Choi Dongil, Lim Hyo K, Kim Min Ju, Kim Suk Jung, Kim Seung Hoon, Lee Won Jae, Lim Jae Hoon, Paik Seung Woon, Yoo Byung Chul, Choi Moon Seok, Kim Seonwoo
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. 2005 Jun;184(6):1860-7. doi: 10.2214/ajr.184.6.01841860.
The purpose of this study was to clarify the frequency and risk factors of liver abscess formation after percutaneous radiofrequency ablation in patients with hepatocellular carcinoma.
Over a 4-year period, 603 patients with 831 hepatocellular carcinomas measuring 5 cm or less in maximum diameter who underwent a total of 751 percutaneous radiofrequency ablation procedures were enrolled in this study. We retrospectively reviewed the medical records and analyzed the overall frequency of liver abscess, risk factors for abscess, and clinical features of the patients. The relationships between liver abscess and potential risk factors were analyzed using either generalized estimating equations or multiple logistic regression analysis.
Liver abscess developed in 14 tumors of 13 patients after 13 (13/751 [1.7%]) ablation procedures. Generalized estimating equations and multiple logistic regression analysis of various potential risk factors revealed that preexisting biliary abnormality prone to ascending biliary infection (p = 0.0088), tumor with retention of iodized oil from previous transcatheter arterial chemoembolization (p = 0.040), and treatment with an internally cooled electrode system (p = 0.016) were associated with a significant risk of liver abscess formation. No patient died of liver abscess, and all successfully recovered from liver abscess with parenteral antibiotics and percutaneous clearance of pus.
Although liver abscess formation was infrequent in patients who underwent percutaneous radiofrequency ablation for hepatocellular carcinoma, the patients with significant risk factors-preexisting biliary abnormality prone to ascending biliary infection, tumor with retention of iodized oil, and treatment with an internally cooled electrode system-for liver abscess formation should be closely monitored after treatment.
本研究旨在阐明肝细胞癌患者经皮射频消融术后肝脓肿形成的频率及危险因素。
在4年期间，本研究纳入了603例患有831个最大直径为5 cm或更小的肝细胞癌患者，这些患者共接受了751次经皮射频消融手术。我们回顾性审查了病历，并分析了肝脓肿的总体发生率、脓肿的危险因素以及患者的临床特征。使用广义估计方程或多元逻辑回归分析来分析肝脓肿与潜在危险因素之间的关系。
13例患者的14个肿瘤在13次（13/751 [1.7%]）消融手术后发生了肝脓肿。对各种潜在危险因素进行广义估计方程和多元逻辑回归分析显示，既往存在易于发生上行性胆道感染的胆道异常（p = 0.0088）、既往经肝动脉化疗栓塞术后碘油残留的肿瘤（p = 0.040）以及使用内部冷却电极系统进行治疗（p = 0.016）与肝脓肿形成的显著风险相关。没有患者死于肝脓肿，所有患者均通过静脉注射抗生素和经皮穿刺引流脓液成功从肝脓肿中康复。
虽然肝细胞癌经皮射频消融患者肝脓肿形成并不常见，但对于存在显著危险因素（既往存在易于发生上行性胆道感染的胆道异常、碘油残留肿瘤以及使用内部冷却电极系统进行治疗）的肝脓肿形成患者，治疗后应密切监测。
