| 摘要: |
| 目的:分析原发性肝癌射频消融后针道出血的影响因素,总结针道出血的预防及处理经验,提高防治水平。方法:回顾1999年12月至2008年1月间我院1 567例次原发性肝癌患者射频消融的临床资料,分析发生针道出血患者的影响因素,总结防治经验。结果:1 567例次射频消融后共有与穿刺损伤有关的针道出血17例,针道出血发生率1.08%。单因素分析显示射频前肝硬化较重、血小板计数低于正常、凝血酶原时间（PT）明显延长、位于包膜下及使用注水式射频电极者更容易发生射频后针道出血(P分别为0.012、0.039、0.023、0.032、0.016)。Logistic多因素回归分析则显示,射频前的血小板计数和PT值、肝硬化程度以及肿瘤部位是针道出血的独立影响因素(分别为OR=4.032,P=0.040;OR=5.611,P=0.009;OR=3.871,P=0.046及OR=5.216,P=0.026)。17例针道出血中,5例仅接受内科药物止血,10例经股动脉穿刺行肝动脉造影栓塞止血,4例行开腹手术止血。共13例存活,4例死亡。结论:对于存在严重肝硬化、凝血机制障碍、位于包膜下等针道出血高危因素者应严格把握适应证,射频后密切观察病情;DSA下血管栓塞或外科手术止血是伴有肝硬化的原发性肝癌患者射频消融后针道出血安全而有效的处理方法。 |
| 关键词: 射频消融 肝肿瘤；肝细胞癌 针道出血 危险因素 预防和处理 |
| DOI：10.3724/SP.J.1008.2008.01360 |
| 投稿时间：2008-02-12修订日期：2008-05-08 |
| 基金项目: |
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| Needle-tract bleeding after percutaneous radiofrequency ablation for hepatocellular carcinomas: risk factors,prevention and treatment |
| ZHAI Bo1,LIU Sheng1,LI Xiao-yan1,CHEN Yi1,XU Ai-min2,ZHAO Jun3* |
| (1.Department of Ultrasonic Intervention,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China;2.Department of Radio-intervention,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438;3.Department of Biliary Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438) |
| Abstract: |
| Objective:To analyze the risk factors,prevention and treatment of needle-tract bleeding after percutaneous image-guided radiofrequency ablation (PRFA) for hepatocellular carcinomas (HCC).Methods: A total of 1 567 RFA sessions were performed on 1 203 patients with 3 067 focuses of hepatocellular carcinoma between December 1999 and January of 2008.The clinical data of patients suffering from needle-tract bleeding were analyzed for risk factors,prevention,and treatment.Results: Seventeen (1.08%,17/1 567) patients developed needle-tract bleeding.Univariate analysis showed that the incidence of needle-tract bleeding was significantly correlated with the lower platelet count,prolongation of prothrombin time,the degree of liver cirrhosis,subcapsular HCCs and pattern of RF needle electrode (P=0.039; P=0.023; P=0.012; P=0.032 and P=0.016,respectively).Logistic regression model found that only lower platelet count,prolongation of prothrombin time,degree of liver cirrhosis and subcapsular HCCs were the independent risk factors for needle-tract bleeding after PRFA in patients with hepatocellular carcinoma (OR=4.032,P=0.040;OR=5.611,P=0.009;OR=3.871,P=0.046 and OR=5.216,P=0.026,respectively).Of the 17 patients 5 received only medicine therapy in the internal department,4 received surgery and 10 received transcatheter embolization.Thirteen patients survived and 4 died.Conclusion: It is indicated that prolongation of prothrombin time,lower platelet count,sub-capsular HCCs and pattern of RF needle electrode can influence the needle-tract bleeding after PRFA in hepatocellular carcinoma patients.The most effective methods to control the bleeding are transcatheter embolization and DSA or surgery for HCC patients after PRFA. |
| Key words: radiofrequency ablation liver neoplasms hepatocellular carcinoma risk factors prevention and treatment |
