【作者】 陈晓明； 罗鹏飞； 陆骊工； 李勇； 胡宝山；

【Author】 Chen Xiao-Ming Luo Peng-Fei Lu Li-Gong Li Yong Hu Bao-Shan Department of Oncology Intervention, Cancer Center, Guangdong Provincial People Hospital, Guangzhou, Guangdong,510080, P.R China

【机构】 广东省人民医院肿瘤中心介入治疗科；

【摘要】 目的:物理消融在肝癌的治疗中占有极其重要的地位,不过,迄今为止有关肝癌物理消融治疗的疗效报道较多, 并发症报道较少。本项目拟探讨肝癌物理消融治疗中的副反应与并发症及其预防措施。方法:216例原发性肝癌,肿瘤大小3-12cm,平均7．8cm,肝功能Child A级136例,B级 8 0例。2 1 6例均行经导管肝动脉碘油化疗药乳剂栓塞 (TOCE)治疗1～3次后再接受物理消融治疗,其中激光治疗75例,射频治疗68例,微波治疗73例,行一次物理消融者71例,2次者87例,3次者42例,4～7次者16例,2次物理消融之间的间隔时间为1w～2m,平均2w。结果:所有患者术中均有不同程度出汗、肝区疼痛,少数出现脉搏缓慢。与射频有关的并发症包括肝包膜下血肿1例,膈肌穿孔并胸腔积液1例,肝脓肿1例,与微波有关的并发症包括肝功能严重受损1例,皮下组织烧伤坏死合并感染1例,穿刺针道种植 1例,没有发现与激光有关的并发症。结论:术中副反应主要与迷走神经反射有关。大多数并发症的发生与消融范围过大,损伤了周围正常组织有关,正确选择病人和消融方式、固定好消融针、术前预防用药等措施可望减少并发症发生。更多还原

【Abstract】 Objective: Physical ablations have been becoming more and more popular in the treatment of hepatocellular carcinoma (HCC). However, the reports of the efficacy of physical ablation for HCC were numerous so far, but the reports of complications were few. The purpose of this study was to investigate the adverse reactions and complication as well as their preventive and therapeutic measures of physical ablation for treatment of hepatocellular carcinoma (HCC). Methods: Tow hundreds sixteen cases of HCC with the range of the largest diameter from 3 to 12 cm underwent physical ablation after they received transcatheter hepatic artery embolization using the emulsion of lipiodol and anti-tumor drugs 1--3 times. Classification of liver function of 216 patients were Child A in 136 and Child B in 80 respectively. Mothods of physical treatment included laser ablation in 75 patients, roadiofrequency ablation (RFA) in 68 patients and microswave ablation (MA) in 73 patients. 71 patients received one ablation session and 87 patients did two sessions and 42 patients did 3 sessions and 16 patients did 4 to 7 sessions. The interval of each sessions was one week to two months, averaging two weeks. Results: All patients suffered from sweating and hepatlgia during physical ablation and minority patients companied with slow pulse. The complications concering with RFA included subcapsular hemorrhage of liver (n=1), diaphragm perforation and hydrops of thoracic cavity (n=1) and abscess of liver (n=1). The complications concerning with MA included significant damage of h’ver function (n=1), The burn and infection of subcutaneous soft tissue (n=1) and implantation metastasis along puncture path (n=1). No complication concerning with LA occurred. Conclusion: The adverse reactions during ablation are associated with vagus reflex. Majority of complications are associated with expanding of ablation range resulting in the injury of normal tissues. Right choice of patients and ablation way and fixing of ablation and preoperative use of medicine may reduce or avoid the occurrence of the complications.更多还原