原发性肝癌经肝动脉化疗栓塞术后短期病死率及死因分析

刘钊; 李智; 杨凯仑; 李思茵; 朱晓黎; 倪才方

doi:10.3969/j.issn.1001-5256.2022.11.014

原发性肝癌经肝动脉化疗栓塞术后短期病死率及死因分析

DOI: 10.3969/j.issn.1001-5256.2022.11.014

刘钊¹,
李智^{1, 2, , ,},
杨凯仑¹,
李思茵¹,
朱晓黎¹,
倪才方¹

1.
苏州大学附属第一医院介入科，江苏苏州 215006
2.
克孜勒苏柯尔克孜自治州人民医院介入中心，新疆克孜勒苏柯尔克孜自治州 845355

伦理学声明：本研究方案于2022年5月9日经由苏州大学附一院医院伦理委员会审核，审核编号：(2022)伦研批第178号。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：刘钊负责课题设计，资料分析，撰写论文；杨凯仑、李思茵负责数据的收集及整理分析；倪才方、朱晓黎负责课题思路及论文写作指导；李智负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李智，lizhisoochow@suda.edu.cn

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出版历程
- 收稿日期: 2022-04-08
- 录用日期: 2022-08-01
- 出版日期: 2022-11-20

Short-term mortality and death causes after TACE in patients with primary liver cancer

Zhao LIU¹,
Zhi LI^{1, 2
, ,
,},
Kailun YANG¹,
Siyin LI¹,
Xiaoli ZHU¹,
Caifang NI¹

1.
Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
2.
Department of Interventional Radiology, Kizilsu People's Hospital of Kirgiz Autonomous Prefecture, Kizilsu Kirgiz Autonomous Prefecture, Xinjiang 845355, China

More Information

Corresponding author: LI Zhi, lizhisoochow@suda.edu.cn(ORCID: 0000-0001-7613-4193)

摘要

摘要: 目的研究原发性肝癌行肝动脉化疗栓塞术(TACE)的短期病死率，分析死亡病例的特征，探讨可能的死亡原因。方法分析2015年1月—2020年12月苏州大学附属第一医院介入科完成的所有TACE病例，排除转移瘤、联合治疗等。收集患者的术前及术后30 d的临床及影像学资料，分析术后短期死亡患者的临床特征。术后30 d内的死亡定义为短期死亡。结果共纳入741例原发性肝癌患者，行1466例次TACE，术后30 d内死亡10例(1.35%)，例次死亡率为0.68%。d-TACE的例次病死率为1.62%(3/185)，c-TACE的例次病死率为0.55%(7/1281)。中国肝癌分期Ⅰ、Ⅱ、Ⅲ期患者的例次病死率分别为0.45%(2/448)、0.33%(2/599)、1.43%(6/419)。死亡病例最大病灶的平均直径为(10.1±0.8)cm。可能的死亡原因为肝功能衰竭4例、肿瘤破裂出血3例、骨髓抑制1例、肺栓塞1例、心衰1例。结论原发性肝癌TACE术后病死率低，术后短期死亡偶有发生，死亡病例的主要特征是肿瘤体积大，常见死因推测为肝功能衰竭和肿瘤破裂出血。
- 肝肿瘤 /
- 化学栓塞, 治疗性 /
- 死亡原因 /
- 肝功能衰竭
Abstract: Objective To investigate the short-term mortality of transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer, and explore the possible causes of death and countermeasures. Methods All patients who underwent TACE at the Department of Interventional Radiology, First Affiliated Hospital of Soochow University from January 2015 to December 2020 were studied, but those with metastatic liver cancer or receiving combined treatment were excluded. The clinical and imaging data of all patients were collected before and 30 days after TACE, and the clinical characteristics of the patients with short-term postoperative death were analyzed. Death within 30 days after TACE was defined as short-term death. Results A total of 1466 TACE in 741 patients with primary liver cancer were included. Ten patients (10/741, 1.35%) died within 30 days after TACE, with a mortality rate of 0.68% for all TACE. The mortality rate of d-TACE and c-TACE was 1.62% (3/185) and 0.55 % (7/1281), respectively. The mortality rates of patients at China Liver Cancer Staging Ⅰ, Ⅱ, and Ⅲ stages were 0.45% (2/448), 0.33% (2/599), and 1.43% (6/419), respectively. The mean diameter of the largest lesion in death cases was 10.1±0.8 cm. The possible causes of death were liver failure (4 cases), rupture bleeding (3 cases), myelotoxicity (1 case), pulmonary embolism (1 case), and heart failure (1 case). Conclusion The mortality rate after TACE in patients with primary liver cancer is low, with occasional short-term postoperative deaths. The death cases are characterized by a large tumor volume, and the most common causes of short-term death are liver failure and rupture bleeding.
- Liver Neoplasms /
- Chemoembolization, Therapeutic /
- Cause of Death /
- Liver Failure

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图 1 术前、术中及术后的腹部检查结果

注：患者男性，66岁，第1次TACE术后3 d死亡。a，术前增强CT冠状位，无腹水；b，术中造影，见多处肿瘤染色，栓塞碘油、Callisphere微球1瓶；c，术后第2天诉腹痛，平扫CT见腹腔大量积液，血红蛋白从术前129 g/L降至55 g/L，考虑肿瘤破裂出血。

Figure 1. Preoperative、intraoperative and postoperative abdominal examination results

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表 1 死亡病例一般特征及死因推测

Table 1. General characteristics of death cases and presumed cause of death

性别	年龄(岁)	ECOG评分	Child评分	病灶数目	主病灶直径(cm)	门静脉癌栓	TACE次数	栓塞材料及剂量	化疗药及剂量	死亡时间(d)	死因推测
女	60	0	6	1	9.8	主干及左支	1	碘油10 mL、Callisphere微球2瓶	表柔比星50 mg	3	肝功能衰竭
男	46	0	5	5	12.9	无	4	碘油9 mL、明胶海绵颗粒	氟脲苷1000 mg、奥沙利铂100 mg	21	肝功能衰竭
女	66	0	7	3	9.9	主干及右支	3	碘油15 mL	奥沙利铂100 mg、吡柔比星10 mg	3	肿瘤破裂出血
男	66	0	5	5	8.0	右支	1	碘油、Callisphere微球1瓶	表柔比星50 mg	3	肿瘤破裂出血
男	80	0	5	1	12.6	无	2	碘油6 mL、Callisphere微球1瓶、PVA颗粒1瓶	奥沙利铂100 mg、表柔比星50 mg	1	肿瘤破裂出血
男	67	0	7	3	6.7	无	2	碘油20 mL、明胶海绵颗粒	吡柔比星20 mg	2	肺栓塞
男	78	1	5	1	13.2	无	1	碘油15 mL、明胶海绵颗粒	无	4	心功能衰竭
男	79	0	6	3	5.9	无	3	碘油14 mL、Embosphere颗粒1瓶	奥沙利铂100 mg、吡柔比星40 mg、雷替曲塞4 mg	13	骨髓抑制
男	46	1	6	1	11.2	右支	1	碘油20 mL	奥沙利铂100 mg、吡柔比星10 mg	30	肝功能衰竭
男	47	0	6	3	11.6	无	1	碘油10 mL、明胶海绵颗粒	吡柔比星20 mg	23	肝功能衰竭、感染

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