目的 探讨老年肝癌患者肝动脉化疗栓塞术后疲劳恢复情况及影响因素.方法 采用便利抽样法选取 2020 年10 月～2022 年 3 月在某三级甲等医院住院治疗的老年肝癌患者 80 例,使用简明围术期疲劳评测量表(ICFS-10)进行调查,分别评估术前 1d、术后 1、3、7、14、28 d疲劳发生情况,分析患者术后疲劳恢复的影响因素.结果 80 例患者中,术后 1d疲劳评分最高(33.88±7.03)分,此后逐渐下降,术后 14、28 d疲劳评分[(23.55±6.21)、(22.09±6.23)分]恢复正常.logistic回归分析显示,年龄、肿瘤转移是老年肝癌患者肝动脉化疗栓塞术后疲劳恢复的影响因素(P＜0.05).结论 老年肝癌患者肝动脉化疗栓塞术后 1d疲劳分值最高,随后逐渐恢复,恢复情况与年龄、肿瘤是否转移密切相关,可以通过积极止痛、有效退热等方法促进患者术后疲劳恢复.

目的 分析多个血清标志物联合检测对甲胎蛋白(AFP)阴性原发性肝癌患者经导管肝动脉化疗栓塞术(TACE)治疗后疗效及预后的临床价值.方法 纳入解放军总医院第五医学中心2016年9月至2018年3月接受TACE治疗的120例肝细胞癌(HCC)患者,其中44例AFP水平正常(AFP阴性),76例AFP水平增高(AFP阳性),分别检测患者TACE术前、术后1个月和3个月的血清AFP、癌胚抗原(CEA)、糖类抗原-199(CA199)、CA125、γ-谷氨酰转移酶(GGT)、白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、IFN-γ、TNF-α等指标水平.随访至2018年7月,观察患者肿瘤活性情况,分析不同标志物组合对AFP阴性HCC患者TACE术后疗效及预后的临床价值.结果 AFP阴性和阳性患者术前各项指标水平比较,差异均无统计学意义(P>0.05).IL-6联合GGT检测AFP阴性和阳性HCC患者TACE术后疗效及预后的灵敏度、特异度、阴性预测值、阳性预测值分别为95.2％、87.0％、87.0％、95.2％和85.7％、59.6％、70.1％、79.1％;IL-6对AFP阴性及阳性HCC患者预后的ROC曲线下面积分别为0.839和0.666.结论 血清IL-6联合GGT检测可作为一种预测AFP阴性HCC患者TA C E术后疗效及肿瘤活性的有效指标.

Objective To investigate the ruptured hepatocellular carcinoma with minimally invasive interventional treatment of Embosphere microspheres. Methods Using Seldinger technology, the use of micro catheter implantation of Embosphere microspheres as embolization agents, 203 cases of ruptured hepatocellular carcinoma were treated by hepatic artery super selectiveembolization. Results 203 cases of ruptured hepatocellular carcinoma patients after emergency hepatic artery embolism, 198 cases showed effective hemostasis. Another 4 patients were again active bleeding (2 cases were cured by embolization of disease control, the other 1 cases of incomplete embolism 5 days later died of hemorrhagic shock, 1 cases of repeated angiography is still no clear bleeding vascular line"blind bolt", 48 h died of hemorrhagic shock, consider to venous bleeding may vary) in 1 cases, preoperative liver function is poor, died of liver function failure after two weeks. Conclusion Injection of microspheres via hepatic artery super selective embolism and hemorrhage of liver artery can be used as an effective measure to rescue the ruptured hepatocellular carcinoma, Embosphere microspheres have good histocompatibility, uniform, accurate, complete with embolization, the expansion coefficient is small, the advantages of permanent embolism, super selective embolization has little effect on the liver function of patients, adverse reaction small, especially suitable for the poor liver function patients who cannot tolerate operation.