de Baère Thierry, Risse Olivier, Kuoch Viseth, Dromain Clarisse, Sengel Christophe, Smayra Tarek, Gamal El Din Mostafa, Letoublon Christian, Elias Dominique
Departement d'Imagerie Medicale et de Chirurgie, Institut Gustave Roussy, 39 Rue Camille Desmoulins, Villejuif 94805, France.
AJR Am J Roentgenol. 2003 Sep;181(3):695-700. doi: 10.2214/ajr.181.3.1810695.
We describe the rates and potential risk factors of complications of radiofrequency ablation of hepatic tumors. SUBJECTS AND METHODS. Over a 5-year period, 312 patients underwent 350 sessions of radiofrequency ablation (124 intraoperative and 226 percutaneous) for treatment of 582 liver tumors including 115 hepatocellular carcinomas and 467 metastatic tumors. The chi-square test was used for a group-to-group comparison of the occurrence of adverse events.
Thirty-seven (10.6%) adverse events and five (1.4%) deaths were related to radiofrequency treatment. The deaths were caused by liver insufficiency (n = 1), colon perforation (n = 1), and portal vein thrombosis (n = 3). Portal vein thrombosis was significantly (p < 0.00001) more frequent in cirrhotic livers (2/5) than in noncirrhotic livers (0/54) after intraoperative radiofrequency ablation performed during a Pringle maneuver. Liver abscess (n = 7) was the most common complication. Abscess occurred significantly (p < 0.00001) more frequently in patients bearing a bilioenteric anastomosis (3/3) than in other patients (4/223). We encountered five pleural effusions, five skin burns, four hypoxemias, three pneumothoraces, two small subcapsular hematomas, one acute renal insufficiency, one hemoperitoneum, and one needle-tract seeding. The 6.3% of minor complications did not require specific treatment or a prolonged hospital stay. Among the 5.7% major complications, 3.7% required less than 5 days of hospitalization for treatment or surveillance and 2% required more than 5 days for treatment.
Radiofrequency ablation of liver tumors is a well-tolerated technique, but caution should be exercised when treating patients with a bilioenteric anastomosis, and radiofrequency ablation during vascular occlusion in cirrhotic livers should be avoided.
我们描述了肝肿瘤射频消融并发症的发生率及潜在危险因素。
在5年期间，312例患者接受了350次射频消融治疗（124例术中消融，226例经皮消融），以治疗582个肝肿瘤，其中包括115例肝细胞癌和467例转移瘤。采用卡方检验对不良事件的发生率进行组间比较。
37例（10.6%）不良事件和5例（1.4%）死亡与射频治疗相关。死亡原因包括肝功能不全（n = 1）、结肠穿孔（n = 1）和门静脉血栓形成（n = 3）。在Pringle手法下进行术中射频消融后，肝硬化肝脏（2/5）中门静脉血栓形成的发生率显著高于非肝硬化肝脏（0/54）（p < 0.00001）。肝脓肿（n = 7）是最常见的并发症。有胆肠吻合术的患者（3/3）中脓肿的发生率显著高于其他患者（4/223）（p < 0.00001）。我们还遇到了5例胸腔积液、5例皮肤烧伤、4例低氧血症、3例气胸、2例小的肝包膜下血肿、1例急性肾功能不全、1例腹腔积血和1例针道种植转移。6.3%的轻微并发症无需特殊治疗或延长住院时间。在5.7%的严重并发症中，3.7%需要住院治疗或监测少于5天，2%需要住院治疗超过5天。
肝肿瘤射频消融是一种耐受性良好的技术，但在治疗有胆肠吻合术的患者时应谨慎，并且应避免在肝硬化肝脏的血管闭塞期间进行射频消融。
