin Arno, Kylänpää Leena, Udd Marianne
Department of Abdominal Surgery, Helsinki University Hospital, University of Helsinki , Helsinki , Finland.
Department of Interventional Radiology, Helsinki University Hospital , Helsinki , Finland.
Scand J Gastroenterol. 2019 Jul;54(7):917-924. doi: 10.1080/00365521.2019.1633566. Epub 2019 Jun 26.
Spontaneous hepatic tumor hemorrhage is a rare but challenging emergency especially among cirrhotic patients with poor hepatic function. This study aimed at analyzing the safety, efficacy and feasibility of transcatheter arterial embolization (TAE) in the treatment of hepatic tumor hemorrhage. This retrospective study included all patients undergoing embolization attempt for hepatic tumor hemorrhage in the Helsinki University Hospital during 2004-2017. Electronic medical records provided the study data. Outcomes included the 30-day rebleeding, complication and mortality rates, need for blood transfusions, durations of intensive care unit and hospital admissions, estimates of overall survival, and analysis of factors associated with 30-day mortality. During the study period, 49 patients underwent angiography for hepatic tumor hemorrhage. TAE was technically feasible in 45 patients (92%), and controlled the bleeding with the first attempt in 84%. The 30-day complication and mortality rates were 57 and 33%, respectively. Major complications occurred in 33% of patients. In-hospital mortality was higher among cirrhotic than non-cirrhotic patients (55 versus 7%, < .001). Patients with bleeding hepatic metastases, but no cirrhosis, had an in-hospital mortality of 0% with no major complications. Patients with benign etiology had a good prognosis and no bleeding- or tumor-related mortality. TAE is an effective method in controlling the bleeding in spontaneous hepatic hemorrhage. Underlying pathology determines the prognosis that is poor especially in cirrhotic patients with bleeding hepatocellular carcinoma.
自发性肝肿瘤出血是一种罕见但具有挑战性的急症，尤其在肝功能差的肝硬化患者中。本研究旨在分析经导管动脉栓塞术（TAE）治疗肝肿瘤出血的安全性、有效性和可行性。这项回顾性研究纳入了2004年至2017年期间在赫尔辛基大学医院接受肝肿瘤出血栓塞治疗尝试的所有患者。电子病历提供了研究数据。结果包括30天再出血率、并发症和死亡率、输血需求、重症监护病房和住院时间、总生存率估计以及与30天死亡率相关的因素分析。在研究期间，49例患者因肝肿瘤出血接受了血管造影。TAE在45例患者（92%）中技术上可行，84%的患者首次尝试即控制了出血。30天并发症和死亡率分别为57%和33%。33%的患者发生了严重并发症。肝硬化患者的院内死亡率高于非肝硬化患者（55%对7%，P＜0.001）。有肝转移出血但无肝硬化的患者院内死亡率为0%，无严重并发症。病因良性的患者预后良好，无出血或肿瘤相关死亡。TAE是控制自发性肝出血的有效方法。潜在病理决定预后，尤其是出血性肝细胞癌的肝硬化患者预后较差。
