358例肝肿瘤微波消融并发症的临床分析
安东均 郑晓燕 张成
摘 要
目的：探讨肝肿瘤微波消融（MWA）治疗的并发症发生原因和处理措施，提升MWA安全性。
方法：回顾性分析2004年6月～2014年8月采用MWA治疗肝肿瘤患者358例临床资料。
结果：358例患者中发生各种严重并发症33例，其中B超下经皮入肝行MWA发生并发症26例，经腹腔镜入肝MWA者4例，开腹手术直视下行MWA者3例。分析显示消融针所致的器械损伤性并发症7例；MWA热损伤性并发症，包括肝胆管热损伤、膈肌损伤及胃肠道损伤等16例；消融灶感染肝脓肿4例；多因素导致的肺梗死和肝功能不全6例。2例肝功能不全在MWA后1～2周内死亡，其余患者经及时处理并发症均获痊愈。
结论：MWA在肝肿瘤综合治疗中，可有严重的并发症发生，要加强对其并发症的防范和处理，使其得到进一步的规范和推广。
关键词
肝肿瘤；微波消融/治疗；并发症
A clinical study of complications arising from microwave ablation for 358 liver tumors
（AN Dongjun，ZHENG Xiaoyan，ZHANG Cheng.Department of hepatobiliary surgery，the Center Hospital of xianyang City，Xianyang 712000，China）
ABSTRACT
Objective:To investigate the causes and treatment measures of complications arising from microwave ablation（MWA）for liver tumor，to improve security of MWA.
Methods:The clinical data of 358 patients with liver tumor received MWA treatment from June 2004 to August 2014 were analyzed retrospectively.
Results:On the 358 patients，33 cases suffered serious complications，including 26 patients who received MWA under B ultrasound guided percutaneous into the liver，4 cases underwent MWA by laparoscopic into liver and 3 cases of open operation whose MWA were operated under direct vision.On the 33 patients，Mechanical damage of microwave ablation needle occured in 7 cases；Hot traumatic complications of MWA include the Hepatobiliary duct thermal damage，diaphragmatic muscle injury and gastrointestinal lesions in 16cases；Liver abscess arised from the Ablation lesions infection in 4 cases.Many factors lead up to pulmonary embolism and hepatic insufficiency in 6 patients.2 cases of Liver failure died after MWA within 1～2 weeks.The rest of the patients with complications were cured after timely treatments.
Conclusion:MWA can have serious complications in comprehensive therapy of liver tumors，to strengthen the prevention and treatment of complications.MWA must be further standardized and promotion.
KEY WORDS
liver tumor；microwave ablation/therapy；complication
微波消融（microwave ablation，MWA）治疗原发性肝癌、肝转移癌、肝血管瘤等肝肿瘤性疾病，是一种简便有效、创伤小、费用低且适应证广的方法［1，2］。近年来，在肝肿瘤的临床治疗中MWA得到广泛的应用，随之与其相关的并发症时有发生。我科自2004年6月至2014年8月采用MWA治疗肝肿瘤患者358例，发生各种严重并发症 33例，现就MWA治疗并发症的原因和处理报告如下。