高强度聚焦超声治疗tace术后残余肝癌的近期疗效及护理方法杨雪梅.docVIP

高强度聚焦超声治疗TACE术后残余肝癌的疗效及护理方法（400010 重庆重庆医科大学附属第二医院）摘要 目的 探讨高强度聚焦超声(HIFU)治疗经肝动脉化疗栓塞(TACE)术后残余肝癌的近期疗效及护理方法。方法 64例TACE治疗后有残余癌组织的原发性肝癌晚期患者接受HIFU治疗，并比较HIFU前后肝功能、甲胎蛋白(AFP)、MRI和CT的变化，观察术前、术中、术后护理方法及并发症处理的效果。结果 HIFU治疗前、后肝功能分别是ALT (70.3±48.2)U/L、AST (70.4±51.3)U/L、γ-GT(104.7±67.4) U/L与ALT (50.1±28.4) U/L、AST (50.2±30.7) U/L、γ-GT (73.8±54.1)，前后比较具有统计学意义 (分别依次t=4.25、4.23、2.64， P均0.05)；术前、术后AFP分别是634.6ng/ml 和14.7ng/ml，前后比较具有统计学意义（t=2.54, P0.05）。术后MRI和CT结果显示肿瘤靶区出现凝固性坏死，TACE术后未出现皮肤严重损伤、重症感染、肝功能衰竭等严重并发症。结论 高强度聚焦超声治疗TACE术后残余肝癌是一种安全、有效的方式。围手术期合理、周密的护理有利于减少并发症，提高临床疗效及患者生活质量。 [关键词高强度聚焦超声；肝动脉化疗栓塞；残余肝癌组织；护理；Observation and nursing care for patients with high intensity focused ultrasound ablation used for residual hepatocellular carcinoma after TACE treatment Yang Xuemei1, Wang Mengna2, Wang Xiaomei2 (1Clinical Central for Tumor Therapy, 2Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China) [Abstract] Objective To explore the nursing for patients with high intensity focused ultrasound ablation (HIFU) ascribes to residual hepatocellular carcinoma after TACE treatment．Methods 64 patients with residual hepatocellular carcinoma after TACE were treated by HIFU. The changes of MRI or CT and the AFP level between before and after HIFU were compared to evaluate HIFU effect. The liver enzymes including ATL, AST and γ-GT were tested for liver function evaluation. The nursing methods including skin nursing in pre-operation, operation and post-operation were used to reduce the possibility of HIFU?complication. Results There were significant difference respectively (t=4.25, t=4.23, t=2.64, t=2.54, P0.05) between the values of after HIFU ablation and before HIFU ablation (ALT(50.1±28.4) U/L vs (70.3±48.2) U/L, AST (50.2±30.7) U/L vs (70.4±51.3) U/L, γ-GT (73.8±54.1) vs (104.7±67.4) U/L, AFP (14.7ng/ml) ) vs (634.6ng/ml)). MRI or CT demonstrated tumor coagulation necrosis with disappearance of blood supply in the target region a