Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama, Japan.
Dig Dis. 2013;31(5-6):480-4. doi: 10.1159/000355254. Epub 2013 Nov 21.
To evaluate whether iatrogenic hemorrhage can be prevented by intrahepatic tract ablation following radiofrequency ablation (RFA) therapy for hepatic malignancies.
A retrospective cohort study analyzing a prospective database in a single institution was conducted. The incidence of postprocedural complications was compared in two groups: one with cauterization of the needle tracts after RFA and the other without.
The complication rates of intraperitoneal hemorrhage were 1.05% (4/380) and 0.92% (6/652) in the nonablation group and the ablation group, respectively (p = 0.90). All of these 10 patients with iatrogenic bleeding were classified as Child-Pugh grade A. Among the 15 hemodialysis patients in this study, hemorrhage was seen in 2 (13.3%), compared with 8 (0.79%) of the nonhemodialysis patients (p = 0.0002). There were no statistically significant differences in the incidence of other complications including pleural effusion, serous ascites, pneumothorax, hemothorax, hepatic infarction, bile duct injury and pericardial effusion between the two groups. Gastrointestinal perforation, peritonitis or tumor seeding were not observed.
Our study found a high incidence of bleeding after RFA among hemodialysis patients. Irrespective of tract ablation being after RFA, iatrogenic hemorrhage appeared to be equivalent in this population.
评估肝恶性肿瘤射频消融（RFA）治疗后行肝内管道消融是否可以预防医源性出血。
本研究采用单中心前瞻性数据库的回顾性队列研究。比较了两组患者术后并发症的发生率：一组在 RFA 后对针道进行烧灼，另一组不进行烧灼。
非消融组和消融组的腹腔内出血并发症发生率分别为 1.05%（4/380）和 0.92%（6/652）（p=0.90）。这 10 例医源性出血患者均为 Child-Pugh 分级 A。在本研究的 15 例血液透析患者中，有 2 例（13.3%）发生出血，而非血液透析患者有 8 例（0.79%）（p=0.0002）。两组患者其他并发症（如胸腔积液、浆液性腹水、气胸、血胸、肝梗死、胆管损伤和心包积液）的发生率无统计学差异。两组均未观察到胃肠道穿孔、腹膜炎或肿瘤种植。
本研究发现血液透析患者 RFA 后出血发生率较高。无论 RFA 后是否进行管道消融，该人群的医源性出血似乎相当。
