Giorgio Antonio, Tarantino Luciano, de Stefano Giorgio, Francica Giampiero, Esposito Francesco, Perrotta Anna, Aloisio Vincenza, Farella Nunzia, Mariniello Nicola, Coppola Carmine, Caturelli Eugenio
Interventional Ultrasound Service, D. Cotugno Hospital, Naples, Italy.
J Ultrasound Med. 2003 Feb;22(2):193-205. doi: 10.7863/jum.2003.22.2.193.
To analyze the complications of diagnostic and therapeutic sonographically guided interventional procedures of focal liver lesions observed during a 22-year period in a single center.
Complications of sonographically guided diagnostic and therapeutic procedures on focal liver lesions, observed during a 22-year period in a single center, were reviewed. From 1979 to 2001, 13,222 patients (age range, 7-89 years; mean, 59 years; 8,688 male and 4,534 female) with 13,777 focal liver lesions underwent 16,648 sonographically guided biopsies and 3,035 therapeutic procedures: pyogenic and amebic abscess aspiration, ethanol injection of hydatid liver cysts, and percutaneous ablative treatments (ethanol injection in either multiple or one-shot sessions, radio frequency ablation, and interstitial laser photocoagulation) of primary and secondary liver tumors.
The overall mortality was 0.06%. No death or major complication occurred after diagnostic procedures and liver abscess drainage. In the therapeutic group mortality was 0.6%: 1 patient died of anaphylactic shock during treatment of a hydatid cyst; 7 patients died after liver tumor ablation with ethanol injection (6 after one-shot treatments and 1 after multisession treatments). Major complications after liver tumor ablative procedures included 10 cases of acute liver failure, 2 cases of acute tubular necrosis, 2 cases of self-limiting hemoperitoneum, 2 cases of paralytic ileum, 2 abscesses, and 1 case of cholangitis. One case of a biliary cyst fistula and 1 case of intracystic hemorrhage occurred after treatment of hydatid liver cysts.
Sonographically guided diagnostic biopsy of focal liver lesions and liver abscess drainage are safe procedures. In contrast, liver tumor ablation procedures have a low but definite risk of mortality and major complications. Puncture of hydatid cysts must be performed only in institutions that can treat anaphylactic shock.
分析在单一中心22年期间观察到的超声引导下局灶性肝病变诊断和治疗性介入操作的并发症。
回顾了在单一中心22年期间观察到的超声引导下局灶性肝病变诊断和治疗性操作的并发症。1979年至2001年，13222例患者（年龄范围7 - 89岁；平均59岁；男性8688例，女性4534例），患有13777处局灶性肝病变，接受了16648次超声引导下活检和3035次治疗性操作：化脓性和阿米巴性脓肿穿刺抽吸、肝包虫囊肿乙醇注射以及原发性和继发性肝肿瘤的经皮消融治疗（多次或单次乙醇注射、射频消融和间质激光光凝）。
总死亡率为0.06%。诊断性操作和肝脓肿引流后未发生死亡或严重并发症。治疗组死亡率为0.6%：1例患者在肝包虫囊肿治疗期间死于过敏性休克；7例患者在乙醇注射肝肿瘤消融后死亡（6例单次治疗后死亡，1例多次治疗后死亡）。肝肿瘤消融术后的主要并发症包括10例急性肝衰竭、2例急性肾小管坏死、2例自限性腹腔内出血、2例麻痹性肠梗阻、2例脓肿和1例胆管炎。肝包虫囊肿治疗后发生1例胆囊肿瘘和1例囊内出血。
超声引导下局灶性肝病变诊断性活检和肝脓肿引流是安全的操作。相比之下，肝肿瘤消融操作有较低但明确的死亡和严重并发症风险。肝包虫囊肿穿刺必须仅在能够治疗过敏性休克的机构进行。
