射频消融治疗肝癌严重并发症原因分析及其防治方法探讨  

A discussion of reasons and methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas

作　　者：张登科[1] 纪建松[1] 涂建飞[1] 赵中伟[1] 范晓希[1] 应希慧[1] 吴发宗[1] 宋晶晶[1] 陈丽[1] 杨伟斌[1] 

机构地区：[1]浙江大学丽水医院,温州医科大学附属第五医院介入诊疗中心,323000

出　　处：《中华放射学杂志》2016年第3期213-216,共4页Chinese Journal of Radiology

基　　金：浙江省重大科技专项重大社会发展项目（2013C03010）;浙江省科技厅公益项目（2010C33113）

摘　　要：目的了解射频消融治疗肝癌严重并发症的发生原因，探讨其防治措施。方法对我院2009年6月至2014年11月410例巴塞罗那分期为A、B期的原发性肝癌患者行504例次肝内病变射频消融治疗，回顾分析严重并发症发生的原因，然后总结分析其防治策略。结果504例次射频消融治疗，共出现穿刺损伤引起大出血2例，2例肿瘤靠近肝包膜。热消融损伤胆囊引起胆汁性腹膜炎1例，肿瘤最大径5cm，紧贴胆囊。针道消融不彻底引起针道肿瘤种植转移2例，1例位于肝包膜下；1例针道消融温度不够。肿瘤爆发生长2例，1例肿瘤部分位于肝包膜外，靠近门静脉；1例患者肿瘤最大径12cm，肿瘤血供丰富。肝脓肿2例，1例肿瘤靠近升结肠，1例合并糖尿病。热消融损伤引起结肠穿孔1例，肿瘤位于肝右后叶下段，毗邻升结肠。严重并发症发生比率为1．98％（10／504）。结论肝癌射频消融严重并发症发生率较低，引起严重并发症的主要原因有穿刺直接损伤、热辐射损伤、肿瘤靠近大血管、肿瘤临近胆囊及肠腔、肿瘤血供丰富、穿刺道未经过正常肝组织、肝功能评分差、机体免疫力差、合并糖尿病等。术前评估患者基础情况、术中选择合适穿刺通道，如肿瘤靠近重要血管、肠腔、胆囊者控制消融范是避免及减少严重并发症发生的关键。Objective To investigate the reasons and the methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas. Methods A total of 410 patients with BCLC at A or B stage of hepatocellular carcinomas in our hospital were enrolled between November 2014 and June 2009. These patients underwent a total of 504 times radiofrequency ablations for the treatments of liver lesions. This retrospective study analysed the reasons and the strategies of prevention and cure for the serious complications. Results In the patients with a total of 504 times radiofrequency ablations, 2 patients had massive hemorrhage caused by puncture injuries, 2 patients had the tumors which were close to the liver capsules and 1 patient had bile peritonitis caused by the injury of thermal ablation on the gallbladder. The maximum diameter of tumor was 5 cm. That tumor was close to the gallbladder. 2 patients had needle tract metastases caused by incompletely needle path ablations. 1 of the 2 patients had a tumor near the liver capsule, and the other patient had nn-enough temperature for needle path ablation. Tumor outbreaks were happened in 2 patients. 1 of the 2 patients had a tumor which was located in the liver capsule and close to the portal vein. The other patient had a 12 cm diameter tumor with rich blood supplement. 2 patients had liver abscesses. 1 of the 2 patients had a tumor near the ascending colon, and the other patient had diabetes. 1 patient had colonic perforation caused by thermal ablation. The tumor in that patient was located in the right hepatic lobe segment and adjacent to the ascending colon. The incidence of serious complications was 1.98% （10/504）. Conclusions The incidence of the serious complications of radiofrequency ablations for the treatments of hepatocellular carcinomas is relatively low. The main reasons for the serious complications were direct injuries caused by punctures, heat radiation injuries, tumors adjacent to large blood vessels, gallbladde

关 键 词：癌 肝细胞 消融技术 手术后并发症 诊断 临床方案 

分 类 号：R735.7[医药卫生—肿瘤]