肝癌介入治疗后并发弥散性血管内凝血的预防及治疗

目的：探讨肝癌介入治疗后并发弥散性血管内凝血（DIC）的原因、预防措施、临床检查及治疗。方法：原发性肝癌病人3例，均接受经导管肝动脉化疗栓塞治疗。结果：3你病人均出现穿刺点出血、血肿，静脉输液部位淤斑，1例伴口腔黏膜出血并颌下血肿。实验室检查显示血小板计数进行性下降，凝血酶原时间、激活的部分凝血活酶时间延长，纤维蛋白原降解产物、D-二聚体值升高。经治疗后，2例好转出院，1例因多器官功能衰竭而死亡。结论：肝癌介入治疗后所发生的DIC是一种少见而严重的并发症，且死亡率较高。因此，对可疑凝血机制障碍的病人，在介入治疗前后应加强观察，及时进行实验室检查，以期早期发现，及时处理。

Prevention and treatment of disseminated intravascular coagulation complicating intraarterial chemoembolization of hepatocellular carcinoma

Objective To investigate the cause of DIC complicating intraarterial chemoembolization in the patients with hepatocellular carcinoma (HCC) and methods of examination, treatment, and prevention. Methods Three cases of DIC complicating intraarterial chemoembolization of HCC were reviewed. Results All patients had secondary bleeding / hemotoma at the arterial puncture site and difficulty in hemostasis at the venous puncture site. Laboratory examination showed progressive decrease of PLT count, prolongation of prothrombin time (PT) and activated partial thromboplastin time (APTT), and increase of fibrin degeneration products (FDP) and D-dimer (D-D). Two cases recovered after treatment and the other died of multiple organ failures. Conclusion DIC complicating intraarterial chemoembolization of HCC is uncommon but serious and fatal. For those patients with potential coagulation deficiencies, early detection, prophylactic management, and timely treatment are very important.