肝肿瘤消融术后肝包膜下出血的诊断与治疗  

Diagnosis and treatment of subcapsular hemorrhage after liver tumor ablation

作　　者：鹿宁宁[1] 孙斌[1] 崔雄伟[1] 龙江[1] 高文峰[1] 郑加生[1] 

机构地区：[1]首都医科大学附属北京佑安医院肿瘤介入治疗中心,北京100069

出　　处：《临床肝胆病杂志》2017年第12期2326-2330,共5页Journal of Clinical Hepatology

摘　　要：目的研究肝肿瘤消融术所致肝包膜下出血的诊断与治疗。方法回顾性分析2016年1月-2017年7月首都医科大学附属北京佑安医院行CT引导下肝肿瘤微波/射频消融术患者1596例,消融术后肝包膜下出血患者20例。收集20例患者的临床资料,分析其诊断方法、治疗方案及预后。计量资料组间比较采用χ~2检验。结果行微波消融术638例患者中术后发生肝包膜下出血患者10例(1.57%),射频消融术958例患者中术后发生肝包膜下出血患者10例(1.04%),两组之间该并发症发生率的差异无统计学意义(χ~2=0.848,P=0.357)。20例患者中17例术后即刻增强CT见造影剂外溢,3例患者术后即刻增强CT为阴性,术后24 h内发现出血,急诊CT明确诊断后行经导管动脉栓塞治疗(TAE)。20例出血患者中2例同时合并胆囊内出血;19例行TAE治疗,其中6例患者血管造影可见明显造影剂渗漏。治疗后随访1~3个月20例患者均恢复良好,无死亡病例。结论肝包膜下出血为消融术后严重并发症之一,术后即刻增强CT能及时发现大多数出血,少量出血可先行对症保守治疗,活动性动脉出血及保守治疗无效的大量出血应尽早行TAE。Objective To investigate the diagnosis and treatment of subcapsular hemorrhage caused by liver tumor ablation. Methods A retrospective analysis was performed for the clinical data of 1596 patients who underwent CT-guided liver tumor microwave/radiofrequency ablation in Beijing You An Hospital,Capital Medical University,from January 2016 to July 2017,and among these patients,20 experienced subcapsular hemorrhage after ablation. The clinical data of the 20 patients were collected,and their diagnostic method,treatment regimen,and prognosis were analyzed. The chi-square test was used for comparison of categorical data between groups. Results Among the 638 patients who underwent microwave ablation,10 experienced subcapsular hemorrhage,resulting in an incidence rate of 1. 57%; among the 958 patients who underwent radiofrequency ablation,10 experienced subcapsular hemorrhage,resulting in an incidence rate of 1. 04%; there was no significant difference in the incidence rate of this complication between the two groups（ χ^2= 0. 848,P = 0. 357）. Among the 20 patients,17 were found to have spillage of the contrast media on contrast-enhanced CT immediately after ablation; 3 had negative findings on contrast-enhanced CT immediately after ablation and were found to have hemorrhage within 24 hours after ablation,and transcatheter arterial embolization（ TAE） was performed after a definite diagnosis was made by emergency CT. Of all 20 patients with hemorrhage,2 were complicated by gallbladder hemorrhage; 19 underwent TAE,among whom 6 had the leakage of the contrast agent on angiography. The patients were followed up for 1-3 months,and all of them recovered well; there were no deaths. Conclusion Subcapsular hemorrhage is one of the serious complications after liver tumor ablation,and contrast-enhanced CT immediately after ablation can find most cases of bleeding. Patients with mild hemorrhage can be given symptomatic and conservative treatment first,and TAE should be performed as early as possible for patients with active

关 键 词：肝肿瘤 导管消融术 出血 诊断 治疗 

分 类 号：R735.7[医药卫生—肿瘤]