肝癌介入治疗的相关因素与死亡时间关系探讨

目的 分析肝癌介入治疗（TACE）几个因素与死亡时间的关系。方法 随机选择经过TACE治疗,在不同时间内死亡者195例。将患者的年龄、性别、灌注的化疗药物和碘油的剂量、术前肿瘤的大小、形态、转移、门静脉癌栓、术后复发、肝功能和AFP共分为15项变量,统计学采用Cox回归分析和Cox逐步回归分析方法。结果 治疗后6个月和12个月死亡率为49．7％和75．9％。死亡时间与门静脉癌栓、弥漫型肿瘤和多发性肿瘤有明显相关（P＜0．05,P＜0．0001）;肿瘤形态中弥漫型与多发性、单结节和巨块型间相关显著（P＜0．05,P＜0．001,P＜0．001）,死亡时间与其他各组在统计学上无明显相关性（P＞0．05）。患者死于肝昏迷为27．2％,消化道大出血为36．9％,肝功能衰竭为23．1％,全身衰竭为5．1％,其他为7．2％。结论 对部分肝功能不良的患者,TACE有加重肝功能损害和加速患者死亡的作用。对于肝癌患者,特别是有门静脉癌栓、多发性和弥漫型患者,治疗时应首先考虑全身和肝功能情况、肝脏对药物的耐受性,严格掌握时机、方法和剂量,术后保肝十分重要。

Relation between transcatheter arterial chemoembolization and time of death in patients with hepatic carcinoma

OBJECTIVE: To evaluate the relationship between transcatheter arterial chemoembolization (TACE) and time of death in hepatic carcinoma patients. METHODS: One hundred and ninety-five patients (male 188, female 7) with liver cancer underwent TACE with patients dying at different intervals after treatment. Dose of antitumor drugs, amount of iodized oil, liver function, size, recurrence of surgical resection, pattern of tumor, metastasis, presence of portal vein thrombosis, post TACE relapse, post TACE liver function and AFP, etc, altogether 15 variables were subjected to statistical analysis with the Cox's hazard proportional model. RESULTS: According to univariate and forward stepwise regression analysis, factors associated with significantly worse survival were diffused type, multi-nodular growth of tumor, and tumor embolus in the portal vein (P < 0.0001). Before death, most patients had symptoms of chest oppression, shortness of breath, ascites, abdominal distension, jaundice, hepatic failure and hematemesis. Causes of death were hepatic coma (27.2%, n = 53), hepatic failure (23.1%, n = 45), hemorrhage from the digestive tract (36.9%, n = 72), multiple organ failure (5.1%, n = 10) and others (7.2%, n = 14). CONCLUSION: Several factors of TACE may lead to failure in liver function and death. TACE may hasten death in patients with severe liver functional embarrassment. Before instituting TACE, careful weighing the pros and cons of the general condition and liver function is important for patients with portal vein embolism, multiple tumors or diffused lesions. Tolerance of liver to the drug, time, dose and method of treatment should be meticulously and carefully planned. Post TACE protection of liver is also very important.