Kim Young-Sun, Rhim Hyunchul, Lim Hyo K, Choi Dongil, Lee Won Jae, Kim Seung Hoon
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 IIwon-dong, Kangnam-ku, Seoul 135-710, Korea.
J Vasc Interv Radiol. 2007 Sep;18(9):1126-33. doi: 10.1016/j.jvir.2007.06.005.
To elucidate the attributes of hepatic infarction after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with an internally cooled electrode.
The authors retrospectively reviewed follow-up computed tomographic (CT) scans (follow-up period, 1-60.1 months; mean, 15.4 months) in 872 consecutive patients (male:female ratio, 672:200; mean age, 59.5 years) who had undergone 1,120 sessions of RFA for 1,335 HCCs with an internally cooled electrode. Diagnosis of hepatic infarction was made on the basis of CT findings. The authors evaluated the frequency of hepatic infarction, clinical features, initial and follow-up CT findings, accompanied complications, and prognosis. Potential risk factors were evaluated with multiple logistic regression analysis.
The frequency of hepatic infarction was 1.8% (20 of 1,120 sessions). Common presenting symptoms were abdominal pain (16 of 20 patients) and fever (11 of 20 patients). All infarctions were found at the first follow-up CT examination. Gas collections were noted in 65% of patients. All lesions showed progressive shrinkage. Accompanied complications were biloma (n = 2), abscess (n = 2), and portal vein thrombosis (n = 1). One patient with a lobar infarction died from hepatic failure. Older age (P = .048) and larger tumor size (P = .026) were statistically significant risk factors by multivariate analysis.
RFA complicated by hepatic infarction is uncommon. Although hepatic infarction can be managed conservatively in most cases, possible extensive involvement should be considered seriously because it may cause mortality.
阐明使用内部冷却电极对肝细胞癌（HCC）进行射频消融（RFA）后肝梗死的特征。
作者回顾性分析了872例连续患者（男:女比例为672:200；平均年龄59.5岁）的随访计算机断层扫描（CT）图像（随访期为1 - 60.1个月，平均15.4个月），这些患者使用内部冷却电极对1335个HCC进行了1120次RFA治疗。根据CT表现诊断肝梗死。作者评估了肝梗死的发生率、临床特征、初始和随访CT表现、伴随的并发症及预后。通过多因素逻辑回归分析评估潜在危险因素。
肝梗死的发生率为1.8%（1120次治疗中有20次）。常见的症状为腹痛（20例患者中有16例）和发热（20例患者中有11例）。所有梗死均在首次随访CT检查时发现。65%的患者出现气体聚集。所有病变均呈进行性缩小。伴随的并发症有胆汁瘤（n = 2）、脓肿（n = 2）和门静脉血栓形成（n = 1）。1例大叶梗死患者死于肝衰竭。多因素分析显示，年龄较大（P = .048）和肿瘤体积较大（P = .026）是具有统计学意义的危险因素。
RFA并发肝梗死并不常见。尽管大多数情况下肝梗死可采用保守治疗，但应认真考虑可能出现的广泛累及，因为这可能导致死亡。
