肝细胞癌肝移植术后经动脉化疗栓塞及早期动脉并发症

V. V. Borovik, A. Polikarpov, D. Granov
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摘要

目的:探讨新辅助经动脉化疗栓塞(TACE)对原位肝移植术后早期动脉并发症发生的可能影响。材料和方法。这项工作是基于250名接受者的治疗相关数据。分析组包括21例肝细胞癌患者。对所有接受首次移植的受者(228例),分析可能影响早期动脉并发症发生的不利因素,如异体移植脂肪变性程度、冷热缺血时间、血运重建时间、动脉重建后血压水平、换血量等。同种异体移植脂肪变性的程度在HCC患者和一般样本之间没有差异(95% CI, p = 0.25)。TACE期间未发现早期动脉并发症。两组保存参数、动脉血运重建时间、血流开始时收缩压水平、换血量差异无统计学意义(CI 95%, p > 0.05)。研究组早期血管并发症的发生率为16.7%,与整个样本没有差异(95% CI, p = 0.96)。根据文献和我们自己的研究结果,接受TACE的患者早期OLTx动脉并发症的发生率并没有显著增加。当OLTx发生血管并发症时,图像引导的血管内介入治疗是治疗的首选方法。
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Transarterial chemoembolization and early arterial complications after liver transplantation for hepatocellular carcinoma
Objective: to evaluate the possible influence of neoadjuvant transarterial chemoembolization (TACE) on development of early arterial complications after orthotopic liver transplantation (OLTx).Materials and methods. The work is based on treatment-related data of 250 recipients. The analyzed group included 21 patients with hepatocellular carcinoma (HCC). In all recipients who underwent primary transplantation (n = 228), possible negative factors influencing the development of early arterial complications were analyzed, such as degree of allograft steatosis, cold and warm ischemia time, revascularization duration, blood pressure level after arterial reconstruction, and exchange transfusion volume.Results. The degree of allograft steatosis did not differ between HCC patients and the general sample (95% CI, p = 0.25). No early arterial complications were revealed during TACE. There was no significant difference in preservation parameters, arterial revascularization time, systolic blood pressure level at blood flow start, and exchange transfusion volume (CI 95%, p > 0.05). The incidence of early vascular complications in the study group was 16.7%, it did not differ from the entire sample (95% CI, p = 0.96).Conclusion. The incidence of early arterial complications of OLTx in patients who underwent TACE does not significantly increase both according to the literature and our own findings. When vascular complications of OLTx occur, image-guided endovascular intervention is the method of choice for treatment.
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