肝癌微波消融术后出血因素分析和预防

Analysis and Prevention of Bleeding After Microwave Ablationin the Treatment of Liver Cancer

目的分析肝癌微波消融术后出血因素以及总结其预防措施。方法回顾性分析2015年1月~2016年12月在超声或CT引导下行微波消融治疗的226例肝癌患者临床病例资料,分析其出血因素并针对性采取预防措施。结果 226例肝癌患者经微波消融术治疗后11例患者发生出血,出血率为4.9%,其中腹腔出血4例,胆道出血7例,11例患者经积极治疗后均完全恢复,单因素分析发现凝血酶原时间长、血小板计数减少、再次行微波消融患者更容易发生术后出血。结论凝血功能障碍、血小板计数和微波消融次数等均是引起微波消融术治疗肝癌术后出血的主要因素,若内科止血较差的情况下,在数字减影动脉造影下行止血是一种有效的止血方式。

Objective To analyze the bleeding factors after microwave ablation for hepatocellular carcinoma and summa-rize the preventive measures. Methods The clinical data of 226 patients with liver cancer treated with microwave ablation un-der ultrasound or CT guidance from January 2015 to December were analyzed retrospectively. The bleeding factors were ana-lyzed and the preventive measures were taken. Results In 226 patients with liver cancer after microwave ablation, bleeding oc-curred in 11 patients, the rate of bleeding was 4. 9%, including 4 cases of abdominal bleeding, 7 cases of bile duct bleeding, and 11 patients recovered completely after active treatment. Univariate analysis showed that patients with long prothrombin time, reduced platelet count, and repeated microwave ablation were more likely to develop postoperative bleeding. Conclusion Coagulation dysfunction, platelet count and microwave ablation frequency were the main causes of postoperative bleeding after microwave ablation. In the case of poor hemostasis, digital subtraction angiography was an effective way to stop bleeding.