射频消融治疗临近特殊部位肝癌的并发症及预防

张俊超; 林苏; 朱月永

doi:10.3969/j.issn.1001-5256.2017.05.038

射频消融治疗临近特殊部位肝癌的并发症及预防

DOI: 10.3969/j.issn.1001-5256.2017.05.038

福建医科大学附属第一医院肝病中心

基金项目:

福建省科技厅引导性项目(2015Y0057)；

详细信息

中图分类号: R735.7
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出版历程
- 收稿日期: 2016-12-09
- 出版日期: 2017-05-20

Complications of radiofrequency ablation for liver cancer in high-risk locations and their prevention

Liver Diseases Research Center, The First Affiliated Hospital of Fujian Medical University

Research funding:

摘要

摘要: 射频消融是治疗肝癌的重要方法之一,具有创伤小、操作简单、可重复治疗等优点。但是对于肝门静脉一、二级分支5 mm以内,肝静脉、下腔静脉主干旁,靠近胆囊、肠道5 mm以内或者肝包膜下、膈肌等特殊部位的肝癌,射频消融存在完全消融率低、局部复发率高以及严重并发症等问题。介绍了射频消融治疗靠近特殊部位肝癌的并发症及其预防。指出随着个体化、规范化的射频消融推广,这些"禁区"成为可能。
- 肝肿瘤 /
- 导管消融术 /
- 综述
Abstract: Radiofrequency ablation (RFA) is one of the most important methods for the treatment of liver cancer and has the advantages of small trauma, simple operation, and repeatability.However, for tumors in high-risk locations within 5 mm of the first and second branches of the hepatic portal vein, near the hepatic vein, the inferior vena cava, or the gallbladder, within 5 mm of the intestinal tract, under the Glisson's capsule, and in the diaphragm, RFA has the issues of a low complete ablation rate, a high local recurrence rate, and serious complications.This article introduces the complications of RFA for liver cancer in high-risk locations and their prevention and points out that with the promotion of individualized and standardized RFA, liver cancer in these high-risk locations is no longer a contradiction for RFA.
- liver neoplasms /
- catheter ablation /
- review

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参考文献(42)

[1]NCCN clinical practice guidelines in oncology:hepatobiliary cancers, version 1[EB/OL].[2015-1-23].https://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

[2]CHEN Y, ZHOU J, FAN J, et al.Clinical effect and progrostic factors analysis of intraoperative radiofrequency ablation in treatment of hepatocellular carcinoma with severe cirrhosis[J].Chin J Dig Surg, 2017, 16 (2) :159-163. (in Chinese) 陈漪, 周俭, 樊嘉, 等.术中射频消融治疗合并重度肝硬化肝细胞癌的临床疗效及预后因素分析[J].中华消化外科杂志, 2017, 16 (2) :159-163.

[3]LU DSK, RAMAN SS, VODOPICH DJ, et al.Effect of vessel size on creation of hepatic radiofrequency lesions in pigs[J].Am J Roentgenol, 2002, 178 (1) :47-51.

[4]HUANG JS, LI T, LIU NZ, et al.Safety and reliability of hepatic radiofrequency ablation near the inferior vena cava:an experimental study[J].Int J Hyperthermia, 2011, 27 (2) :116-123.

[5]CHEN MH.Standardized treatment of radiofrequency ablation for hepatoceuular carcinoma under image guidance[J].Natl Med J China, 2015, 95 (27) :2129-2132. (in Chinese) 陈敏华.影像指导肝癌射频消融规范化治疗[J].中华医学杂志, 2015, 95 (27) :2129-2132.

[6]de BAERE T, RISSE O, KUOCH V, et al.Adverse events during radiofrequency treatment of 582 hepatic tumors[J].Am J Roentgenol, 2003, 181 (3) :695-700.

[7]CHINN SB, LEE LF, KENNEDY GD, et al.Effect of vascular occlusion on radiofrequency ablation of the liver:results in a porcine model[J].Am J Roentgenol, 2001, 176 (3) :789-795.

[8]NG KK, LAM CM, POON RT, et al.Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein[J].Br J Surg, 2004, 91 (5) :632-639.

[9]MULIER S, MULIER P, NI Y, et al, Complications of radiofrequency coagulation of liver tumours[J].Br J Surg, 2002, 89 (10) :1206-1222.

[10] Chinese Expert Consensus Statement Chinese Society of Liver Cancer (CSLC) , Chinese Society of Clinical Oncology (CSCO) , Liver Cancer Group, Chinese Society of Hepatology.Guidelines for radiofrequency ablation therapy of liver cancer[J].J Clin Hepatol, 2011, 27 (3) :236-238. (in Chinese) 中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作委员会, 中华医学会肝病学分会肝癌学组.肝癌射频消融治疗规范的专家共识[J].临床肝胆病杂志, 2011, 27 (3) :236-238.

[11]de SANTIS A, MOSCATELLI R, CATALANO C, et al.Systemic thrombolysis of portal vein thrombosis in cirrhotic patients:a pilot study[J].Digest Liver Dis, 2010, 42 (6) :451-455.

[12]AMITRANO L, GUARDASCIONE MA, MENCHISE A, et al.Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis[J].J Clin Gastroenterol, 2010, 44 (6) :a22.

[13]MARIA GABRIELA D, SUSANA S, ISMAEL Y, et al.Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis[J].Clin Gastroenterol Hepatol, 2012, 10 (7) :776-783.

[14]LIU NZ, GAO J, LIU YK, et al.The safety of radiofrequency ablation near major intrahepatic bile ducts[J].Chin J Hepatobiliary Surg, 2013, 19 (5) :373-377. (in Chinese) 刘念洲, 高峻, 刘永康, 等.肝内大胆管旁射频消融治疗的安全性研究[J].中华肝胆外科杂志, 2013, 19 (5) :373-377.

[15]PITTON MB, HERBER S, RAAB P, et al.Percutaneous radiofrequency ablation of liver tumors using the Le Veen 4 cm array probe[J].Rofo, 2003, 175 (11) :1525-1531.

[16]KIM SH, LIM HK, CHOI D, et al.Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma:frequency and clinical significance.[J].Am J Roentgenol, 2005, 183 (6) :1611-1617.

[17]GUO H, LIN YJ, CAO CN, et al.Efficacy of intraductal perfusion to prevent bile duct thermal injury during radiofrequency ablation in rabbits[J].J Sun Yat-Sen Univ:Medical Sciences, 2014, 35 (3) :459-464. (in Chinese) 郭辉, 林宇静, 蔡潮农, 等.胆管灌注对兔肝射频消融术中胆道热损伤的保护作用[J].中山大学学报:医学科学版, 2014, 35 (3) :459-464.

[18]STIPPEL DL, BANGARD C, KASPER HU, et al.Experimental bile duct protection by intraductal cooling during radiofrequency ablation.[J].Brit J Surg, 2005, 92 (7) :849-855.

[19]OHNISHI T, YASUDA I, NISHIGAKI Y, et al.Intraductal chilled saline perfusion to prevent bile duct injury during percutaneous radiofrequency ablation for hepatocellular carcinoma[J].J Gastroenterol Hepatol, 2008, 23 (8pt2) :e410-e415.

[20]OGAWA T, KAWAMOTO H, KOBAYASHI Y, et al.Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube[J].Eur J Radiol, 2010, 73 (2) :385-390.

[21]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].Radiol, 2003, 226 (2) :441-451.

[22]GOTO E, TATEISHI R, SHIINA S, et al.Hemorrhagic complications of percutaneous radiofrequency ablation for liver tumors[J].JClin Gastroenterol, 2009, 44 (5) :374-380.

[23]CHANG IS, RHIM H, KIM SH, et al.Biloma formation after radiofrequency ablation of hepatocellular carcinoma:incidence, imaging features, and clinical significance[J].Am J Roentgenol, 2010, 195 (5) :1131-1136.

[24]YOON DH, SHIM JH, LEE WJ, et al.Percutaneous management of a bronchobiliary fistula after radiofrequency ablation in a patient with hepatocellular carcinoma[J].Korean J Radiol, 2008, 10 (4) :411-415.

[25]ZENG Z, CAI MY, HUANG WS, et al.Delayed bronchobiliary fistula following radiofrequency ablation in a patient with hepatocellular carcinoma:a case report and lesson regarding treatment[J].Oncol Lett, 2016, 11 (5) :3213-3217.

[26]JAMES D, PERKINS MD.Seeding risk following percutaneous approach to hepatocellular carcinoma[J].Liver Transplantat, 2007, 13 (11) :1603-1607.

[27]GUO YJ, HUANG WS, ZHOU B, et al.Transarterial chemoembolization plus computed tomography-guided percutaneous radiofrequency ablation for small hepatocellular carcinoma in special locations[J].Natl Med J China, 2013, 93 (33) :2627-2630. (in Chinese) 郭永建, 黄文薮, 周斌, 等.TACE联合CT引导下射频消融治疗特殊部位小肝癌[J].中华医学杂志, 2013, 93 (33) :2627-2630.

[28]ZHANG DK, JI JS, TU JF, et al.A discussion of reasons and methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas[J].Chin J Radiol, 2016, 50 (3) :213-216. (in Chinese) 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 (3) :213-216.

[29]ZHAO XX, YOU FP, YUAN QZ, et al.Safety and effectiveness of radiofrequency combined with laparoscopic cholecystectomy in management of liver cancer near the gallbladder[J].World Chin J Dig, 2013, 21 (22) :2212-2216. (in Chinese) 赵希学, 由法平, 袁庆忠, 等.胆囊区肝癌射频治疗联合LC手术安全性评估[J].世界华人消化杂志, 2013, 21 (22) :2212-2216.

[30]HARUYUKI T, KOICHIRO Y, ATSUHIRO N, et al.Frequency of and risk factors for complications after liver radiofrequency ablation under CT fluoroscopic guidance in 1500 sessions:single-center experience.[J].Am J Roentgenol, 2013, 200 (3) :658-664.

[31]RHIM H.Complications of radiofrequency ablation in hepatocellular carcinoma[J].Abdom Radiol, 2005, 30 (4) :409-418.

[32]KANSO F, NAHON P, BLAISON D, et al.Diaphragmatic necrosis after radiofrequency ablation of hepatocellular carcinoma:a successful surgical repair[J].Clin Res Hepatol Gastroenterol, 2013, 37 (2) :e59-e63.

[33]SASAHIRA N, TADA M, YOSHIDA H, et al.Extrahepatic biliary obstruction after percutaneous tumour ablation for hepatocellular carcinoma:aetiology and successful treatment with endoscopic papillary balloon dilatation[J].Gut, 2005, 54 (5) :698-702.

[34]MENG KW.Clinical applications to hepatic carcinoma of radiofrequency ablation by laparoscopic at special orthophoric area[J/CD].Chin J Clinicians:Electronic Edition, 2015, 9 (20) :5-7. (in Chinese) 孟珂伟.腹腔镜下特殊部位肝癌射频治疗的临床应用[J/CD].中华临床医师杂志:电子版, 2015, 9 (20) :5-7.

[35]THIEMANN M, BENHIDJEB T, ANDERS S, et al.Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis:a case report and review of the literature.[J].Langenbeck Arch Surg, 2008, 393 (6) :1013-1016.

[36]ZHANG ZB, ZHUANG ZN, XU ZJ, et al.Post-operative pericardial effusion following treatment of small hepatocellular carcinoma with radiofrequency ablation:a case report[J].Oncol Lett, 2014, 7 (2) :345-348.

[37]MOUMOUH A, HANNEQUIN J, CHAGNEAU C, et al.A tamponade leading to death after radiofrequency ablation of hepatocellular carcinoma[J].Eur Radiol, 2005, 15 (2) :234-237.

[38]KANG TW, RHIM H, LEE MW, et al.Radiofrequency ab lation for hepatocellular carcinoma abutting the diaphragm:comparison of effects of thermal protection and therapeutic eficacy[J].Am J Roentgenol, 2011, 149 (4) :907-913.

[39]PARK SY, TAK WY, JEON SW, et al.The eficacy of intraperitoneal saline infusion for pereutaneous radiofrequency ablation for hepatocellular carcinoma[J].Eur J Radiol, 2010, 74 (3) :536-540.

[40]IWAI S, SAKAGUCHI H, FUJII H, et al.Benefits of artificially induced pleural effusion and/or ascites for percutaneous radiofrequency ablation of hepatocellular carcinoma located on the liver surface and in the hepatic dome.[J].Hepatogastroenterol, 2012, 59 (114) :546-550.

[41]MA K, MIN C, IAN HX, et al.Prevention and cure of complications from multiple-electrode radiofrequency treatment of liver tumors[J].Digest Dis, 2001, 19 (4) :364-366.

[42]CROCETTI L, de BAERE T, LENCIONI R, et al.Quality improvement guidelines for radiofrequency ablation of liver tumours[J].Cardiovasc Inter Ra, 2010, 33 (1) :11-17.

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