经皮热消融治疗肝脏恶性肿瘤Glisson系统相关并发症分析

Glisson system-related complications after percutaneous thermal ablation of liver cancer

目的探讨经皮热消融治疗肝脏恶性肿瘤术后Glisson系统相关并发症发生率及与肿瘤位置的关系。方法回顾性分析1 879例肝脏恶性肿瘤患者共2 218例次超声引导下经皮热消融治疗的资料。根据肿瘤与Glisson系统的位置关系分为4类,肿瘤邻近1、2、3级门静脉分支分别定义为Ⅰ、Ⅱ、Ⅲ类(邻近Glisson系统组),远离门静脉定义为Ⅳ类(非邻近Glisson系统组)。分析并发症(胆脂瘤、胆漏、胆管严重狭窄、胆管—支气管瘘、动脉—门静脉瘘及动脉瘤)的发生情况。结果共20例次(20/2 218,0.90%)患者发生Glisson系统相关严重并发症。邻近Glisson系统组Glisson系统相关严重并发症发生率[1.81%(16/886)]高于非邻近Glisson系统组[0.30%(4/1 332),P<0.001]。Ⅰ、Ⅱ、Ⅲ、Ⅳ类患者Glisson系统相关严重并发症发生率[6.35%(4/63)、3.52%(5/142)、1.03%(7/681)、0.30%(4/1 332)]差异有统计学意义(P<0.001)。Glisson系统相关轻微并发症包括肝功能损伤(280例次)、门静脉血栓形成(156例次)及消融区末梢胆管扩张(82例次),且发生率在Ⅰ~Ⅳ类患者中呈逐渐降低的趋势。结论经皮热消融治疗具有较高的安全性,但Glisson系统相关严重并发症的发生率随肿瘤靠近上级门静脉分支有增高趋势。

Objective To analyze Glisson system-related complications after percutaneous thermal ablation of liver cancer and the relationship with tumor location. Methods Data of 2 218 case-times of ultrasound-guided percutaneous thermal ab- lation in 1 879 patients with liver cancer were retrospectively analyzed. Four types were defined according to the relative po- sition between the tumor and Glisson system： Tumor close to the first branch of the portal vein （type I ）, the second branch of the portal vein （type ]I ）, the third branch of the portal vein （type 1~ ） and far away from portal vein （type IV）. Types I to Ill were classified as close to Glisson system group, while type IV was classified as far away from Glisson sys- tem group. The Glisson system-related complications （cholesteatoma, bile leakage, serious biliary stricture, cholangio- bronchial fistula, arterio-venous fistula and arterial aneurysm） were analyzed. Results Glisson system-related severe com- plications occurred after 20 case-times （20/2 218, 0.90 %） of thermal ablation. The incidence of Glisson system-related se- vere complications in close to Glisson system group （1.81 % [16/886]） was higher than that in far away from Glisson sys- tem group （0.30% [4/1 332], P〈0. 001）. The incidence of Glisson system-related severe complications of type I , II , and 1V was 6.35% （4/63）, 3.52% （5/142）, 1.03% （7/681） and 0.30% （4/1 332）, respectively （P^0. 001）. Glis- son system-related mild complications included liver function damage （280 case-times）, portal thrombosis （156 case-times） and slight cholangiectasis （82 case-times）. The incidences of the three Glisson system-related complications mentioned a- bove decreased from type I to IV. Conclusion Percutaneous thermal ablation is safe in treating patients with tumors close to Glisson system. But the risk of incidence of Glisson system-related severe complications is higher when the tumor is close to the more advanced branch of portal vein.