【摘要】 目的分析微波消融(MWA)治疗肝脏恶性肿瘤并发症发生的原因及其防治措施。方法对328例肝脏恶性肿瘤患者进行MWA治疗,其中原发性肝癌298例[肝细胞肝癌286例,胆管细胞癌12例,病灶最大直径(2.3±1.1)cm],肝转移癌30例[来源于大肠癌16例,胰腺癌6例,胆囊癌3例,十二指肠乳头癌、乳腺癌、胃癌、胃间质瘤各1例,病灶最大直径(2.6±1.4)cm]。328例(655个病灶,经皮、腹腔镜、开腹)3种途径进行MWA治疗,治疗后定期随访。根据患者临床症状、影像学及血清学检查判断并发症的发生。结果 328例655个病灶共行391例次MWA治疗,平均每例次治疗1.7个病灶。312例次在超声引导下经皮完成治疗,20例次和5例次分别在开腹手术和腹腔镜手术辅助下完成治疗,54例次同时行肝切除或其他脏器切除联合治疗。328例中发生轻微并发症12例次,发生率3.1%(12/391,其中3例少量腹腔出血,2例消融灶液化,1例门静脉血栓,5例胸腔积液,1例皮肤烫伤);发生严重并发症11例次,发生率2.8%(11/391,2例腹腔出血,4例肝功能不全,2例膈疝,1例胆漏,2例顽固性胸腔积液);1例死亡,病死率0.3%(1/391)。结论 MWA治疗肝脏恶性肿瘤并发症少,易于耐受。合理地选择病例,采用适当的辅助方法有助于增加治疗的安全性。更多还原

【Abstract】 Objective To analyze the causes of the complications in treating hepatic malignant tumor with microwave ablation(MWA),and to explore the management for the complications.Methods Three hundred and twenty-eight patients were treated with MWA,including 298 cases of primary liver cancer and 30 cases of metastatic liver cancer.The average largest diameter of the two groups lesions was(2.3±1.1)cm and(2.6±1.4)cm,respectively.MWA was performed through percutaneous,laparoscopy or laparotomy approach.Follow-up examinations were performed regularly.Complications were identified by clinical symptoms,imaging techniques and serologic examinations.Results Three hundred and twenty-eight patients with 655 lesions(average,1.7 nodules)received MWA(391 procedures).MWA was performed by the percutaneous approach(312 cases),laparoscopy(5 cases),or open surgical treatment(74 cases).Minor complications occurred in 12(12/391,3.1%)patients,including:little bleeding(3 cases),ablated area liquefaction(2 cases),portal vein thrombosis(1 cases),pleural effusion(5 cases),and skin burn(1 case).Major complications occurred in 11(11/391,2.8%)patients,including:hemorrhage(2 cases),liver decompensation(4 cases),diaphragmatic hernia(2 cases),bile leak(1 case),and pleural effusion(2 cases).One death was encountered,and mortality rate was 0.3%(1/391).Conclusions MWA as a therapeutic technique for hepatic malignant tumor is a safe and well-tolerated with less complication method.The safety of the treatment can be raised by selecting patients properly and adopting assistant approach reasonably.更多还原