目的 探討肝癌微波消融術(shù)后出血的原因和防治措施。方法 回顧性總結(jié)我院2006年9月至2009年12月期間156例肝癌患者實施226次微波消融術(shù)的臨床資料,分析影響術(shù)后出血的危險因素。結(jié)果 226次微波消融術(shù)后共有11例次(11例患者)出血,出血率為4.87%,其中膽道出血2例,腹腔出血9例。所有出血患者均首先接受內(nèi)科止血治療,5例止血成功; 其余6例內(nèi)科止血無效后,1例經(jīng)開腹手術(shù)止血成功,4例經(jīng)股動脈肝動脈穿刺數(shù)字減影動脈造影下予以明膠海綿封堵止血成功,1例因大出血死亡。單因素分析結(jié)果表明,合并肝硬變、血小板數(shù)量少、凝血酶原時間延長、腫瘤位于肝臟表面、Child-Pugh B/C級及再次行微波消融的肝癌患者更容易發(fā)生微波消融術(shù)后出血(P=0.044,0.041,0.028,0.001,0.016,0.016)。進一步的多因素logistic回歸分析結(jié)果表明,肝硬變、血小板數(shù)量、凝血酶原時間、腫瘤位置及肝功能分級是影響微波消融術(shù)后出血的獨立因素(OR=5.273,P=0.036; OR=8.534,P=0.043; OR=4.893,P=0.045; OR=7.747,P=0.010; OR=6.882,P=0.015)。結(jié)論 肝癌微波消融術(shù)后出血相關(guān)因素主要包括: 肝癌合并肝硬變、凝血功能異常(包括血小板數(shù)量異常和凝血酶原時間異常)、腫瘤在肝臟表面及肝功能較差; 內(nèi)科止血無效的情況下,在數(shù)字減影動脈造影下封堵止血是有效的止血方法。
引用本文: 唐裕福,姜曉峰,趙宇,林琳,郭大偉,梁健. 肝癌微波消融術(shù)后出血的原因和預(yù)防. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1294-1298. doi: 復(fù)制
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1. | Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178. |
2. | Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454. |
3. | Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337. |
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5. | Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137. |
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7. | 郭大偉, 魏云濤, 侯學(xué)忠, 等. 肝癌微波治療術(shù)中出現(xiàn)血紅蛋白尿的影響因素 [J]. 現(xiàn)代腫瘤醫(yī)學(xué), 2009; 17(3): 504-507. |
8. | 肖朝輝, 文天夫. 肝切除術(shù)后死亡因素及其防治 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(2): 143-146. |
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10. | Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26. |
11. | Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451. |
12. | 戴瑩, 陳敏華. 射頻消融在肝腫瘤治療中的并發(fā)癥 [J]. 中華外科雜志, 2004; 42(19): 1193-1195. |
13. | 翟博, 徐愛民, 盛月紅, 等. 肝癌射頻消融后針道出血防治21例 [J]. 世界華人消化雜志, 2008; 16(21): 2423-2427. |
14. | 夏景林, 任正剛, 葉勝龍, 等. 肝癌射頻消融治療嚴(yán)重或少見并發(fā)癥分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5(4): 268-270. |
15. | 鄭加生, 李建軍, 崔雄偉, 等. 肝動脈化療栓塞聯(lián)合CT引導(dǎo)下射頻消融術(shù)治療肝癌的療效分析 [J]. 介入放射學(xué)雜志, 2009; 18(5): 324-327. |
16. | 李紹欽, 倪才方, 蔣國民, 等. 射頻消融聯(lián)合肝動脈栓塞治療兔肝癌的安全性 [J]. 世界華人消化雜志, 2008; 16(32): 3677-3680. |
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18. | Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]. Ann Surg Oncol, 2005; 12(8): 616-628. |
19. | Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209. |
20. | Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271. |
21. | 陳敏華, 嚴(yán)昆, 戴瑩, 等. 肝腫瘤經(jīng)皮射頻消融治療中腹腔出血的處理-附3例臨床報告 [J]. 中華外科雜志, 2004; 42(17): 1083-1084. |
22. | Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403. |
23. | Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134. |
24. | Carrafiello G, Laganà D, Ianniello A, et al. Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]. Eur J Radiol, 2007; 61(2): 351-355. |
25. | Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869. |
- 1. Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178.
- 2. Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454.
- 3. Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337.
- 4. Murakami R, Yoshimatsu S, Yamashita Y, et al. Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation [J]. AJR Am J Roentgenol, 1995; 164(5): 1159-1164.
- 5. Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137.
- 6. Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives [J]. J Chin Med Assoc, 2005; 68(4): 155-159.
- 7. 郭大偉, 魏云濤, 侯學(xué)忠, 等. 肝癌微波治療術(shù)中出現(xiàn)血紅蛋白尿的影響因素 [J]. 現(xiàn)代腫瘤醫(yī)學(xué), 2009; 17(3): 504-507.
- 8. 肖朝輝, 文天夫. 肝切除術(shù)后死亡因素及其防治 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(2): 143-146.
- 9. Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J]. Liver Transpl, 2004; 10(2 Suppl 1): S39-S45.
- 10. Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26.
- 11. Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451.
- 12. 戴瑩, 陳敏華. 射頻消融在肝腫瘤治療中的并發(fā)癥 [J]. 中華外科雜志, 2004; 42(19): 1193-1195.
- 13. 翟博, 徐愛民, 盛月紅, 等. 肝癌射頻消融后針道出血防治21例 [J]. 世界華人消化雜志, 2008; 16(21): 2423-2427.
- 14. 夏景林, 任正剛, 葉勝龍, 等. 肝癌射頻消融治療嚴(yán)重或少見并發(fā)癥分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5(4): 268-270.
- 15. 鄭加生, 李建軍, 崔雄偉, 等. 肝動脈化療栓塞聯(lián)合CT引導(dǎo)下射頻消融術(shù)治療肝癌的療效分析 [J]. 介入放射學(xué)雜志, 2009; 18(5): 324-327.
- 16. 李紹欽, 倪才方, 蔣國民, 等. 射頻消融聯(lián)合肝動脈栓塞治療兔肝癌的安全性 [J]. 世界華人消化雜志, 2008; 16(32): 3677-3680.
- 17. Yu HC, Cheng JS, Lai KH, et al. Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy [J]. World J Gastroenterol, 2005; 11(10): 1439-1444.
- 18. Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]. Ann Surg Oncol, 2005; 12(8): 616-628.
- 19. Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209.
- 20. Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271.
- 21. 陳敏華, 嚴(yán)昆, 戴瑩, 等. 肝腫瘤經(jīng)皮射頻消融治療中腹腔出血的處理-附3例臨床報告 [J]. 中華外科雜志, 2004; 42(17): 1083-1084.
- 22. Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403.
- 23. Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134.
- 24. Carrafiello G, Laganà D, Ianniello A, et al. Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]. Eur J Radiol, 2007; 61(2): 351-355.
- 25. Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869.