肝脏肿瘤射频消融术后并发肝内静脉系统血栓的回顾性研究
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摘要
目的回顾性分析肝脏肿瘤射频消融(RFA)术后并发肝内静脉系统血栓患者的资料,总结RFA术后并发静脉系统血栓的影像学特点。方法搜集因肝脏恶性占位而行RFA治疗的患者共293例,根据术后1个月的影像学资料判断是否并发静脉系统血栓分为阳性组和阴性组,分别比较两组患者的一般资料、术前Child-Pugh分级、病理分型、术前肿瘤最大径、术后消融坏死区最大径以及术前与术后的肝功能指标,P<0.05为差异有统计学意义。结果 RFA术后1个月结果显示,13例(4.4%)患者并发肝脏静脉血栓,7例(2.4%)分布于门静脉及远端分支,4例(1.4%)分布于肝静脉及其亚段,2例(0.6%)同时累及门静脉及肝静脉系统内。血栓阳性组RFA术后坏死区最大径明显大于阴性组[(7.12±1.6)cm vs.(5.72±1.2)cm,P<0.01],其他各项指标均无统计学差异(P>0.05)。结论肝脏肿瘤RFA术后并发静脉系统血栓可累及门静脉、肝静脉或同时累及两者,好发部位为RFA术所在区域或邻近的肝段和肝叶,需定期随访。
Objective To explore the diagnosis and therapy of hepatic venous thrombosis after Radiofrequency Ablation(RFA) by comparing the clinical and imaging features in patients with liver tumors. Methods 293 patients with malignant liver tumors underwent RFA in this retrospective study,and they were classified into positive and negative group for the occurrence of venous thrombosis at 1-month follow-up with contrast CT examination. The general patients' data,Child-Pugh grade,pathological type,maximal tumor diameters before RFA,maximal necrotic diameter after RFA,and liver fun ction results before and after RFA were compared. Results Hepatic venous thrombosis was detected in 13(4.4%) patients,including 7(2.4%) in portal veins,4(1.4%) in hepatic veins,and 2(0.6%) in both venous systems. The maximal diameter of necrotic area after RFA in positive thrombosis group is larger than negative group(7.12±1.6 vs. 5.72±1.2,P<0.01). However, no significant statistical results were found in other parameters(all P>0.05). Conclusion Liver venous thrombosis is a rare complication after RFA,which commonly lies in or around the liver segment or lobe of RFA area. Both venous systems can be affected,and regular follow-up is necessary.
Objective To explore the diagnosis and therapy of hepatic venous thrombosis after Radiofrequency Ablation(RFA) by comparing the clinical and imaging features in patients with liver tumors. Methods 293 patients with malignant liver tumors underwent RFA in this retrospective study,and they were classified into positive and negative group for the occurrence of venous thrombosis at 1-month follow-up with contrast CT examination. The general patients' data,Child-Pugh grade,pathological type,maximal tumor diameters before RFA,maximal necrotic diameter after RFA,and liver fun ction results before and after RFA were compared. Results Hepatic venous thrombosis was detected in 13(4.4%) patients,including 7(2.4%) in portal veins,4(1.4%) in hepatic veins,and 2(0.6%) in both venous systems. The maximal diameter of necrotic area after RFA in positive thrombosis group is larger than negative group(7.12±1.6 vs. 5.72±1.2,P<0.01). However, no significant statistical results were found in other parameters(all P>0.05). Conclusion Liver venous thrombosis is a rare complication after RFA,which commonly lies in or around the liver segment or lobe of RFA area. Both venous systems can be affected,and regular follow-up is necessary.
引文
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11 王峰,牟培源,周宁新,等.腹腔镜超声在肝癌射频消融治疗中的临床应用[J].世界华人消化杂志,2009,17:205-208.
12 Kim AY,Rhim H,Park M,et al.Venous thrombosis after radiofrequency ablation for hepatocellular carcinoma[J].AJR,2011,197:1474-1480.
13 Mohnike K,Sauerland H,Seidensticker M,et al.Haemorrhagic Complications and Symptomatic Venous Thromboembolism in Interventional Tumour Ablations:The Impact of Peri-interventional Thrombosis Prophylaxis[J].Cardiovasc Intervent Radiol,2016,39:1716-1721.
14 王能,钱国军,沈强,等.经皮肝穿刺射频治疗肝恶性肿瘤的严重并发症分析[J].中华肝胆外科杂志,2011,17:186-188.
15 张登科,纪建松,涂建飞,等.射频消融治疗肝癌严重并发症原因分析及其防治方法探讨[J].中华放射学杂志,2016,50:213-216.
16 张俊超,林苏,朱月永.射频消融治疗临近特殊部位肝癌的并发症及预防[J].临床肝胆病杂志,2017,33:969-973.
17 Peng Z,Chen S,Wei M,et al.Advanced Recurrent Hepatocellular Carcinoma:Treatment with Sorafenib Alone or in Combination with Transarterial Chemoembolization and Radiofrequency Ablation[J].Radiology,2018,287:705-714.
18 Thanos L,Sotiropoulou E,Tanteles S,et al.Direct radiofrequency ablation of portal vein tumor thrombus in continuity with hepatocellular carcinoma[J].J Vasc Interv Radiol,2010,21:285-288.
19 卢平,熊皆兵,周雅妮.15例肝癌射频消融治疗的并发症观察及护理[J].当代护士(专科版),2009,17:45-46.
20 马庆久,王青,鲁建国,等.射频消融治疗肝肿瘤并发症的原因分析及其防治[J].肝胆外科杂志,2003,11:250-252.
2 Han K,Kim JH.Transarterial chemoembolization in hepatocellular carcinoma treatment:Barcelona clinic liver cancer staging system[J].World J Gastroenterol,2015,21:10327-10335.
3 Zheng J,Zhang H,Sun Y,et al.CT-guided radiofrequency ablation following high-dose chemotherapy of a liver-metastasizing pancreatoblastoma with tumor thrombus in the portal vein[J].Pediatr Radiol,2013,43:1391-1395.
4 Giorgio A,Di Sarno A,de Stefano G,et al.Hepatocellular carcinoma with cirrhosis:are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus?[J].AJR,2009,193:948-954.
5 Grieco A,Pompili M,Caminiti G,et al.Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy:comparison of Okuda,CLIP,and BCLC staging systems in a single Italian centre[J].Gut,2005,54:411-418.
6 曾智明,罗园媛.肝癌射频消融术与手术切除术疗效的Meta分析[J].医学信息,2014,27:321.
7 Chang NK,Shin SS,Kim JW,et al.Effect of ultrasound-guided radiofrequency ablation in incompletely treated hepatocellular carcinoma after transcatheter arterial chemoembolization[J].Korean J Radiol,2012,13 Suppl 1:S104-S111.
8 Giorgio A,Calisti G,Montesarchio L,et al.Hepatocellular carcinoma invading portal venous system in cirrhosis:long-term results of percutaneous radiofrequency ablation of both the nodule and portal vein tumor thrombus.A case control study[J].Anticancer Res,2014,34:6785-6790.
9 Mizandari M,Ao G,Zhang Y,et al.Novel percutaneous radiofrequency ablation of portal vein tumor thrombus:safety and feasibility[J].Cardiovasc Intervent Radiol,2013,36:245-248.
10 李春晓,赵齐羽,陈芬,等.射频消融治疗肝移植术后肝癌的临床价值探讨[J].中国超声医学杂志,2013,29:622-626.
11 王峰,牟培源,周宁新,等.腹腔镜超声在肝癌射频消融治疗中的临床应用[J].世界华人消化杂志,2009,17:205-208.
12 Kim AY,Rhim H,Park M,et al.Venous thrombosis after radiofrequency ablation for hepatocellular carcinoma[J].AJR,2011,197:1474-1480.
13 Mohnike K,Sauerland H,Seidensticker M,et al.Haemorrhagic Complications and Symptomatic Venous Thromboembolism in Interventional Tumour Ablations:The Impact of Peri-interventional Thrombosis Prophylaxis[J].Cardiovasc Intervent Radiol,2016,39:1716-1721.
14 王能,钱国军,沈强,等.经皮肝穿刺射频治疗肝恶性肿瘤的严重并发症分析[J].中华肝胆外科杂志,2011,17:186-188.
15 张登科,纪建松,涂建飞,等.射频消融治疗肝癌严重并发症原因分析及其防治方法探讨[J].中华放射学杂志,2016,50:213-216.
16 张俊超,林苏,朱月永.射频消融治疗临近特殊部位肝癌的并发症及预防[J].临床肝胆病杂志,2017,33:969-973.
17 Peng Z,Chen S,Wei M,et al.Advanced Recurrent Hepatocellular Carcinoma:Treatment with Sorafenib Alone or in Combination with Transarterial Chemoembolization and Radiofrequency Ablation[J].Radiology,2018,287:705-714.
18 Thanos L,Sotiropoulou E,Tanteles S,et al.Direct radiofrequency ablation of portal vein tumor thrombus in continuity with hepatocellular carcinoma[J].J Vasc Interv Radiol,2010,21:285-288.
19 卢平,熊皆兵,周雅妮.15例肝癌射频消融治疗的并发症观察及护理[J].当代护士(专科版),2009,17:45-46.
20 马庆久,王青,鲁建国,等.射频消融治疗肝肿瘤并发症的原因分析及其防治[J].肝胆外科杂志,2003,11:250-252.