微波消融治疗7403例肝癌的严重并发症  

Severe complications after microwave ablation in 7 403 cases with liver cancer

作　　者：王延明[1] 王能[1] 许赟[1] 沈强[1] 钱国军[1] 

机构地区：[1]第二军医大学东方肝胆外科医院微创一科,上海200438

出　　处：《中华肝胆外科杂志》2016年第10期655-660,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究肝癌微波消融术后严重并发症及其危险因素。方法利用电子病历系统，回顾性分析2010年1月至2015年11月进行微波消融治疗的肝癌患者，记录术后严重并发症情况，探讨发生严重并发症的危险因素。结果7403例肝癌患者共进行12558次微波消融，严重并发症发生率为1．3％（96／7403），死亡率为0．07％（5／7403）。其中肝脓肿34例（0．46％），胸腔积液20例（0．27％），胆道损伤15例（0．2％），出血6例（0．08％），肝功能衰竭6例（0．08％），邻近器官损伤5例（0．07％），腹壁肿瘤种植2例，脓胸2例，腹腔积液伴感染1例，术后心跳呼吸骤停1例，脉管血栓1例，肾功能不全1例，2例术后并发其他脏器疾病复发。单因素分析显示转移性肝癌和更早治疗年份是并发症发生的危险因素。结论微波消融是一种安全有效的肝癌局部治疗方法，肝脓肿是最常见的术后严重并发症。并发症的发生与操作者经验、肿瘤类型有关，与术前曾进行消融次数无关。通过适当的措施可有效减少发生严重并发症的风险。Objective To identify the types, frequency and risk factors of major complications u- sing microwave ablation （MWA） to treat liver malignancies in a single center. Methods Using the elec- tronic medical record system, patients with liver cancer who were treated with MWA from January 2010 to November 2015 were retrospectively studied, and the risk factors of severe complications were analyzed. Re- suits Of the 7 403 patients who were treated with MWA （ 12 558 ablations）. 96 cases experienced severe complications （ 1.3% ） and 5 patients died （0. 07% ） . The complications included liver abscess （ n = 34, 0.46% ） , pleural effusion （ n = 20, 0. 27% ）, bile duct injury （ n = 15, 0. 20% ） , hemorrhage （ n = 6, 0. 08% ） , liver failure （ n = 6, 0.08% ） , extrahepa-tic organ injuries （ n = 5, 0.07% ） , cancerous cells im- plantation of abdominal walls （ n = 2） , cardiac arrest （ n = 1 ） , vascular thrombosis （ n = 1 ） , renal insuffi- ciency （ n = 1 ） , and patients with other associated diseases which developed after the MWA therapy （ n = 2 ）. Metastatic liver cancer and earlier treatment of MWA sessions were associated with a higher major com- plication rate （P 〈 0.05）. Conclusions MWA is a well-tolerated local treatment for liver cancer, with an acceptably low incidence of severe complications. Liver abscess was the most common postoperative severe complication. The surgeons＇ experience and tumor type were associated with the incidence of severe compli- cations, however, not relavant with the frequency of preoperative ablations. Appropriate measures can be taken to effectively reduce the risk of serious complications.

关 键 词：肝癌 微波消融 肝脓肿 并发症 

分 类 号：R735.7[医药卫生—肿瘤]