论文部分内容阅读
目的分析冷刀治疗后出血的原因,探索出血防治方法。方法 1999-10/2014-12月487例肝脏肿瘤患者完成术前检查后接受了冻融治疗,损伤到较大的血管或冰球破裂,并出现出汗,心慌,血压下降等临床症状和体征,计为冷刀治疗并发出血。考虑并发出血时,完成超声、计算机断层扫描(computed tomography,CT)或数字减影血管造影(digital subtracion angiography,DSA)检查进一步明确诊断;并给予局部压迫、静脉止血药物应用及输注冷沉淀、红细胞等处理,效果不佳时及时给与肝动脉栓塞治疗或手术治疗。结果 487例肝癌患者冷刀治疗中或治疗后发现有出血征象并诊断为出血者共51例(10.5%),死亡2例。单因素分析提示:患者不同性别、年龄、肿瘤来源及肿瘤大小对出血影响无统计学差异(P>0.05);但是患者是否存在肝硬化(P=0.03)、凝血功能是否异常(P=0.03)、血小板是否明显减少(P=0.024)、肿瘤在肝内不同位置(P=0.043)、使用不同直径的冷刀(P=0.003)以及冷冻时穿刺次数(P=0.025)对出血的影响有统计学差异。结论氩氦冷冻消融治疗肿瘤比较安全,但在选择患者或治疗前、治疗中及治疗后有出血倾向时,必须作出准确判断,采取合适的治疗方法,积极治疗。
Objective To analyze the causes of bleeding after cold knife treatment and to explore the methods of prevention and treatment of bleeding. Methods From January 1997 to December 2014, 487 liver cancer patients underwent preoperative examination and were treated with freeze - thaw therapy. They were injured by the rupture of larger blood vessels or puck, and presented with clinical symptoms and signs such as sweating, palpitation and blood pressure drop. Known as cold knife treatment of concurrent bleeding. Computed tomography (CT) or digital subtraction angiography (DSA) was used to further confirm the diagnosis of concurrent hemorrhage. Local oppression, intravenous hemostatic medications and infusion of cryoprecipitate were also performed. Red blood cells and other treatment, the poor effect of timely treatment of hepatic artery embolization or surgery. Results 487 cases of hepatocellular carcinoma patients after cold knife treatment or after treatment found bleeding signs and diagnosed as bleeding in a total of 51 cases (10.5%), 2 patients died. Univariate analysis showed that there was no significant difference in hemorrhage between different gender, age, tumor origin and tumor size (P> 0.05), but whether patients had cirrhosis (P = 0.03) or abnormal blood coagulation (P = 0.03) (P = 0.043), the number of platelets decreased significantly (P = 0.024), the location of the tumor in different sites of the liver (P = 0.043), the effect of bleeding with different diameters of cold knife (P = 0.003) Differences Conclusion Argon-helium cryoablation is safe for the treatment of tumors. However, it is necessary to make accurate judgments in the selection of patients or bleeding before and after treatment and after treatment. Appropriate treatment methods and active treatment should be taken.