射频消融肝脏恶性肿瘤并发症的防治  

Prevention and treatment for complications of radiofrequency ablation for hepatic malignancy

作　　者：张智坚[1] 吴孟超[1] 陈汉[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海200438

出　　处：《中国微创外科杂志》2005年第2期113-115,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：上海市科学技术发展基金资助项目(014119043)

摘　　要：目的探讨肝恶性肿瘤射频消融术中、术后并发症的预防和治疗. 方法 1999年10月～2003年3月,353例经病理和临床证实为原发性肝癌、继发性肝恶性肿瘤者进行452例次射频消融治疗,其中经皮肝穿刺治疗344例,开腹术中进行9例.未手术原发性肝癌198例,肝癌术后复发81例,继发性肝恶性肿瘤74例.定期随访,了解与手术相关的近、远期并发症. 结果发生并发症12例,其中电极皮肤灼伤2例,气胸1例,右胸腔积液1例,腔静脉血栓1例,右肝管损伤狭窄1例,胃损伤外瘘1例,肝左外叶胆管外瘘1例,单纯肝脓肿1例,肝脓肿致升结肠外瘘1例,肝脓肿致十二指肠、肝、右胸腔内瘘1例,内出血1例.并发症发生率2.65%(12/452),并发症相关死亡率8.33%(1/12). 结论射频消融是一种微创治疗,但对于肝门区、肝表面和与空腔脏器贴近的部位,尤其是有腹腔手术史且空腔脏器与肝脏相粘连者,经皮肝穿刺射频治疗有一定危险性.术前适应证选择恰当,术中仔细操作,术后加强监护、预防感染、止血等,一些并发症是可以有效预防和治疗的.Objective To study the prevention and treatment of intra- or post- operative complications of radiofrequency ablation (RFA) for hepatic malignancy. Methods A series of 353 patients with primary hepatic carcinoma or secondary hepatic malignancy verified by pathological examinations and clinical manifestations underwent 452 times of RFA between October 1999 and March 2003, including 344 cases of percutaneous RFA and 9 cases of RFA during open surgery. There were 198 cases of primary hepatic carcinoma previously unoperated, 81 cases of recurrent hepatic carcinoma after surgery, and 74 cases of secondary hepatic malignancy. All the patients were followed up to make out short- or long-term surgical complications. Results Complications happened in 12 cases: skin burn by the electrode (2 cases), pneumothorax (1 case), right hydrothorax (1 case), vena cava thrombus (1 case), right bile duct injury and stricture (1 case), gastric external fistula (1 case), bile leakage in the left lateral lobe of the liver (1 case), hepatic abscess (1 case), external fistula of the ascending colon resulted from hepatic abscess (1 case), internal fistula of the duodenum, liver and right thorax resulted from hepatic abscess (1 case), and intra-abdominal hemorrhage (1 case). The incidence of complication was 2 65% (12/452) and the complication-related mortality was 8 33% (1/12). Conclusions RFA is a kind of minimally invasive procedure. But RFA especially percutaneous RFA may involve some risks for patients with the tumor located at the porta hepatic or the surface of the liver, or adhered to hollow organs, especially those who had a history of abdominal operation and adhesions of hollow viscera to the liver. Some complications can be prevented and effectively treated in the event of proper selection of patients, careful performance during the surgery, intensive postoperative care, effective hemostasia and efficient infection prevention.

关 键 词：并发症 肝恶性肿瘤 射频消融 肝脓肿 术中 预防和治疗 肝脏恶性肿瘤 右胸腔 原发性肝癌 继发性 

分 类 号：R735.705.4[医药卫生—肿瘤]