肝脏肿瘤患者射频治疗后康复及并发症防治

Management of complications and rehabilitation of 256 hepatic tumors after radiofrequency ablation therapy

目的总结分析经皮射频（PRFA）治疗肝脏肿瘤的并发症及患者康复特点。方法PRFA治疗肝脏肿瘤患者187例256个病灶，肿瘤直径1．5～15．0cm，肝脏原发性及转移性恶性肿瘤157例，良性肿瘤30例。应用RF-2000射频仪和10电极LeVeen射频针，局部麻醉，B超引导下经皮肝穿刺治疗。随访观察患者术后康复特点、缓解率和并发症情况。结果PRFA操作均顺利完成。平均5．5d后患者康复出院或接受其他治疗方案。并发症10例（5．3％），包括电极片灼伤皮肤（Ⅱ度）3例，腹水外渗皮下积水2例，胆漏（肝包膜下积聚胆汁）1例，腹腔出血1例，肝曲结肠穿孔1例，腹壁穿刺针道转移1例，急性胆囊炎1例。PRFA相关死亡1例（0．5％），该患者PRFA治疗后3d死于脑梗死。肝脏恶性肿瘤患者PRFA治疗后随访率93．0％（146／157），随访期20～68个月，缓解率（CR＋PR）为94．5％（138／146）；患者1、2、3年生存率分别为95．9％（140／146）、75．0％（99／132）和40．8％（42／103）。肝脏良性肿瘤患者PRFA治疗后无并发症，均获得随访，缓解率100％。结论PRFA治疗肝脏肿瘤具有微创、有效、患者康复快等优势，其并发症可通过相应措施而有效防治。

Objective To analyze the complications and rehabilitation after percutaneous radiofrequency ablation therapy （PRFA） for hepatic tumors. Methods A total of 256 liver tumors （61.5 - 15.0 cm） in 187 patients were ablated by using RF-2000 generator and 10-needle LeVeen electrode percutaneously guided by Bultrasound under local anesthesia in our hospital from February 2000 to February 2004. Of 187 patients, 157 were with primary and metastatic malignancies, and 30 with benign tumors. The post-PRFA complications and patients＇ rehabilitation were followed up. Results The procedures were performed successfully in all patients, and they left the hospital or received other treatment 5.5 d later. The post-PRFA complications occurred in l0 cases （5.3%）, including skin burn （3 patients）, ascites leakage （2 patients）, bile leakage （ 1 patient）, abdominal hemorrhage （ 1 patient）, colon perforation （ 1 patient）, abdominal wall tumor seeding （ 1 patient）, and acute cholecystitis （ 1 patient）. The PRFA-related death rate was only 0.5 % （ 1 patient died of cerebral infarction 3 d after PRFA）. For the hepatic malignancies, 93.0% patients were followed up with an effective rate （ CR ＋ PR） of 94.5%. The patients＇ survival rates were 95.9% at 1 year, 75.0% at 2 years, and 40.8% at 3 years respectively. Follow-up showed that the patients with benign hepatic tumors achieved 100% effective rates without any complication. Conclusion Our study indicates that the PRFA is an effective mini-invasive local ablation therapy for benign and malignant liver tumors, and its complications could be prevented and managed through skill measures.