Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
Int J Hyperthermia. 2011;27(5):503-9. doi: 10.3109/02656736.2011.555876.
To report complications encountered after microwave ablation (MWA) of liver metastatic cholangiocarcinoma who had history of pancreatoduodenectomy or liver resection with bilioenteric anastomosis.
Retrospective study of eight intrahepatic metastatic cholangiocarcinoma lesions treated with MWA (range from 1.5 to 3.6 cm, mean, 3.2 ± 1.1 cm) in five male patients from February 2008 to August 2009. All five patients underwent surgical resection of the primary neoplasm before MWA and bilioenteric anastomosis, four of them had intrahepatic biliary dilatation pneumatosis.
All lesions were completely ablated according to results of contrast-enhanced ultrasound (CEUS) or contrast-enhanced CT/MRI 1 month after MWA. Liver abscess occurred in five ablation zones (5/8 62.5%) of four patients. Fistula encountered in all of the four cases including liver-pleural cavity fistula in two cases, liver-subcutaneous fistula in one case, both liver-pleural cavity and liver-subcutaneous fistula in one case. Two patients had right empyema, and one patient combined with melaena. Tumour cells were isolated from pus in one case. Three cases were satisfactorily cured with antibiotic administration, catheter drainage and supportive treatment; one case died 13 days after MWA.
There is a high incidence of abscess formation due to multiple risk factors when MWA was used for treatment of intrahepatic metastatic cholangiocarcinoma with bilioenteric anastomosis. Understanding the causes and grasping disposal methods will help to avoid or successfully cure this major complication.
报道既往接受过胰十二指肠切除术或伴有胆肠吻合术的肝切除术的肝转移胆管细胞癌患者行微波消融（MWA）治疗后出现的并发症。
回顾性分析 2008 年 2 月至 2009 年 8 月期间，5 例男性患者的 8 个肝内转移性胆管细胞癌病灶接受 MWA 治疗（范围 1.5 至 3.6cm，平均 3.2±1.1cm）。所有 5 例患者均在 MWA 前行原发性肿瘤的手术切除和胆肠吻合术，其中 4 例存在肝内胆管积气扩张。
所有病灶均根据 MWA 后 1 个月的超声造影（CEUS）或增强 CT/MRI 结果完全消融。4 例患者的 5 个消融区域（4/8，62.5%）均出现肝脓肿。所有 4 例患者均出现瘘管，包括 2 例肝-胸腔瘘、1 例肝-皮下瘘、1 例肝-胸腔和肝-皮下瘘。2 例患者发生右侧脓胸，1 例患者合并黑便。1 例患者的脓液中分离出肿瘤细胞。3 例患者经抗生素治疗、导管引流和支持治疗后痊愈，1 例患者于 MWA 后 13 天死亡。
既往接受过胰十二指肠切除术或伴有胆肠吻合术的肝切除术的肝转移胆管细胞癌患者行 MWA 治疗时，由于存在多种危险因素，脓肿形成的发生率较高。了解其病因并掌握处理方法有助于避免或成功治愈这种严重并发症。
