肝脏恶性肿瘤腹腔镜下射频消融术后并发静脉血栓的回顾性研究  

The complicated venous thrombosis of hepatic malignant tumors post laparoscopic RFA: A retrospective study

作　　者：刘长春[1] 董景辉[1] 安维民[1] 马威[1] 王斌 刘春燕 王仁贵[2] 董健[2] LIU Chang-chun;DONG Jing-hui;AN Wei-min(Department of Radiotherapy,The 302th Hospital of PLA,Beijing 100039,China.)

机构地区：[1]解放军第302医院放射科,北京100039 [2]首都医科大学附属北京世纪坛医院放射科,北京100038

出　　处：《中国医学装备》2018年第6期79-83,共5页China Medical Equipment

摘　　要：目的:对比分析肝脏恶性肿瘤腹腔镜下射频消融(RFA)术后并发静脉血栓的分布和血清学指标,总结其发生的部位、分布及血清学检查结果的特点。方法:选取94例因肝脏恶性占位而行腹腔镜下RFA术的患者资料进行回顾性分析,按RFA术后是否发生静脉血栓而分为阴性组(68例)和阳性组(26例)。所有患者均于术前1周内行MR增强检查和术后3 d内CT增强检查,分别比较两组患者的年龄、性别、肝硬化Child-Pugh分级、病灶大小、术后消融坏死区大小以及血清学检查结果。结果:在阳性组26例并发静脉血栓患者中,仅分布于门静脉及远端分支15例(占16.0%),仅分布于肝静脉及其亚段及远端7例(占7.4%),同时累及门静脉及肝静脉系统内4例(占4.3%)。血栓阳性组术后坏死区最大径为(7.05±1.4)cm,明显大于阴性组的(5.87±1.3)cm;丙氨酸氨基转移酶(ALT)和谷氨酸氨基转移酶(AST)明显高于阴性组,其差异有统计学意义(t=2.56,t=4.23;P<0.05);白蛋白、胆红素及胆碱酯酶等其他各项指标差异均无统计学意义。结论:腹腔镜下RFA术后并发症静脉血栓分布于门静脉、肝静脉或同时累及两者,发生部位于RFA所在的肝段和肝叶,具有可自行吸收和机化而无需积极干预的特点。Objective： To compare and analyze the distribution of complicated venous thrombosis of hepatic malignant tumors post laparoscopic radiofrequency ablation（RFA） and serological indicators, and summarize the position, distribution and characteristics of serological examination. Methods： The documents of 94 patients with hepatic malignant tumors who once received laparoscopic RFA were implemented retrospective analysis, and all of them were divided into negative group（68 cases） and positive group（26 cases） according to whether occurred venous thrombosis. And MR enhanced examination within 1 week pre-operation and CT enhanced examination of the 3 rd d post operation were implemented on each patient. And then, the age, gender, Child-Pugh grade of hepatic sclerosis, size of lesions, range of ablation necrosis post operation and serological results were further compared, respectively. Results： In 26 patients with complicated venous thrombosis of positive group, the venous thrombosis only distributed at portal vein and far-end branch of 15 cases（16.0%）, and it only distributed at hepatic vein and its sub-segment of 7 cases（7.4%）. At the same time, it implicated portal vein and hepatic vein system in 4 cases（4.3%）. And the maximum diameter of necrosis range of positive group [（7.05±1.4） cm ]was significant larger than that of negative group [（5.87±1.3） cm]. And the results of ALT and AST of positive group were significantly larger than that of negative group（t=2.56, t=4.23, P〈0.05）, respectively. And the differences of albumin, billirubin, cholinesterase and other various indicators were not significant between the two groups. Conclusion： The complicated venous thrombosis post laparoscopic RFA distributes at portal vein and hepatic vein, or it implicates both venous systems at the same time. And its occurred position was at hepatic segments and hepatic lobe of implementing RFA. And its characteristics were self-absorption and spontaneously organization and it doesn＇t need a

关 键 词：肝脏 恶性肿瘤 射频消融 腹腔镜 静脉血栓 

分 类 号：R735.7[医药卫生—肿瘤]