PDF下载 ( 1663 KB)
Diagnosis and treatment of subcapsular hemorrhage after liver tumor ablation
-
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χ2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（χ2=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13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...Abstract: 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 ( χ2= 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 arterial hemorrhage or who do not respond to conservative treatment.
-
Key words:
- liver neoplasms /
- catheter ablation /
- hemorrhage /
- diagnosis /
- therapy
-
[1]ZHU JB, HUANG S.Application of fusion imaging navjgation system in local ablation for liver cancer[J].Clin J Med offic, 44 (2) :213-215. (in Chinese) 朱金彪, 黄枢.融合成像导航系统在肝癌局部消融中的应用[J].临床军医杂志, 2016, 44 (2) :213-215. [2]CUI RW, ZHU SG, FAN L, et al.Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma:a Meta-analysis[J/CD].Chin J Hepatic Surg:Electronic Edition, 2017, 6 (4) :280-284. (in Chinese) 崔瑞文, 朱曙光, 范磊, 等.射频消融与手术切除治疗早期肝细胞癌疗效比较Meta分析[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (4) :280-284. [3]AHMED M, SOLBIATI L, BRACE CL, et al.Image-guided tumor ablation:standardization of terminology and reporting criteria---a 10-year update[J].Radiology, 2014, 273 (1) :241-260. [4]SHIINA S, TATEISHI R, ARANO T, et al.Radiofrequency ablation for hepatocellular carcinoma:10-year outcome and prognostic factors[J].Am J Gastroenterol, 2012, 107 (4) :569-577. [5]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. [6] CHEN MH.Radiofrequency ablation in the treatment of liver cancer in the era of minimally invasive surgery[J].Chin J Dig Surg, 2009, 8 (1) :4-6. (in Chinese) 陈敏华.微创时代如何看待肝癌的射频治疗[J].中华消化外科杂志, 2009, 8 (1) :4-6. [7]Interventional Group, Chinese Society of Radiology, Chinese Medical Association.Expert consensus on standard therapeutic procedures of percutaneous radiofrequency ablation for liver tumor[J].Chin J Radiol, 2012, 46 (7) :581-585. (in Chinese) 中华医学会放射学分会介入学组.经皮肝脏肿瘤射频消融治疗操作规范专家共识[J].中华放射学杂志, 2012, 46 (7) :581-585. [8]ZHENG JS, LI JJ, CUI XW, et al.Therapeutic combination of hepatic arterial chemoembolization with CT-guided radiofrequency ablation for hepatocellular carcinoma:an analysis of curative effect[J].J Intervent Radiol, 2009, 5 (18) :324-327. (in Chinese) 郑加生, 李建军, 崔雄伟, 等.肝动脉化疗栓塞联合CT引导下射频消融术治疗肝癌的疗效分析[J].介入放射学杂志, 2009, 5 (18) :324-327. [9]SHENG SP, ZHENG JS, CUI SC, et al.Clinical features and treatment of hemobilia associated with liver tumor ablation therapy[J].Chin J Interv Imaging Ther, 2016, 13 (1) :3-6. (in Chinese) 生守鹏, 郑加生, 崔石昌, 等.肝肿瘤消融相关胆道出血的临床表现及治疗[J].中国介入影像与治疗学, 2016, 13 (1) :3-6. [10]Interventional Radiology Group, Editorial Board of Chinese Journal of Radiology, Chinese Medical Association.Regulations on standardization of interventional treatment of liver cancer (draft) [J].Chin J Radiol, 2001, 35 (12) :887-891. (in Chinese) 中华医学会中华放射学杂志编委会介入放射学组.肝癌介入治疗规范化条例 (草案) [J].中华放射学杂志, 2001, 35 (12) :887-891. [11]ZHAO GS, XU K, LIANG SN, et al.Causes and prevention of serious complication after transcatheter arterial chemoembolization for primary hepatic carcinoma[J].J Intervent Radiol, 2008, 17 (11) :773-775. (in Chinese) 赵广生, 徐克, 梁松年, 等.原发性肝癌TACE术后严重并发症原因及预防[J].介入放射学杂志, 2008, 17 (11) :773-775. -
本文二维码
计量
- 文章访问数: 2779
- HTML全文浏览量: 62
- PDF下载量: 508
- 被引次数: 0
下载:
