肝细胞肝癌TACE术导致碘油肺栓塞的危险因素分析(硕士)

肝细胞肝癌TACE术导致碘油肺栓塞的危险因素分析(硕士)(论文25000字)
中文摘要
目的
探讨肝细胞肝癌患者经导管肝动脉化疗栓塞术（Transcatheter arterial chemoembolization，TACE）后碘油肺栓塞的危险因素及防治方法。
方法
回顾性分析2011年1月-2016年12月在附属第二医院行TACE术并在术后2周内进行了CT检查的310例肝细胞肝癌患者的临床资料。将TACE术后发生碘肺栓塞的患者归为观察组，将TACE术后未发生碘油肺栓塞的患者归为对照组。再分别统计两组患者的年龄、肿瘤直径、碘油用量、甲胎蛋白水平等18个可能与碘油肺栓塞有关的影响因素，并对这些影响因素进行单因素分析。然后把单因素分析显示差异具有统计学意义的因素纳入非条件二元多因素logistic回归分析，找到肝细胞肝癌TACE术后碘油肺栓塞的独立危险因素。
结果
1. 在310例肝细胞肝癌患者中，有27例患者在TACE术后发生了碘油肺栓塞，发生率为8.71%。
2. 单因素分析结果显示：肝动-静脉瘘、最大肿瘤直径≥10 cm、碘油使用量≥15 mL、肝癌破裂和未经治疗的下腔静脉癌栓是TACE术后碘油肺栓塞的危险因素（P＜0.05）。
3. 非条件二元多因素logistic回归分析结果显示：肝动-静脉瘘、最大肿瘤直径≥10 cm、碘油使用量≥15 mL、肝癌破裂是TACE术后碘油肺栓塞的独立危险因素（P＜0.05）。
结论
肝细胞肝癌患者TACE术后碘油肺栓塞的发生率并不低，其独立的危险因素包括：肝动-静脉瘘、最大肿瘤直径≥10 cm、碘油使用量≥15 mL、肝癌破裂。针对上述相关危险因素，采取相应预防措施可能有助于减少肝细胞肝癌患者TACE术后碘油肺栓塞的发生或减轻碘油肺栓塞的严重程度。碘油肺栓塞的治疗应根据病情严重程度而采取不同的治疗方案。

关键词：肝细胞肝癌；经导管肝动脉化疗栓塞术；碘油；肺栓塞；危险因素

Analysis of the Risk Factors forPulmonaryLipiodolEmbolism Due to TACE in Hepatocellular Carcinoma
Abstract
Objective
The study was designed to investigate the risk factors of pulmonary lipiodol embolism following transcatheter arterial chemoembolization (TACE) performed on patients with hepatocellular carcinoma (HCC), and to explore corresponding preventive and therapeutic approaches.
Methods
The clinical data of 310 HCC patients were retrospectively collected, who received TACE at the Second Affiliated Hospital of Wenzhou Medical University from January, 2011 to December, 2016 and underwent computed tomography within two weeks after operation. Patients harboring pulmonary lipiodol embolism were assigned to the observation group, and those without were assigned to the control group. A total of 18 potential influencing factors were analyzed in two groups, which might be associated with pulmonary lipiodol embolism, such as age, tumor diameter, the amount of lipiodol, the level of alpha-fetoprotein (AFP), followed by univariate analysis of these influencing factors. Factors, which were statistically significant were further enrolled in unconditional binary multivariate logistic regression analysis to figure out the independent risk factors for pulmonary lipiodol embolism following TACE.
Results
1.Of the 310 patients with HCC, 27 of them suffered from pulmonary lipiodol embolism following TACE, with an incidence rate of 8.71%.
2.Univariate analysis indicated that the following factors were risk factors for the presenceof pulmonary lipiodol embolism following TACE: hepatic arteriovenous fistula, the biggest tumor diameter over 10cm, the amount of lipiodol over 15 mL, HCC rupture and untreated inferior vena cava tumor thrombus (all P < 0.05).
3.Unconditional binary multivariate logistic regression analysis revealed that hepatic arteriovenous fistula, the biggest tumor diameter over 10cm, the amount of lipiodol over 15 mL and HCC rupture were independent risk factors forpulmonarylipiodol embolism following TACE (all P < 0.05).
Conclusions
The incidence rate of pulmonary lipiodol embolism following TACE in HCC patients were not low, the independent risk factors of which, included hepatic arteriovenous fistula,the biggest tumor diameter over 10cm, the amount of lipiodol over 15 mLand HCC rupture.The corresponding precautions should be taken to reduce the occurrence or severity of pulmonary lipiodol embolism following TACE according to the above-described risk factors.The diverse therapy of pulmonary lipiodol embolism following TACE should be dependent of the severity of disease.

Keywords：Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Lipiodol; Pulmonary embolism; Risk factors

目录
缩略词表................................................1
中文摘要................................................2
英文摘要................................................4
引言................................................6
材料与方法..............................................8
结果....................................................11
分析与讨论..............................................17
小结....................................................21
参考文献................................................22
附录....................................................25
致谢....................................................26
综述及参考文献..........................................27

 
英文缩写    英文全称    中文全称
TACE    Transcatheter arterial chemoembolization    经导管肝动脉化疗栓塞术
HCC    Hepatocellular carcinoma    肝细胞肝癌
DSA    Digital subtraction angiography    数字减影血管造影
CT    Computed tomography    计算机断层扫描
MRI    Magnetic resonance imaging    磁共振成像
AFP    Alpha-fetoprotein    甲胎蛋白
DIC    Disseminated intravascular coagulation    弥散性血管内凝血
CRP    C-reactive protein    C-反应蛋白
BNP    Brain natriuretic peptide    脑钠肽
SPSS    Statistical packageforsocialscience    社会科学统计软件包