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頁籤選單縮合
題 名 | Ruptured hepatocellular Carcinoma: Treatment Strategy and Prognostic Factor Analysis=破裂肝癌預後因子之分析 |
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作 者 | 陳重榮; 吳肇卿; 陳祖裕; 盛文鴦; 顏福順; 姜仁惠; 周嘉揚; 雷永耀; 李壽東; | 書刊名 | 中華醫學雜誌 |
卷 期 | 57:5 1996.05[民85.05] |
頁 次 | 頁322-328 |
分類號 | 416.246 |
關鍵詞 | 肝癌; 支持性療法; 肝動脈栓塞術; Hepatocellular carcinoma; Supportive treatment; Transcatheter arterial embolization; |
語 文 | 英文(English) |
中文摘要 | 背景 破裂肝癌之預後通常不佳,但是鮮少有研究特別著眼於此一嚴 重事件其預後因子之分析。 方法 本院收集過去9年來,連續84位因肝癌破裂而就診的病人,以單變項及 多變項分析探討29個臨床及實驗檢查變項與預後之相關性。 結果 肝癌破裂之臨床表現以上腹痛為最常見之求診症狀,佔70%,其次是休 克(43%),腹脹(27%)及其他(17%)。在84位病人當中,50位僅接受支持性療法, 21位施行手術治療,13位接受肝動脈栓塞術。三組病人之存活中期分別為13 天,30天及202天,而84位病人之存活中期為24天。三種治療方式中,以肝 動脈栓塞術具最低之止血失敗率(20%)。在所有病人當中,單變項分析發現積極 性治療(手術或肝動脈栓塞術),單一結節或單一結節合併周邊癌增生(group I), 血清肌酸配(小於等於1.2mg/ml),鹼性磷酸(小於等於95U/L),ALT(小於等 於40U/L),膽紅素(小於等於1.6mg/ml),最初之收縮壓(大於等於90 mmHg) 及無主門脈瘤栓皆與存活期大於90天有關(p值皆小於0.05);在多變項分析中, 積極性治療(O.R.= 3.94,p = 0.0003),ALT(O.R.=2.12,p =0.008及最初之收縮壓 (O.R.=2.37,p=0.01)仍為有意義的因子。 結論 肝動脈栓塞術可用來有效地制止肝腫瘤出血。治療方針與最初之收縮壓 則會影響肝癌破裂之預後。對於某些具有單一肝腫瘤且肝、腎功能俱佳的病人, 在一般狀況穩定之後,仍應考慮接受肝腫瘤切除術。至於對所有的肝癌破裂病 人而言,究竟那一種治療方針才是最佳的選擇,則有待隨機對照之研究才能解 答。 |
英文摘要 | Background. The prognosis of ruptured hepatocellular carcinoma (HCC) is generally poor, but few studies have focused on the analysis of prognostic factors of this catastrophic event. Methods. Eighty-four consecutive patients with ruptured HCC were included. Twenty-nine clinical and laboratory variables were correlated to prognosis by using uni- and multivariate analyses. Results. Epigastralgia and/or right upper quadrant abdominal pain was the most common initial presentation (70%), followed by shock (42%), abdominal distension (27%) and others (17%). Of these 84 patients, 50 patients were treated by supportive measure, 21 by operation and 13 by transcatheter arterial embolization (TAE). The median survival was 13, 30 and 202 days in each group, respectively, and 24 days overall. TAE showed the lowest hemostatic failure rate (20%). Univariate analysis showed that active treatment (operation or TAE), group I tumor with a solitary nodule or single nodule with proliferation into surrounding area, serum creatinine (<= 1.2 mg/ml), alkaline phosphatase (<= 95 U/L), alanine aminotransferase (ALT, <= 40 U/L), total bilirubin (<= 1.6 mg/ml), initial systolic blood pressure (>= 90 mmHg), and absence of main portal vein thrombosis were correlated with a survival longer than 90 days (p<0.05) in univariate analysis. Active treatment, ALT level and initial systolic blood pressure were still significant in multivariate analysis (p<0.05). Conclusions. TAE may help stop the tumor bleeding. Treatment regimen, ALT levels and initial blood pressure are correlated with the prognosis of ruptured HCC. |
本系統中英文摘要資訊取自各篇刊載內容。