• 中國醫(yī)科大學(xué)附屬第四醫(yī)院肝膽胰外科（沈陽 110032）;

目的 探討肝癌微波消融術(shù)后出血的原因和防治措施。方法 回顧性總結(jié)我院2006年9月至2009年12月期間156例肝癌患者實(shí)施226次微波消融術(shù)的臨床資料，分析影響術(shù)后出血的危險(xiǎn)因素。結(jié)果 226次微波消融術(shù)后共有11例次（11例患者）出血，出血率為4.87%，其中膽道出血2例，腹腔出血9例。所有出血患者均首先接受內(nèi)科止血治療，5例止血成功； 其余6例內(nèi)科止血無效后，1例經(jīng)開腹手術(shù)止血成功，4例經(jīng)股動(dòng)脈肝動(dòng)脈穿刺數(shù)字減影動(dòng)脈造影下予以明膠海綿封堵止血成功，1例因大出血死亡。單因素分析結(jié)果表明，合并肝硬變、血小板數(shù)量少、凝血酶原時(shí)間延長、腫瘤位于肝臟表面、Child-Pugh B/C級(jí)及再次行微波消融的肝癌患者更容易發(fā)生微波消融術(shù)后出血（P=0.044,0.041,0.028,0.001,0.016，0.016）。進(jìn)一步的多因素logistic回歸分析結(jié)果表明，肝硬變、血小板數(shù)量、凝血酶原時(shí)間、腫瘤位置及肝功能分級(jí)是影響微波消融術(shù)后出血的獨(dú)立因素（OR=5.273，P=0.036; OR=8.534，P=0.043; OR=4.893，P=0.045; OR=7.747，P=0.010; OR=6.882，P=0.015）。結(jié)論 肝癌微波消融術(shù)后出血相關(guān)因素主要包括： 肝癌合并肝硬變、凝血功能異常（包括血小板數(shù)量異常和凝血酶原時(shí)間異常）、腫瘤在肝臟表面及肝功能較差； 內(nèi)科止血無效的情況下，在數(shù)字減影動(dòng)脈造影下封堵止血是有效的止血方法。

引用本文： 唐裕福,姜曉峰,趙宇,林琳,郭大偉,梁健. 肝癌微波消融術(shù)后出血的原因和預(yù)防. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1294-1298. doi: 復(fù)制

1. Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178.
2. Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454.
3. Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337.
4. Murakami R, Yoshimatsu S, Yamashita Y, et al. Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation [J]. AJR Am J Roentgenol, 1995; 164(5): 1159-1164.
5. Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137.
6. Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives [J]. J Chin Med Assoc, 2005; 68(4): 155-159.
7. 郭大偉， 魏云濤， 侯學(xué)忠， 等. 肝癌微波治療術(shù)中出現(xiàn)血紅蛋白尿的影響因素 [J]. 現(xiàn)代腫瘤醫(yī)學(xué), 2009; 17（3）： 504-507.
8. 肖朝輝， 文天夫. 肝切除術(shù)后死亡因素及其防治 [J]. 中國普外基礎(chǔ)與臨床雜志， 2008； 15（2）： 143-146.
9. Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J]. Liver Transpl, 2004; 10(2 Suppl 1): S39-S45.
10. Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26.
11. Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451.
12. 戴瑩， 陳敏華. 射頻消融在肝腫瘤治療中的并發(fā)癥 [J]. 中華外科雜志， 2004； 42（19）： 1193-1195.
13. 翟博， 徐愛民， 盛月紅, 等. 肝癌射頻消融后針道出血防治21例 [J]. 世界華人消化雜志, 2008; 16(21): 2423-2427.
14. 夏景林， 任正剛， 葉勝龍, 等. 肝癌射頻消融治療嚴(yán)重或少見并發(fā)癥分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5（4）： 268-270.
15. 鄭加生， 李建軍， 崔雄偉, 等. 肝動(dòng)脈化療栓塞聯(lián)合CT引導(dǎo)下射頻消融術(shù)治療肝癌的療效分析 [J]. 介入放射學(xué)雜志, 2009; 18（5）: 324-327.
16. 李紹欽， 倪才方， 蔣國民, 等. 射頻消融聯(lián)合肝動(dòng)脈栓塞治療兔肝癌的安全性 [J]. 世界華人消化雜志, 2008; 16(32): 3677-3680.
17. Yu HC, Cheng JS, Lai KH, et al． Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy [J]． World J Gastroenterol, 2005; 11(10): 1439-1444.
18. Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]． Ann Surg Oncol, 2005; 12(8): 616-628.
19. Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209.
20. Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271.
21. 陳敏華， 嚴(yán)昆， 戴瑩, 等. 肝腫瘤經(jīng)皮射頻消融治療中腹腔出血的處理-附3例臨床報(bào)告 [J]. 中華外科雜志, 2004; 42（17）: 1083-1084.
22. Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403.
23. Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134.
24. Carrafiello G, Laganà D, Ianniello A, et al． Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]． Eur J Radiol, 2007; 61(2): 351-355.
25. Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869.
  1. 1. Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178.
  2. 2. Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454.
  3. 3. Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337.
  4. 4. Murakami R, Yoshimatsu S, Yamashita Y, et al. Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation [J]. AJR Am J Roentgenol, 1995; 164(5): 1159-1164.
  5. 5. Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137.
  6. 6. Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives [J]. J Chin Med Assoc, 2005; 68(4): 155-159.
  7. 7. 郭大偉， 魏云濤， 侯學(xué)忠， 等. 肝癌微波治療術(shù)中出現(xiàn)血紅蛋白尿的影響因素 [J]. 現(xiàn)代腫瘤醫(yī)學(xué), 2009; 17（3）： 504-507.
  8. 8. 肖朝輝， 文天夫. 肝切除術(shù)后死亡因素及其防治 [J]. 中國普外基礎(chǔ)與臨床雜志， 2008； 15（2）： 143-146.
  9. 9. Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J]. Liver Transpl, 2004; 10(2 Suppl 1): S39-S45.
  10. 10. Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26.
  11. 11. Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451.
  12. 12. 戴瑩， 陳敏華. 射頻消融在肝腫瘤治療中的并發(fā)癥 [J]. 中華外科雜志， 2004； 42（19）： 1193-1195.
  13. 13. 翟博， 徐愛民， 盛月紅, 等. 肝癌射頻消融后針道出血防治21例 [J]. 世界華人消化雜志, 2008; 16(21): 2423-2427.
  14. 14. 夏景林， 任正剛， 葉勝龍, 等. 肝癌射頻消融治療嚴(yán)重或少見并發(fā)癥分析 [J]. 中國微創(chuàng)外科雜志, 2005; 5（4）： 268-270.
  15. 15. 鄭加生， 李建軍， 崔雄偉, 等. 肝動(dòng)脈化療栓塞聯(lián)合CT引導(dǎo)下射頻消融術(shù)治療肝癌的療效分析 [J]. 介入放射學(xué)雜志, 2009; 18（5）: 324-327.
  16. 16. 李紹欽， 倪才方， 蔣國民, 等. 射頻消融聯(lián)合肝動(dòng)脈栓塞治療兔肝癌的安全性 [J]. 世界華人消化雜志, 2008; 16(32): 3677-3680.
  17. 17. Yu HC, Cheng JS, Lai KH, et al． Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy [J]． World J Gastroenterol, 2005; 11(10): 1439-1444.
  18. 18. Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]． Ann Surg Oncol, 2005; 12(8): 616-628.
  19. 19. Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209.
  20. 20. Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271.
  21. 21. 陳敏華， 嚴(yán)昆， 戴瑩, 等. 肝腫瘤經(jīng)皮射頻消融治療中腹腔出血的處理-附3例臨床報(bào)告 [J]. 中華外科雜志, 2004; 42（17）: 1083-1084.
  22. 22. Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403.
  23. 23. Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134.
  24. 24. Carrafiello G, Laganà D, Ianniello A, et al． Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]． Eur J Radiol, 2007; 61(2): 351-355.
  25. 25. Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869.