本文選題：肝癌 + 熱消融　； 參考：《天津醫(yī)科大學(xué)》2016年碩士論文

【摘要】：研究背景和目的:近些年,在影像引導(dǎo)下局部熱消融治療原發(fā)性肝癌(Primary liver carcinoma,PLC)及繼發(fā)性肝癌(Metastatic liver carcinoma,MLC)已在全球范圍內(nèi)得到廣泛的應(yīng)用。肝癌的熱消融是一種安全、微創(chuàng)、有效的方法,是腫瘤非手術(shù)醫(yī)治的重要突破,已變?yōu)槔^肝移植和肝切除后第三種能達到根治性治療原發(fā)性肝癌的方法,而且對于手術(shù)無法切除的中晚期肝癌患者,局部熱消融也可成為一種重要的保守性治療方法。術(shù)后出血是肝癌熱消融治療的主要并發(fā)癥之一,本研究旨在對肝癌熱消融治療出血并發(fā)癥的相關(guān)因素進行多因素分析,并進一步探討防治措施。資料和方法:2002年1月至2014年12月,天津市第三中心醫(yī)院對1797例病人實施了2356例次熱消融治療,其中男性1362例,女性435例,年齡24-91歲,平均(58.9±9.7)歲,其中PLC 1614例、MLC 183例。PLC由病理和(或)臨床確定診斷,診斷標(biāo)準(zhǔn)滿足我國衛(wèi)生部PLC診療規(guī)范(2011年版);MLC有確切的原發(fā)病灶,由兩種或以上的強化影像學(xué)方法及腫瘤標(biāo)志物診斷。入選標(biāo)準(zhǔn):腫瘤最大直徑≤6.0 cm,數(shù)量≤5個,無肝內(nèi)主干膽道、主干血管及下腔血管浸潤為原則。本研究回顧性總結(jié)病人相關(guān)的臨床信息,對發(fā)生出血并發(fā)癥的相關(guān)因素作多因素分析并總結(jié)防治措施。本研究采用SPSS 20.0統(tǒng)計工具,應(yīng)用單因素分析對可能導(dǎo)致熱消融出血的相關(guān)因素:性別、年齡、病灶類別、病灶數(shù)目、病灶直徑、病灶位置、熱消融次數(shù)、術(shù)前是否行TACE、血小板數(shù)值、凝血酶原時間、肝功能Child-Pugh分級、肝周腹水進行統(tǒng)計學(xué)分析,有統(tǒng)計學(xué)意義者進行多因素分析,從而選出導(dǎo)致熱消融出血并發(fā)癥的高危因素。P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1797例患者共3200個腫瘤行2356例次熱消融治療,射頻消融(Radiofrequency ablation,RFA)治療547例次,微波消融(Microwave ablation,MWA)治療1809例次。治療后共有18例患者出現(xiàn)了出血,發(fā)生率為0.76%,嚴(yán)重出血6例,發(fā)生率0.25%(6/2356);輕微出血12例,發(fā)生率0.51%(12/2356)。多因素Logistic回歸分析結(jié)果顯示:凝血功能障礙(PLT50×109/L、PT18s)、腫瘤鄰近血管以及肝功能Child B級可導(dǎo)致出血的風(fēng)險增加。結(jié)論肝癌熱消融出血并發(fā)癥發(fā)生率低,但大量出血非常兇險,處理不當(dāng)可危及生命。當(dāng)患者具有凝血功能障礙(PLT50×109/L、PT18s)、腫瘤鄰近血管以及肝功能Child-Pugh B級高危因素時應(yīng)做好預(yù)防措施,有助于加強熱消融治療的安全系數(shù)。
[Abstract]:Background and objective: in recent years, primary liver carcinoma (PLCs) and secondary hepatocellular carcinoma (HCC) have been widely used in the treatment of primary liver carcinoma under the guidance of local thermal ablation. Thermal ablation of liver cancer is a safe, minimally invasive and effective method. It is an important breakthrough in non-surgical treatment of tumor. It has become the third method to achieve radical treatment of primary liver cancer after liver transplantation and hepatectomy. Local thermal ablation may also be an important conservative treatment for patients with advanced liver cancer who can not be resected surgically. Postoperative hemorrhage is one of the main complications in the treatment of liver cancer by thermal ablation. The purpose of this study was to analyze the factors related to the complications of heat ablation for liver cancer and to further explore the preventive and therapeutic measures. Materials and methods: from January 2002 to December 2014, 2356 patients (1362 male and 435 female, aged 24-91 years, mean 58.9 鹵9.7 years) were treated with thermal ablation in Tianjin third Central Hospital. 1614 cases of PLC were confirmed by pathology and / or clinical diagnosis. The diagnostic standard met the standard of PLC diagnosis and treatment of Ministry of Health of our country. (2011 edition of PLC has definite primary lesion, diagnosed by two or more enhanced imaging methods and tumor markers. Inclusion criteria: the maximum diameter of tumor 鈮，

本文編號：1948331