摘要
目的探讨经皮热消融治疗肝癌的胆道并发症发生原因及防治措施。方法以接受经皮热消融治疗的1797例肝癌患者为研究对象，根据肿瘤与最近胆管的距离分为四组，比较邻近一级（I组）、二级（Ⅱ组）、三级（HI组）分支胆管及非邻近胆管肿瘤（IV组）经皮热消融治疗的胆管相关并发症发生率和局部疗效；评估邻近胆囊肿瘤经皮热消融治疗的安全性。结果1797例患者3200个肿瘤共行2356例次热消融治疗，邻近胆管肿瘤（I组＋Ⅱ组＋Ⅲ组）与非邻近胆管肿瘤（1V组）两组完全消融率分别为96．5％、97．2％（P=0．298），局部进展率分别为10．0％、8．2％（P：0．080）。治疗后出现胆道相关严重并发症14例，发生率为0．59％（14／2356），包括胆管相关严重并发症13例和急性胆囊炎1例。I组、Ⅱ组、Ⅲ组、Ⅳ组胆管相关严重并发症发生率分别为6．5％、2．9％、0．3％、0．2％，各组间严重并发症比较，I组与Ⅱ组、Ⅲ组与Ⅳ组间差异均无统计学意义（P〉0．05），I组与Ⅲ组、I组与Ⅳ组、Ⅱ组与Ⅲ组、Ⅱ组与Ⅳ组间差异均有统计学意义（P〈0．01）。结论经皮热消融治疗邻近胆道肿瘤疗效确切，邻近较高级别分支胆管可能导致严重并发症，需慎重，通过个体化联合治疗可预防胆道相关并发症。
Objective To investigate the risk factors of biliary tract complications in patients with liver cancer after thermal ablation and the prevention methods. Methods One thousand seven hundred and ninety-seven patients with liver cancer underwent percutaneous thermal ablation were enrolled in this retrospective study. According to the relative position of the tumor and biliary tract, patients were classified into 4 groups：with the tumor close to the first branch （group Ⅰ ）, the second branch （group Ⅱ ）, the third branch of bile duct （group Ⅲ ） and far away from the biliary tract （group Ⅳ）. The tumor response and complications, especially biliary tract complications after ablation therapy of subgroups were analyzed. Results A total of 2 356 sessions were performed in 1 797 patients with 3 200 lesions. The local progression rates of the tumors close to and far away from biliary were 10.0% and 8.2% （ P = 0.080） and the rate of complete ablation were 96.5% and 97.2% （ P = 0. 298）, respectively. Fourteen patients suffered from major biliary complications after thermal ablation. Biliary complication incidences of the patients with the tumor close to the first, the second biliary tract were 6.5% and 2.9% respectively, which were all higher than those of the patients with the tumor close to the third（0. 3%） and far away from biliary duct（0. 2%）. Conclusions Percutaneous thermal ablation is an efficient and safe method in the treatment of tumors close to biliary tract and with a low incidence of major biliary complications. Patients with a tumor close to the large branch of biliary duct were at high risk of complications. Those tumors, therefore, should be ablated with assisting methods and extra care.
出处
《中华超声影像学杂志》
CSCD
北大核心
2016年第11期970-974,共5页
Chinese Journal of Ultrasonography
基金
天津市卫生局重点课题（2014KR05）
关键词
超声检查
肝肿瘤
热消融
并发症
胆道
Ultrasonography
Liver neoplasms
Thermal ablation
Complications
Biliary tract
作者简介
通信作者：经翔，Email：dr．jingxiang@aliyun．com
