대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권1호
  • /
  • Pages.33-38
  • /
  • 2011
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

수술적 절제가 어려운 간암환자에서 간동맥화학색전술 후 장기입원을 야기하는 원인인자에 대한 분석

The Analysis of the Causes of Prolonged Hospitalization after Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma

  • 박서연 (전남대학교병원 영상의학과, 전남대학교 의과대학 영상의학과교실) ;
  • 장남규 (화순전남대학교병원 영상의학과, 전남대학교 의과대학 영상의학과교실) ;
  • 김재규 (전남대학교병원 영상의학과, 전남대학교 의과대학 영상의학과교실) ;
  • 정용연 (화순전남대학교병원 영상의학과, 전남대학교 의과대학 영상의학과교실)
  • Park, Seo-Yeon (Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Chang, Nam-Kyu (Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital) ;
  • Kim, Jae-Kyu (Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Jeong, Yong-Yeon (Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital)
  • 발행 : 2011.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 수술적 절제가 어려운 간세포 암으로 간동맥화학색전술을 시행한 환자군에서 총 입원기간이 일주일 이상으로 장기입원이 필요했던 경우를 분석하여 이와 관련된 환자인자를 알아보고자 하였다. 대상과 방법: 최근 6개월 동안 간동맥화학색전술을 시행한 환자들의 재원기간을 조사하여 7일 미만인 223건과 7일 이상이었던 57건을 대상으로 하여 총 280건을 조사하였다. 재원기간이 7일 미만이었던 경우를 대조군으로 설정하고 7일 이상이었던 경우와 환자의 나이, 성별, 빌리루빈, 알부민, a-FT수치, 혈소판수치, AST/ALT, 간문맥분지 혈전증과 복수의 존재 유무와, Child-Pugh 점수, CLIP 점수, OKUDA 점수, 그리고 시술 시에 추가했던 색전술 시행 여부와의 관련성을 알아보았다. 결과: 재원기간이 7일 이상으로 증가되었던 경우는 복수(p=0.004)와 간문맥분지 혈전증 (p=0.000)이 있고, platelet 수치 10만 이하(p=0.012), Child 점수 B이상(p=0.023), CLIP 2점 이상(p=0.000), OKUDA II 단계이상(p=0.000)인 경우가 대조군과 비교하여 의의 있는 차이를 보였다. 결론: 간동맥화학색전술을 시행한 후 장기입원을 예측할 수 있는 여러 인자들을 충분히 고려해야 한다.

Purpose: We wanted to analyze the causes of prolonged hospitalization (over 7 days) after transarterial chemoembolization (TACE) in patients with unresectable Hepatocellular Carcinoma and its related factors. Materials and Methods: We analyzed the total hospital days after patients with unresectable Hepatocellular Carcinoma received transarterial chemoembolization, and these patients were treated during the recent 6 month at our hospital. Two hundred twenty three sessions showed a short term hospital stay (less than 7 days) and 57 sessions showed a prolonged hospital stay (more than 7 days), so a total of 280 sessions were analyzed. The hospital stay less than seven days was set for the control group and this was correlated with the patient's age, gender, the level of bilirubin and albumin, the platelet counts, the AST/ALT ratio, the a-FT, the presence of portal vein thrombosis and ascites, several scoring systems (Child-Pugh, CLIP, and OKUDA score) and the need for additional embolization at the time of the procedure. Results: Compared with that of the control group, ascites (p=0.004), portal vein thrombosis (p=0.000), a platelet count below the hundred thousand (p=0.012), a Child-Pugh score more than B (p=0.023), a CLIP score more than 2 (p=0.000) and a OKUDA score more than II (p=0.000) showed significant differences. Conclusion: The evaluation of patients' factors would be useful to predict extended post-procedural hospitalization after hepatic chemoembolisation.

키워드

참고문헌

  1. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429-442 https://doi.org/10.1053/jhep.2003.50047
  2. Chan AO, Yuen MF, Hui CK, Tso WK, Lai CL. A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer 2002;94:1747-1752 https://doi.org/10.1002/cncr.10407
  3. Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004;127 Suppl 5:S179-S188 https://doi.org/10.1053/j.gastro.2004.09.032
  4. Patel NH, Hahn D, Rapp S, Bergan K, Coldwell DM. Hepatic artery embolization: factors predisposing to postembolization pain and nausea. J Vasc Interv Radiol 2000;11:453-460
  5. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 2001;12:321-326 https://doi.org/10.1016/S1051-0443(07)61911-3
  6. Jeon SH, Park KS, Kim YH, Shin YS, Kang MK, Jang BK, et al. Incidence and risk factors of acute hepatic failure after transcatheter arterial chemoembolization for hepatocellular carcinoma. Korean J Gastroenterol 2007;50:176-182
  7. Akashi Y, Koreeda C, Enomoto S, Uchiyama S, Mizuno T, Shiozaki Y, et al. Prognosis of unresectable hepatocellular carcinoma: an evaluation based on multivariate analysis of 90 cases. Hepatology 1991;14:262-268 https://doi.org/10.1002/hep.1840140210
  8. Mondazzi L, Bottelli R, Brambilla G, Rampoldi A, Rezakovic I, Zavaglia C, et al. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology 1994;19:1115-1123 https://doi.org/10.1002/hep.1840190508
  9. Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739 https://doi.org/10.1016/S0140-6736(02)08649-X
  10. Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;56:918-928 https://doi.org/10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E
  11. Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer 1997;79:2087-2094 https://doi.org/10.1002/(SICI)1097-0142(19970601)79:11<2087::AID-CNCR5>3.0.CO;2-M
  12. Ikeda K, Kumada H, Saitoh S, Arase Y, Chayama K. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. An analysis by the cox proportional hazard model. Cancer 1991;68:2150-2154 https://doi.org/10.1002/1097-0142(19911115)68:10<2150::AID-CNCR2820681011>3.0.CO;2-F
  13. Shim JH, Park JW, Choi JI, Kim HB, Lee WJ, Kim CM. Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma? J Vasc Interv Radiol 2009;20:209-216 https://doi.org/10.1016/j.jvir.2008.10.021
  14. Li CP, Chao Y, Chen LT, Lee RC, Lee WP, Yuan JN, et al. Fever after transcatheter arterial chemoembolization for hepatocellular carcinoma: incidence and risk factor analysis. Scand J Gastroenterol 2008;43:992-999 https://doi.org/10.1080/00365520801971744
  15. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171 https://doi.org/10.1053/jhep.2002.33156
  16. Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983;148:397-401 https://doi.org/10.1148/radiology.148.2.6306721
  17. Kuroda C, Iwasaki M, Tanaka T, Tokunaga K, Hori S, Yoshioka H, et al. Gallbladder infarction following hepatic transcatheter arterial embolization. Angiographic study. Radiology 1983;149:85-89 https://doi.org/10.1148/radiology.149.1.6310685
  18. Katsushima S, Oi H, Nakagawa K, Iida Y, Hidaka A, Hatabu H, et al. Hepatic neoplasms: effects of transcatheter arterial embolization on coagulation and fibrinolysis. Radiology 1990;174:747-750 https://doi.org/10.1148/radiology.174.3.2154836
  19. Katsushima S, Inokuma T, Oi H, Okamura J, Higashi T, Takeuchi R, et al. Acute hepatic failure following transcatheter arterial embolization for the treatment of hepatocellular carcinoma. Digestion 1997;58:189-195 https://doi.org/10.1159/000201443
  20. Stuart K, Stokes K, Jenkins R, Trey C, Clouse M. Treatment of hepatocellular carcinoma using doxorubicin/ethiodized oil/gelatin powder chemoembolization. Cancer 1993;72:3202-3209 https://doi.org/10.1002/1097-0142(19931201)72:11<3202::AID-CNCR2820721112>3.0.CO;2-4