Prediction of early death after therapeutic hepatic arterial embolisation.
Prediction of early death after therapeutic hepatic arterial embolisation.
复制标题
治疗性肝动脉栓塞术后早期死亡的预测。
作者：
J. Powell;J. Mcivor;K. Reynolds;I. Murray
回顾性分析了14例肝脏恶性肿瘤患者行姑息性肝动脉栓塞治疗的连续系列。12名患者有肝疼痛，从他们的肿瘤和两个患有类癌综合征。6名患者在手术后4周内死亡（第1组），8名患者存活至少10周（第2组）。寻找可能允许预测早期死亡高风险的因素（第1组）。由“盲”观察者审查的栓塞前血管造影片显示，两组之间的血管分布或肿瘤大小无差异，栓塞后动脉闭塞程度无差异。所有患者门静脉均通畅。除第1组中血清白蛋白浓度较低和碱性磷酸酶活性较高外，两组间栓塞前生化值无显著差异。所有早期死亡的患者血清碱性磷酸酶活性均在45 KAU或以上，而存活时间较长的8人中有6人的活性低于此值（p <0.02）。这些发现表明，血清碱性磷酸酶活性45 KAU或更高（正常范围3-13）可能是一个有用的预测早期死亡。使用血清碱性磷酸酶活性和白蛋白浓度加权组合的逐步判别分析预测了除1例患者外的所有患者的结局（p <0.002）。
A consecutive series of 14 patients with hepatic malignant disease treated by palliative hepatic arterial embolisation was reviewed. Twelve patients had hepatic pain from their tumour and two were suffering from the carcinoid syndrome. Six patients died within four weeks of the procedure (group 1) and eight survived for at least 10 weeks (group 2). Factors were sought that might permit prediction of a high risk of early death (group 1). The pre-embolisation angiograms reviewed by a "blind" observer showed no differences in vascularity or tumour size between the groups and no difference in the extent of arterial occlusion after embolisation. The portal vein was patent in all patients. No significant difference was seen between the groups in the pre-embolisation biochemical values, with the exception of lower serum albumin concentrations and higher alkaline phosphatase activities in group 1. All those who died early had serum alkaline phosphatase activities of 45 KAU or above, while six of the eight who survived longer had activities below this value (p less than 0.02). These findings suggest that serum alkaline phosphatase activity of 45 KAU or more (normal range 3-13) might alone be a useful predictor of early death. Stepwise discriminant analysis using a weighted combination of serum alkaline phosphatase activity and albumin concentration predicted the outcome in all but one of the patients studied (p less than 0.002).