肝脏肿瘤患者射频消融术后感染相关并发症及其临床分析

Postoperative infection-related complications in liver cancer patients undergoing radiofrequency ablation and clinical analysis

目的探讨肝脏肿瘤患者射频消融术后感染相关并发症及其临床特征。方法回顾性分析2010年3月-2016年3月医院介入科行肝脏肿瘤射频消融术的患者781例;收集患者的临床资料、肿瘤大小、个数、位置、抗菌药物应用及术后感染发生情况,对有严重感染表现的患者行CT增强扫描,明确局部感染病灶之后,采用置管引流,并对引流液进行细菌学检查和药敏测试,以调整患者的抗菌药物使用。结果 781例患者行射频消融术957次,术后发生感染35例,感染率3.66%;发生严重感染患者的主要临床表现为发热、寒战、肝区疼痛、腹部疼痛;经CT增强证实病灶并引流培养后,检查分离细菌39株,高危因素为既往胆吻合术、多发性肝脏肿瘤、肿瘤比邻肠道和开腹射频消融术,所有患者经更换抗菌药物或加强抗感染治疗后感染均得以控制。结论肝脏肿瘤患者射频消融术治疗有效,但可能会并发肝脓肿、切口感染、胆汁瘤等感染相关并发症,CT增强扫描及细菌培养有助于明确感染相关并发症的诊断及其治疗。

OBJECTIVE To explore the postoperative infection‐related complications in liver cancer patients under‐going radiofrequency ablation and observe the clinical characteristics .METHODS A total of 781 patients who un‐derwent the radiofrequency ablation of liver tumor in invasive technology department from Mar 2010 to Mar 2016 were retrospectively analyzed ,the clinical data ,involving the size ,number ,and location of tumor and use of anti‐biotics as well as incidence of postoperative infections ,were collected from the patients ,the patients who presen‐ted with severe infection were treated with CT enhancement scanning ,the indwelling tube drainage was carried out after the local infection foci were confirmed ,the bacteriological test was performed for the drainage fluid ,and the drug susceptibility testing was conducted so as to adjust the usage of antibiotics .RESULTS The 781 patients under‐went 957 times of radiofrequency ablation in total ,and 35 patients had the postoperative infection ,with the infec‐tion rate 3 .66% .The major clinical manifestations of the patients with severe infection included the fever ,chills , liver pain and abdominal pain .After the foci were confirmed by the enhanced CT and the drainage fluid specimens were cultured ,totally 39 strains of bacteria were isolated .The high risk factors included the history of choledo‐chojejunostomy ,multiple liver tumors ,and tumor adjacent intestinal tract and open radiofrequency ablation .The infections in all of the patients were controlled after the antibiotics dressing change or the anti‐infection therapy was strengthened .CONCLUSION The radiofrequency ablation is effective in the treatment of the liver cancer pa‐tients but may induce the infection‐related complications such as liver abscess ,incision infection ,and cholesteato‐ma .The CT enhancement scanning and drug susceptibility testing may facilitate the identification of the infection‐relat‐ed complications and the treatment .