肺肿瘤射频消融治疗的并发症分析

The complications of radiofrequency ablation for the treatment of pulmonary tumors

目的:探讨肺肿瘤行射频消融治疗中的并发症及其防治措施。方法:选取2010年4月至2017年12月广东省人民医院肿瘤介入科收治的150例接受射频消融治疗的肺恶性肿瘤患者,其中原发性肺癌99例,转移性肺癌51例。99例原发性肺癌包括非小细胞肺癌87例、小细胞肺癌8例及癌肉瘤4例;51例转移性肺癌中来自肝癌的22例,来自软组织肉瘤12例、大肠癌9例、鼻咽癌6例、纵膈卵黄囊瘤及血管平滑肌脂肪肉瘤各1例。所有患者均为单个病灶,肿瘤直径8~47 mm(26±3.6) mm。射频消融均在CT引导下穿刺,其中行1次消融者133例,2次者17例;2次射频消融之间的间隔时间1~4(2±0.5)周。消融功率40~60(51.1±3.9) W,消融时间3~12(6.3±2.7) min。结果:常见并发症包括气胸29例(19.3%),肺实质出血35例(23.3%),咯血12例(8%),胸腔积液3例(2%);少见并发症包括肺脓肿并支气管瘘1例(0.7%),以往未见文献报道,胸部皮下气肿1例(0.7%)。无严重并发症或围手术期死亡病例发生。结论:肺肿瘤射频消融的并发症多为轻中度,但均应给予足够重视,只有及时诊断并及时处理,才能减少和避免严重并发症及死亡的发生。

Objective: To investigate the complications and preventions of radiofrequency ablation for lung tumors. Methods: Totally 150 patients with lung malignant tumors received radiofrequency ablation, including 99 cases of primary lung cancer and 51 cases of metastatic lung cancer. The 99 cases of primary lung cancer included 87 cases of non-small cell lung cancer, 8 cases of small cell lung cancer and 4 cases of carcinosarcoma. Among 51 cases of metastatic lung cancer, 22 cases were from liver cancer, 12 cases were from soft tissue sarcoma, 9 cases were from colorectal cancer, 6 cases were from nasopharyngeal cancer, 1 case was from mediastinal yolk sac tumor and 1 case was from angiomyoliposarcoma. All patients had single lesion with a tumor size of 8-47 mm, with an average of (26±3.6) mm. CT-guided percutaneous radiofrequency ablation was performed in 133 patients once and 17 patients twice. The interval between two radiofrequency ablations was 1-4 weeks, with an average of (2±0.5) weeks. Results: Common complications included pneumothorax in 29 cases(19.3%), pulmonary parenchymal hemorrhage in 35 cases(23.3%), hemoptysis in 12 cases(8%), pleural effusion in 3 cases(2%), rare complications included pulmonary abscess in 1 case (0.7%) and subcutaneous emphysema in 1 case(0.7%). No serious complications or perioperative deaths occurred. Conclusions: The complications of radiofrequency ablation in treatment of lung tumors are mostly mild to moderate, which could be recovered by timely diagnosis and management.