肝癌微波消融術后出血的原因和預防_《中國普外基礎與臨床雜志》

作者：

唐裕福 , 姜曉峰 , 趙宇 , 林琳 , 郭大偉 ,  梁健

中國醫科大學附屬第四醫院肝膽胰外科（沈陽 110032）;

關鍵詞：

微波消融肝癌出血預防

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導出 下載 收藏 掃碼 引用

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目的探討肝癌微波消融術后出血的原因和防治措施。方法回顧性總結我院2006年9月至2009年12月期間156例肝癌患者實施226次微波消融術的臨床資料，分析影響術后出血的危險因素。結果 226次微波消融術后共有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科止血治療，5例止血成功；其余6例內科止血無效后，1例經開腹手術止血成功，4例經股動脈肝動脈穿刺數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。單因素分析結果表明，合并肝硬變、血小板數量少、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生微波消融術后出血（P=0.044,0.041,0.028,0.001,0.016，0.016）。進一步的多因素logistic回歸分析結果表明，肝硬變、血小板數量、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）。結論肝癌微波消融術后出血相關因素主要包括：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；內科止血無效的情況下，在數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. 肝癌微波消融術后出血的原因和預防. 中國普外基礎與臨床雜志, 2010, 17(12): 1294-1298. doi: 復制

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，侯學忠，等. 肝癌微波治療術中出現血紅蛋白尿的影響因素 [J]. 現代腫瘤醫學, 2009; 17（3）： 504-507.
8.	肖朝輝，文天夫. 肝切除術后死亡因素及其防治 [J]. 中國普外基礎與臨床雜志， 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重或少見并發癥分析 [J]. 中國微創外科雜志, 2005; 5（4）： 268-270.
15.	鄭加生，李建軍，崔雄偉, 等. 肝動脈化療栓塞聯合CT引導下射頻消融術治療肝癌的療效分析 [J]. 介入放射學雜志, 2009; 18（5）: 324-327.
16.	李紹欽，倪才方，蔣國民, 等. 射頻消融聯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，嚴昆，戴瑩, 等. 肝腫瘤經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，侯學忠，等. 肝癌微波治療術中出現血紅蛋白尿的影響因素 [J]. 現代腫瘤醫學, 2009; 17（3）： 504-507.
8. 肖朝輝，文天夫. 肝切除術后死亡因素及其防治 [J]. 中國普外基礎與臨床雜志， 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重或少見并發癥分析 [J]. 中國微創外科雜志, 2005; 5（4）： 268-270.
15. 鄭加生，李建軍，崔雄偉, 等. 肝動脈化療栓塞聯合CT引導下射頻消融術治療肝癌的療效分析 [J]. 介入放射學雜志, 2009; 18（5）: 324-327.
16. 李紹欽，倪才方，蔣國民, 等. 射頻消融聯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，嚴昆，戴瑩, 等. 肝腫瘤經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.

《中國普外基礎與臨床雜志》

肝癌微波消融術后出血的原因和預防

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《中國普外基礎與臨床雜志》

肝癌微波消融術后出血的原因和預防

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