肝癌微波消融术后出血的原因和预防

Reasons and Preventions of Bleeding after Percutaneous Microwave Ablation for Liver Cancer

目的探讨肝癌微波消融术后出血的原因和防治措施。方法回顾性总结我院2006年9月至2009年12月期间156例肝癌患者实施226次微波消融术的临床资料,分析影响术后出血的危险因素。结果 226次微波消融术后共有11例次(11例患者)出血,出血率为4.87%,其中胆道出血2例,腹腔出血9例。所有出血患者均首先接受内科止血治疗,5例止血成功;其余6例内科止血无效后,1例经开腹手术止血成功,4例经股动脉肝动脉穿刺数字减影动脉造影下予以明胶海绵封堵止血成功,1例因大出血死亡。单因素分析结果表明,合并肝硬变、血小板数量少、凝血酶原时间延长、肿瘤位于肝脏表面、Child-Pugh B/C级及再次行微波消融的肝癌患者更容易发生微波消融术后出血(P=0.044,0.041,0.028,0.001,0.016,0.016)。进一步的多因素logistic回归分析结果表明,肝硬变、血小板数量、凝血酶原时间、肿瘤位置及肝功能分级是影响微波消融术后出血的独立因素(OR=5.273,P=0.036;OR=8.534,P=0.043;OR=4.893,P=0.045;OR=7.747,P=0.010;OR=6.882,P=0.015)。结论肝癌微波消融术后出血相关因素主要包括:肝癌合并肝硬变、凝血功能异常(包括血小板数量异常和凝血酶原时间异常)、肿瘤在肝脏表面及肝功能较差;内科止血无效的情况下,在数字减影动脉造影下封堵止血是有效的止血方法。

Objective To investigate the reasons and preventions of bleeding after percutaneous microwave ablation for liver cancer.Methods The data of 156 patients with liver cancer between September 2006 and December 2009 treated with percutaneous microwave ablation（226 times） were recorded.The reasons and preventions of bleeding after percutaneous microwave ablation were analyzed.Results Eleven patients（11 times） suffered from bleeding.The rate of bleeding is 4.87%（11/226）,including 2 cases of biliary bleeding,9 cases of intraperitoneal hemorrhage.All patients who suffered from bleeding firstly received medical therapy to control bleeding,5 cases were successful;in the other 6 cases who failed in medical therapy,1 case was stopped bleeding with opening procedures,4 cases received transcatheter embolization to stop bleeding with gelatin sponge,1 case died due to excessive blood loss.According to Chi-square test result,the bleeding was significantly related with liver cirrhosis,lower platelet count,obvious prolongation of prothrombin time,subcapsular tumor,Child-Pugh B/C grade,and re-ablation（P=0.044,0.041,0.028,0.001,0.016,0.016）.The multiple variables logistic regression analysis showed that liver cirrhosis,platelet count,prothrombin time,location of tumor,and Child-Pugh grade were the influential factors of bleeding after microwave ablation（OR=5.273,P=0.036;OR=8.534,P=0.043;OR=4.893,P=0.045;OR=7.747,P=0.010;OR=6.882,P=0.015）.Conclusions There were some factors were significantly related with the bleeding after percutaneous microwave ablation： liver cirrhosis,abnormal blood clotting function（lower platelet count and prolongation of prothrombin time）,tumor located on the surface of liver,and Child-Pugh C grade.When failed to stop bleeding with medical therapy,transcatheter embolization is an effective method to control bleeding.