计算机断层扫描引导下肺肿瘤射频消融术后各种并发症的发生率及危险因素

Frequency and risk factors of various complications after computed tomography-guided radiofrequency ablation of lung tumors.

作者信息

Okuma Tomohisa, Matsuoka Toshiyuki, Yamamoto Akira, Oyama Yoshimasa, Toyoshima Masami, Nakamura Kenji, Inoue Yuichi

机构信息

Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Osaka 545-8585, Japan.

出版信息

Cardiovasc Intervent Radiol. 2008 Jan-Feb;31(1):122-30. doi: 10.1007/s00270-007-9225-0. Epub 2007 Nov 6.

DOI:10.1007/s00270-007-9225-0

PMID:17985181

Abstract

OBJECTIVE

To retrospectively determine the frequency and risk factors of various side effects and complications after percutaneous computed tomography-guided radiofrequency (RF) ablation of lung tumors.

METHODS

We reviewed and analyzed records of 112 treatment sessions in 57 of our patients (45 men and 12 women) with unresectable lung tumors treated by ablation. Risk factors, including sex, age, tumor diameter, tumor location, history of surgery, presence of pulmonary emphysema, electrode gauge, array diameter, patient position, maximum power output, ablation time, and minimum impedance during ablation, were analyzed using univariate and multivariate analyses.

RESULTS

Total rates of side effects and minor and major complications occurred in 17%, 50%, and 8% of treatment sessions, respectively. Side effects, including pain during ablation (46% of sessions) and pleural effusion (13% of sessions), occurred with RF ablation. Minor complications, including pneumothorax not requiring chest tube drainage (30% of sessions), subcutaneous emphysema (16% of sessions), and hemoptysis (9% of sessions) also occurred after the procedure. Regarding major complications, three patients developed fever >38.5 degrees C; three patients developed abscesses; two patients developed pneumothorax requiring chest tube insertion; and one patient had air embolism and was discharged without neurologic deficit. Univariate and multivariate analyses suggested that a lesion located < or =1 cm of the chest wall was significantly related to pain (p < 0.01, hazard index 5.76). Risk factors for pneumothorax increased significantly with previous pulmonary surgery (p < 0.05, hazard index 6.1) and presence of emphysema (p <0.01, hazard index 13.6).

CONCLUSION

The total complication rate for all treatment sessions was 58%, and 25% of patients did not have any complications after RF ablation. Although major complications can occur, RF ablation of lung tumors can be considered a safe and minimally invasive procedure.

摘要

目的

回顾性确定经皮计算机断层扫描引导下肺肿瘤射频消融术后各种副作用和并发症的发生率及危险因素。

方法

我们回顾并分析了57例（45例男性和12例女性）无法切除的肺肿瘤患者接受消融治疗的112个疗程的记录。使用单因素和多因素分析方法，对包括性别、年龄、肿瘤直径、肿瘤位置、手术史、肺气肿的存在、电极规格、阵列直径、患者体位、最大功率输出、消融时间以及消融过程中的最小阻抗等危险因素进行分析。

结果

副作用、轻微并发症和严重并发症的总发生率分别为17%、50%和8%。射频消融会出现副作用，包括消融过程中的疼痛（46%的疗程）和胸腔积液（13%的疗程）。轻微并发症包括无需胸腔闭式引流的气胸（30%的疗程）、皮下气肿（16%的疗程）和咯血（9%的疗程），也发生在术后。严重并发症方面，3例患者体温>38.5℃；3例患者出现脓肿；2例患者出现需要插入胸腔闭式引流管的气胸；1例患者发生空气栓塞，出院时无神经功能缺损。单因素和多因素分析表明，位于距胸壁≤1cm处的病灶与疼痛显著相关（p<0.01，风险指数5.76）。气胸的危险因素随着既往肺部手术（p<0.05，风险指数6.1）和肺气肿的存在（p<0.01，风险指数13.6）而显著增加。