CT引导经皮穿刺肺肿瘤射频消融术的并发症及防治

Prevention and treatment of complications of CT-guided percutaneous radiofrequency ablation for lung cancer

目的探讨CT引导经皮穿刺肺肿瘤射频消融术并发症的发生原因及防治措施。 方法对2015年7月至2017年6月125例肺肿瘤患者进行142次射频消融治疗，回顾性分析并发症发生的原因，总结防治策略。 结果125例患者均完成肺肿瘤射频消融治疗。治疗过程中出血18例，其中3级出血3例，分别为肺磨玻璃结节穿刺出血、肋间血管出血、病灶内部出血；气胸16例，伴慢性阻塞性肺疾病者15例；胸痛28例，23例病灶位于胸膜下；肺炎3例，分别为高龄、合并慢性肺疾病或糖尿病；肺脓肿1例，病灶位于胸膜下且最大径〉3 cm；肺栓塞1例，为肿瘤病史的高凝患者；皮肤烫伤1例。所有患者给予相应治疗，如止血、气胸闭式引流及硬化治疗、抗感染、止痛、吸氧等治疗后好转。 结论射频消融术治疗肺肿瘤引起并发症的主要原因有穿刺直接损伤、肿瘤血供丰富、肿瘤靠近胸膜、肺基础疾病、凝血功能异常、糖尿病控制不佳等。术前对患者进行严格筛选、术中排除技术上可避免的危险因素是避免及减少严重并发症发生的关键。

ObjectiveTo investigate the complications caused by CT-guided percutaneous radiofrequency ablations （RFA） for lung cancer and analyze the prevention approach. MethodsA total of 125 lung cancer patients （142 RFA treatments） in our hospital were enrolled in this study between July 2015 and June 2017. This retrospective study analyzed the reasons and the strategies for preventing the complications. ResultsOne hundred and twenty-five patients underwent RFA treatment for lung lesions. All the operations were successfully completed. During the treatment, 18 patients showed hemorrhage （3 of CTCAE grade 3 hemorrhage）;16 patients showed pneumothorax, among which, 15 patients have chronic obstructive pulmonary disease;28 patients showed chest pain （23 cases were located under the pleura）;3 patients showed pneumonia;1 patient showed pulmonary abscess, which located in the subpleural space with a maximum diameter of 〉3 cm;1 patient showed pulmonary embolism, and 1 patient with scald. Complications were attenuated after symptomatic treatment. ConclusionThe main reasons of complications of RFA in treating lung cancer were direct injuries caused by punctures, tumors with abundant blood supplement, tumors adjacent to pleura, low scores of lung function, coagulation disorders, and diabetes. The key points for avoiding and reducing complications are preoperative evaluation of patients＇ basic situations, exclusion of intraoperative avoidable technical risk factors.