Kim Jong Woo, Shin Ji Hoon, Kim Pyo Nyun, Shin Yong Moon, Won Hyung Jin, Ko Gi-Young, Yoon Hyun-Ki
Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
J Vasc Interv Radiol. 2017 Mar;28(3):356-365.e2. doi: 10.1016/j.jvir.2016.09.031. Epub 2016 Dec 21.
To evaluate safety and clinical efficacy of embolization for management of bleeding after hepatic radiofrequency (RF) ablation.
From January 2000 to December 2014, 5,196 patients with 9,743 tumors underwent 8,303 RF ablation sessions. Of these patients, 62 experienced bleeding after hepatic RF ablation; 15 patients (12 men and 3 women; mean age 62 y; range, 49-76 y) underwent embolization and composed the final study cohort. Tumors were hepatocellular carcinomas in 13 (87%) patients and metastatic adenocarcinomas from colorectal cancer in 2 (13%) patients. Mean number of tumors was 1.5 (22 nodules; range, 1-3). Tumor locations were segment I (n = 1), segment II (n = 2), segment III (n = 1), segment IV (n = 1), segment V (n = 3), segment VI (n = 5), segment VII (n = 1), and segment VIII (n = 9). Mean tumor size was 2.3 cm (range, 0.9-5 cm).
Median time interval between presentation and angiography was 22 hours (mean 38.4 h; range, 3-168 h). On angiography, contrast extravasation with or without pseudoaneurysm was seen in all 15 patients; 14 patients underwent transarterial embolization, and 1 patient underwent percutaneous transhepatic portal vein embolization. Successful hemostasis was achieved in all patients. There was no rebleeding within 30 days after embolization. No embolization-related major complications were observed.
Embolization is safe and effective for controlling bleeding related to hepatic RF ablation without the need for surgery.
评估肝射频（RF）消融术后出血的栓塞治疗的安全性和临床疗效。
2000年1月至2014年12月，5196例患者的9743个肿瘤接受了8303次RF消融治疗。其中，62例患者在肝RF消融术后出现出血；15例患者（12例男性和3例女性；平均年龄62岁；范围49 - 76岁）接受了栓塞治疗，构成最终研究队列。13例（87%）患者的肿瘤为肝细胞癌，2例（13%）患者的肿瘤为结直肠癌转移性腺癌。平均肿瘤数量为1.5个（22个结节；范围1 - 3个）。肿瘤位置为Ⅰ段（n = 1）、Ⅱ段（n = 2）、Ⅲ段（n = 1）、Ⅳ段（n = 1）、Ⅴ段（n = 3）、Ⅵ段（n = 5）、Ⅶ段（n = 1）和Ⅷ段（n = 9）。平均肿瘤大小为2.3 cm（范围0.9 - 5 cm）。
就诊至血管造影的中位时间间隔为22小时（平均38.4小时；范围3 - 168小时）。血管造影显示，所有15例患者均出现对比剂外渗，伴或不伴有假性动脉瘤；14例患者接受了经动脉栓塞，1例患者接受了经皮经肝门静脉栓塞。所有患者均成功止血。栓塞后30天内无再出血。未观察到与栓塞相关的严重并发症。
栓塞治疗对于控制肝RF消融术后出血安全有效，无需手术。
