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目的分析肝细胞癌经动脉化疗栓塞(TACE)术后肿瘤破裂的临床特点。方法对412例肝细胞癌患者实施TACE术985例次。回顾性分析TACE术后肿瘤破裂6例的危险因素及诊疗方法。结果 TACE术后肿瘤破裂发生率为1.46%(6/412)。破裂肿瘤均位于肝右叶,临近肝脏表面或向外突出;肿瘤最大直径7.6~14.9cm。4例碘油栓塞后未追加适量明胶海绵颗粒。肿瘤破裂后,2例行肝动脉栓塞术治疗,1例明确责任血管后予明胶海绵颗粒栓塞后出血止;1例未明确责任血管,栓塞后止血效果不满意,患者因多脏器功能衰竭死亡。另4例患者接受内科治疗,均死亡。结论肿瘤破裂是肝细胞癌TACE术后的严重并发症。肿瘤临近肝脏表面或向外突出、体积较大和栓塞不充分是其发生的危险因素。
Objective To analyze the clinical features of tumor rupture after transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma. Methods A total of 985 HCC patients undergoing TACE were performed on 412 patients with hepatocellular carcinoma. Retrospective analysis of 6 cases of tumor rupture after TACE risk factors and diagnosis and treatment methods. Results The incidence of tumor rupture after TACE was 1.46% (6/412). Ruptured tumors are located in the right lobe of the liver, adjacent to the surface of the liver or outward; the maximum diameter of the tumor 7.6 ~ 14.9cm. Four cases of lipiodol embolization did not add the right amount of gelatin sponge particles. After the rupture of the tumor, 2 patients were treated with hepatic artery embolization, 1 patient with definite responsibility was given post-embolization of gelatin sponge particles, 1 patient was not defined as responsibility vessel, the hemostatic effect was unsatisfactory after embolization, and the patient died of multiple organ failure . The other 4 patients received medical treatment, all died. Conclusion Tumor rupture is a serious complication after TACE of hepatocellular carcinoma. Tumors near the surface of the liver or outward protruding, bulky and embolism is inadequate risk factors.