原发性肝癌患者行超声引导下经皮微波消融术后相关并发症的发生情况  

Severe complications after ultrasound-guided percutaneous microwave coagulation therapy for primary hepatic carcinoma

作　　者：李新慧[1] 冯志强[2] 张洪义[1] 吴迪[3] 赵刚[2] 汪鑫[2] 刘洋[2] 

机构地区：[1]安徽医科大学空军临床学院,合肥230023 [2]中国人民解放军空军总医院肝胆外科,北京100142 [3]中国人民解放军空军总医院超声科,北京100142

出　　处：《临床肝胆病杂志》2016年第1期72-75,共4页Journal of Clinical Hepatology

摘　　要：目的探讨超声引导下原发性肝癌(PHC)经皮微波消融术(PMCT)相关严重并发症的原因及防治对策。方法选取2012年1月-2014年12月中国人民解放军空军总医院肝胆外科收治的PHC患者652例,均在超声引导下行PMCT。观察患者PMCT术后相关并发症的发生情况,并比较2012、2013和2014年并发症发生的差异,总结防治对策。计数资料组间比较采用χ2检验。结果共18例患者出现PMCT相关严重并发症,发生率为2.76%,其中包括腹腔出血10例,肝脓肿2例,肠瘘1例,膈肌破裂2例,急性肾衰竭1例,肿瘤种植转移1例,心脑血管疾病1例;因并发症死亡1例,并发症相关病死率为5.56%(1/18);2012、2013和2014年PMCT相关并发症发生情况差异有统计学意义(χ2=11.78,P=0.003)。结论超声引导下PMCT总体上是安全的,但对于肝肿瘤部位特殊、肝硬化程度重、合并其他系统疾病者风险仍较大,严格掌握手术适应证,加强术前预防性治疗、术中规范性操作、术后严密观察患者病情变化能够显著降低PMCT并发症带来的不良后果。Objective To investigate the severe complications after ultrasound - guided percutaneous microwave coagulation therapy （ PM- CT） for primary hepatic carcinoma （PHC） and measures for prevention and treatment. Methods A total of 652 patients with PHC who were admitted to department of hepatobiliary surgery in Air Force General Hospital, PLA from January 2012 to December 2014 were selected, and ultrasound - guided PMCT was performed for all the patients. The occurrence of post - PMCT complications was observed and compared between the years 2012, 2013, and 2014. Measures for prevention and treatment were summarized. The ehi - square test was applied for comparison of categorical data between groups. Results A total of 18 patients experienced severe PMCT - related complications, with an incidence rate of 2.76%. These complications included intra - abdominal hemorrhage （ n = 10）, liver abscess （ n =2）, intestinal fistula （ n = 1 ） , diaphragmatic rupture （ n = 2 ）, acute renal failure （ n = 1 ）, tumor implantation metastasis （ n = 1 ）, and cardiovascular and cerebrovascular diseases （ n = 1 ）. One patient died of the complications above, and the complication - related mortality was 5.56% （ 1/18 ）. The incidence of PMCT- related complications showed a significant difference between 2012, 2013, and 2014 （X2 = 11.78, P = 0. 003 ）. Conclusion Ultrasound - guided PMCT is generally safe, but the patients with liver tumors in special sites, severe liver cirrhosis, and other systemic dis- eases still have a high risk. The indications for PMCT should be followed strictly, and enhancement in preoperative prophylactic treatment, standard intraoperative procedure, and careful postoperative observation can significantly reduce the adverse outcome caused by PMCT -re- lated complications.

关 键 词：肝肿瘤 导管消融术 手术后并发症 

分 类 号：R735.7[医药卫生—肿瘤]