射频消融治疗难治性细菌性肝脓肿的时机选择

Timing of radiofrequency ablation in treatment of complicated pyogenic liver abscesses

目的探讨射频消融(RFA)治疗难治性细菌性肝脓肿(PLA)的手术时机。方法回顾性分析2010年8月~2020年1月首都医科大学附属北京朝阳医院西院、山东省日照市肝胆胰脾外科研究所、山东省滨州市第二人民医院以RFA为主要手段治疗的49例难治性PLA患者的临床资料。按照发病距RFA时间将患者分为早期RFA组(≤72 h)和延期RFA组(>72 h ),分别为27例和22例。RFA采用腹腔镜联合术中超声及CT引导完成,术后评价技术的安全性、有效性及住院费用等。结果两组患者RFA治疗后均获得临床治愈(有效率100%),且均未发现严重感染、胆汁瘘及大出血等并发症。与早期RFA组相比,延期RFA组的操作时间和住院时间更长[(8.1±1.6)d比(9.5±1.5)d],住院费用更高[(3.4±0.2)万元比(3.8±0.4)万元],差异具有统计学意义(P<0.05)。结论 RFA治疗难治性PLA的最佳时机为发病72 h之内。

Objective To study the timing of radiofrequency ablation(RFA)in treatment of complicated pyogenic liver abscesses(PLA).Methods A retrospective analysis was performed on 49 patients with complicated PLA who were treated with the RFA-based treatment modality from August 2010 to January 2020 at Beijing Chaoyang Hospital,West Campus,Capital Medical University,Institute of Hepatobiliary,Pancreas and Spleen Surgery and the Second Hospital,Binzhou.The patients were divided into the early RFA group(≤72 h,n=27)and the delayed RFA group(>72 h,n=22)according to the timing of RFA.RFA was guided by laparoscopy combined with Ultrasound or CT.The safety and effective rates of RFA,and the total expenses were evaluated.Results All patients in both the early and the delayed RFA groups were successfully cured(100%).No serious complications,including biliary leakage and massive hemorrhage,happened in the 2 groups.Significantly longer operating time and hospital stays[(8.1±1.6)d vs.(9.5±1.5)d],and higher hospital costs[(3.4±0.2)ten thousand yuan vs.(3.8±0.4)ten thousand yuan]were found in the delayed RFA group when compared with the early RFA group(P<0.05).Conclusion RFA treatment of complicated PLA should be completed within 72 hours of onset of PLA.