358例肝肿瘤微波消融并发症的临床分析

A clinical study of complications arising from microwave ablation for 358 liver tumors

目的探讨肝肿瘤微波消融（MWA）治疗的并发症发生原因和处理措施,提升MWA安全性。方法回顾性分析2004年6月~2014年8月采用MWA治疗肝肿瘤患者358例临床资料。结果 358例患者中发生各种严重并发症33例,其中B超下经皮入肝行MWA发生并发症26例,经腹腔镜入肝MWA者4例,开腹手术直视下行MWA者3例。分析显示消融针所致的器械损伤性并发症7例;MWA热损伤性并发症包括肝胆管热损伤、膈肌损伤及胃肠道损伤等16例;消融灶感染肝脓肿4例;多因素导致的肺梗塞和肝功能不全6例。2例肝功能不全在MWA后1~2周内死亡,其余患者经及时处理并发症均获痊愈。结论 MWA在肝肿瘤综合治疗中,可有严重并发症发生,要加强对其并发症的防范和处理,使其得到进一步规范和推广。

Objective To investigate the causes and treatment measures of complications arising from microwave ablation （MWA） for liver tumor, to improve security of MWA. Methods The clinical data of 358 patients with liver tumor received MWA treatment from June 2004 to August 2014 were analyzed retrospectively. Results On the 358 patients, 33 cases suffered serious com- plications, including 26 patients who received MWA under B ultrasound guided percutaneous into the liver, 4 cases underwent MWA by laparoscopic into liver and 3 cases of open operation whose MWA were operated under direct vision. On the 33 patients, Mechanical damage of microwave ablation needle oceured in 7 cases ; Hot traumatic complications of MWA include the Hepatobiliary duct thermal damage, diaphragmatic muscle injury and gastrointestinal lesions in 16 cases; Liver abscess arised from the Ablation lesions infection in 4 cases. Many factors lead up to pulmonary embolism and hepatic insufficiency in 6 patients. 2 cases of Liver failure died after MWA within 1 - 2 weeks. The rest of the patients with complications were cured after timely treatments. Conclusions MWA can have seri- ous complications in comprehensive therapy of liver tumors, to strengthen the prevention and treatment of complications. MWA must be further standardized and promotion.