Vomiting in patients with liver cancer
Vomiting in patients with liver cancer, liver cancer patients complicated with upper gastrointestinal bleeding were more common situation, the majority of liver cancer patients before death were gastrointestinal bleeding, but the exact incidence is hard to estimate. HCC patients with upper gastrointestinal bleeding is one major cause of death. Cause of its occurrence and the following factors may = esophageal varices. portal hypertensive gastric mucosal lesions. coagulopathy. direct invasion of liver stomach, duodenum and so on. Treatment of hemorrhagic shock are mainly taken for the rescue measures. Include:
1. Non-surgical treatment:
(1) Initial treatment: calm bed, oxygen, fluid replacement, blood transfusion, bleeding, acid suppression, somatostatin and so on.
(2) vasopressin: make visceral small artery contraction, the dose is 20 units in 200ml 5% glucose solution drops finished 20-30 minutes, repeated every 4 hours. Portal vein pressure can drop by about 35%, more than half of patients can control the bleeding. In combination with nitroglycerin can reduce the side effects.
(3) endoscopic therapy: bleeding esophageal varices may be thrombin, alcohol, injected directly into the varicose veins to stop the bleeding, but the operation should be soft and cautious, without rendering the other varices, increased bleeding. Large amount of bleeding, often affect the vision, the operation more difficult, and difficult to completely stop the bleeding, so be careful selection of indications. When the bleeding arterial vessels larger than 4 mm in diameter, endoscopic therapy should not be used. The main complications: esophageal ulcer, stricture or perforation. Esophageal perforation is the most serious complications, although there is only 1%, but the mortality rate is as high as 50%. Endoscopic variceal ligation than sclerotherapy treatment operation is relatively simple and safe. Approach is endoscopic variceal ligation will be aspirated into the ligation device, the use of rubber band ligation of varicose veins in the base. Sclerotherapy and band ligation therapy for gastric variceal bleeding is not valid.
(4) three-cavity tube pressure: typically used for endoscopic treatment of vasopressin or per effective bleeding esophageal varices in patients. Three-cavity tube compression can make about 80% of esophageal varices bleeding under control, but about half of the patients with bleeding again immediately after emptying bag. Furthermore, even skilled doctors use balloon tamponade device, the incidence of complications 10% _20%, complications including aspiration pneumonia, esophageal rupture and suffocation. Therefore, application of three-cavity tube hemostasis of patients should be placed on care unit for monitoring. General three-cavity tube for 24 hours, such as bleeding stopped, they may first balloon esophageal emptying, gastric emptying after the balloon, and then observe 12_24 hours, as indeed has been bleeding, it will slowly pull out the tube. Placement period, every 12 hours, should airbag venting 10_20 minutes, if bleeding is refillable oppression. Storage time should not exceed 3_5 days, to prevent mucosal ulceration occurred too long under pressure, necrosis, perforation.
(5) Intervention: Transjugular intrahepatic portosystemic shunt (TIPS) can be used for esophageal and gastric venous bleeding from the sheets by the effect of drugs and endoscopic therapy element, liver decompensation (ChildC level) should not surgery . The complications include hepatic encephalopathy, stent stenosis or occlusion, liver metastasis. Mucosal lesions per effective drug treatment, they may consider intervention, selective insertion bleeding artery infusion of vasopressin, 0.2_0.4 units per minute, continuous 12_24 hours. Intervention can also be applied hemobilia caused by liver cancer, such as Selective hepatic artery embolization.
Vomiting in patients with liver cancer 2. Surgical treatment: liver function better, no yellow disease, severe ascites Yuan, Yuan effective conservative treatment of patients, surgical treatment should be considered, waiting to see may result in the occurrence of hepatic coma. Such patients generally can not tolerate liver resection, surgery should be fighting for local tumor treatment, simultaneously splenic artery ligation and left gastric artery and gastric coronary vein ligation. Hepatocellular carcinoma with upper gastrointestinal bleeding, the most severe liver dysfunction or disease later, although some patients had active treatment being the primary bleeding, but the long-term effect of poor prognosis.