Kim Seong Hyun, Lim Hyo K, Choi Dongil, Lee Won Jae, Kim Seung Hoon, Kim Min Ju, Lee Soon Jin, Lim Jae Hoon
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea.
AJR Am J Roentgenol. 2004 Dec;183(6):1611-7. doi: 10.2214/ajr.183.6.01831611.
The purpose of our study was to determine the frequency of bile duct changes after radiofrequency ablation for hepatocellular carcinoma and to evaluate their clinical significance.
Between April 1999 and August 2003, 389 patients with 521 hepatocellular carcinomas underwent a total of 571 sessions of radiofrequency ablation. The maximum dimension of the tumors measured on sonography was 2.4 +/- 0.9 cm (mean +/- SD) (range, 0.5-5.0 cm). The frequency and type of bile duct changes resulting from radiofrequency ablation, the time interval between radiofrequency ablation and the first appearance of bile duct changes, and the serial changes at follow-up CT were analyzed. Complications related to bile duct changes were also evaluated by reviewing medical records and CT scans.
Bile duct changes occurred in 69 (12%) of 571 sessions and 66 (17%) of 389 patients. Bile duct changes seen on CT included mild dilatation of upstream bile ducts surrounding the ablation zone in 57 patients (82.6%), biloma in the ablation zone in four patients (5.8%), and both in eight patients (11.6%). The mean time interval between radiofrequency ablation and the initial appearance of bile duct change was 1.6 months (range, immediate-9 months). Most (87%) of the 69 patients with bile duct changes showed no progression on follow-up CT, and only nine (13%) had slight progression. All patients but one, in whom cholangitis developed, had no major complications requiring specific treatment during the follow-up period.
Although bile duct changes were frequent after the radiofrequency ablation of hepatocellular carcinoma, most were of no clinical significance, and major complications requiring additional treatment were rare.
本研究旨在确定肝细胞癌射频消融术后胆管改变的发生率，并评估其临床意义。
1999年4月至2003年8月，389例患有521个肝细胞癌的患者共接受了571次射频消融治疗。超声测量的肿瘤最大直径为2.4±0.9厘米（平均值±标准差）（范围0.5 - 5.0厘米）。分析了射频消融导致的胆管改变的频率和类型、射频消融与胆管改变首次出现之间的时间间隔以及随访CT的系列变化。还通过查阅病历和CT扫描评估了与胆管改变相关的并发症。
571次治疗中有69次（12%）出现胆管改变，389例患者中有66例（17%）出现胆管改变。CT上可见的胆管改变包括57例（82.6%）消融区周围上游胆管轻度扩张、4例（5.8%）消融区内胆汁瘤形成以及8例（11.6%）两者皆有。射频消融与胆管改变首次出现之间的平均时间间隔为1.6个月（范围，即刻 - 9个月）。69例出现胆管改变的患者中，大多数（87%）在随访CT上无进展，只有9例（13%）有轻微进展。除1例发生胆管炎的患者外，所有患者在随访期间均无需要特殊治疗的严重并发症。
虽然肝细胞癌射频消融术后胆管改变很常见，但大多数无临床意义，需要额外治疗的严重并发症很少见。
