原发性肝癌首次肝动脉栓塞化疗近期对肝肾功能的影响

目的探讨原发性肝癌(PHC)首次动脉栓塞化疗术(TACE)后早期肝肾功能的变化。方法 PHC 118例患者首次TACE,肝功能Child-Pugh A级94例,B级24例。按碘化油注入量分为三组:A组,31例,≤5ml;B组,51例,5-10ml;C组,36例,>10ml。检测并比较TACE术前与术后1周、1个月的肝肾功能。结果所有病例均成功获得肝动脉超选择栓塞化疗。碘化油中位注入量:A组(4.62±1.41)ml;B组(8.41±2.1)ml;C组(14.80±4.65)ml。与术前比较,三组TACE后1周的ALB下降,而TBil、DBil、AST及ALT均升高(P<0.05);但三组间比较均无统计学差异。TACE后1个月,三组各项指标与术前无统计学差异。术后1周、1个月各组肾功能均无统计学差异。TACE后1个月,Child-Pugh B级者ALB较术前下降了3.5g/L。结论 PHC患者首次TACE后1周肝功能有一过性损伤,但对肾功能无影响。按肿瘤大小注入碘油对肝功能影响程度相当。

Effects of initial transcatheter arterial chemoembolization on liver and renal function in patients with hepatocellular carcinoma

Objective To investigate the changes of liver and renal function early after initial transcatheter arterial chemoembolization(TACE) in the patients with hepatocellular carcinoma(HCC).Methods A total of 118 HCC patients underwent initial TACE,of whom 94 cases were Child grade A and 24 cases were Child grade B.On the basis of the volume of lipiodol injected,the patients were divided into three groups of A(≤5 ml,31 cases),B(5-10 ml,51 cases) and C(>10 ml,36 cases).The liver and renal functions were examined and compared before TACE,one week and one month after TACE.Results The TACE was successful in all patients.The mean volume of lipiodol injected was 4.6 ml in group A,8.4 ml in group B and 14.8 ml in group C.Compared to before,ALB was decreased,while Tbil,Dbil,AST and ALT were increased,one week after TACE(P<0.05),which were not significantly different among three groups and between before and one month after TACE(P>0.05).There was no significant difference in renal function before and one week or one month after TACE(P>0.05).Conclusion There is a transient damage of liver,but not renal,function in the early stage after TACE.The volumes of lipiodol injected according to tumor sizes in TACE have a similar effect on liver function.