肝細胞肝癌TACE術導致碘油肺栓塞的危險因素分析(碩士)

以下是資料介紹,如需要完整的請充值下載. 本資料已審核過,確保內容和網頁里介紹一致.  
無需注冊登錄,支付后按照提示操作即可獲取該資料.
資料介紹:

肝細胞肝癌TACE術導致碘油肺栓塞的危險因素分析(碩士)(論文25000字)
中文摘要
目的
探討肝細胞肝癌患者經導管肝動脈化療栓塞術(Transcatheter arterial chemoembolization,TACE)后碘油肺栓塞的危險因素及防治方法。
方法
回顧性分析2011年1月-2016年12月在附屬第二醫院行TACE術并在術后2周內進行了CT檢查的310例肝細胞肝癌患者的臨床資料。將TACE術后發生碘肺栓塞的患者歸為觀察組,將TACE術后未發生碘油肺栓塞的患者歸為對照組。再分別統計兩組患者的年齡、腫瘤直徑、碘油用量、甲胎蛋白水平等18個可能與碘油肺栓塞有關的影響因素,并對這些影響因素進行單因素分析。然后把單因素分析顯示差異具有統計學意義的因素納入非條件二元多因素logistic回歸分析,找到肝細胞肝癌TACE術后碘油肺栓塞的獨立危險因素。
結果
1. 在310例肝細胞肝癌患者中,有27例患者在TACE術后發生了碘油肺栓塞,發生率為8.71%。
2. 單因素分析結果顯示:肝動-靜脈瘺、最大腫瘤直徑≥10 cm、碘油使用量≥15 mL、肝癌破裂和未經治療的下腔靜脈癌栓是TACE術后碘油肺栓塞的危險因素(P<0.05)。
3. 非條件二元多因素logistic回歸分析結果顯示:肝動-靜脈瘺、最大腫瘤直徑≥10 cm、碘油使用量≥15 mL、肝癌破裂是TACE術后碘油肺栓塞的獨立危險因素(P<0.05)。
結論
肝細胞肝癌患者TACE術后碘油肺栓塞的發生率并不低,其獨立的危險因素包括:肝動-靜脈瘺、最大腫瘤直徑≥10 cm、碘油使用量≥15 mL、肝癌破裂。針對上述相關危險因素,采取相應預防措施可能有助于減少肝細胞肝癌患者TACE術后碘油肺栓塞的發生或減輕碘油肺栓塞的嚴重程度。碘油肺栓塞的治療應根據病情嚴重程度而采取不同的治療方案。

關鍵詞:肝細胞肝癌;經導管肝動脈化療栓塞術;碘油;肺栓塞;危險因素

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

目錄
縮略詞表................................................1
中文摘要................................................2
英文摘要................................................4
引言................................................6
材料與方法..............................................8
結果....................................................11
分析與討論..............................................17
小結....................................................21
參考文獻................................................22
附錄....................................................25
致謝....................................................26
綜述及參考文獻..........................................27

 
英文縮寫    英文全稱    中文全稱
TACE    Transcatheter arterial chemoembolization    經導管肝動脈化療栓塞術
HCC    Hepatocellular carcinoma    肝細胞肝癌
DSA    Digital subtraction angiography    數字減影血管造影
CT    Computed tomography    計算機斷層掃描
MRI    Magnetic resonance imaging    磁共振成像
AFP    Alpha-fetoprotein    甲胎蛋白
DIC    Disseminated intravascular coagulation    彌散性血管內凝血
CRP    C-reactive protein    C-反應蛋白
BNP    Brain natriuretic peptide    腦鈉肽
SPSS    Statistical packageforsocialscience    社會科學統計軟件包

302宿舍白露全文阅读