原发性肝癌热消融术后并发膈疝的研究进展

张玉蓉; 王晓栋; 朱晓宁; 汪静

doi:10.3969/j.issn.1001-5256.2021.12.043

原发性肝癌热消融术后并发膈疝的研究进展

DOI: 10.3969/j.issn.1001-5256.2021.12.043

西南医科大学附属中医医院肝胆病科，泸州 646000

基金项目:

四川省科学技术厅重大科技专项 (2019YFS0018);

泸州市人民政府-西南医科大学科技战略合作项目 (2019LZXNYDZ12);

西南医科大学附属中医医院国家中医临床研究基地建设单位科研项目 (〔2020〕33, Hospital of Traditional Chinese Medicine of Southwest Medical University)

详细信息

通信作者:
汪静，lywj68@126.com

中图分类号: R735.7
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出版历程
- 收稿日期: 2021-05-08
- 录用日期: 2021-06-25
- 出版日期: 2021-12-20

Research advances in diaphragmatic hernia after thermal ablation for primary liver cancer

Department of Hepatobiliary Diseases, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

Major Science and Technology Project of Sichuan Provincial Science and Technology Department (2019YFS0018);

Luzhou Municipal People's Government-Southwest Medical University Science and Technology Strategic Cooperation Project (2019LZXNYDZ12);

National TCM Clinical Research Base Construction Unit Research Project of Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University (〔2020〕33, Hospital of Traditional Chinese Medicine of Southwest Medical University)

摘要

摘要: 包括射频消融和微波消融的热消融术是目前原发性肝癌局部治疗的常用手段，疗效明确，近年来得到广泛应用。膈疝是其较罕见的并发症，但近年来亦有逐渐增长的趋势。回顾了国内外原发性肝癌热消融治疗后并发膈疝的病例，并对其可能的危险因素、诊治及预防策略等进行阐述和总结，以期加强临床工作者对原发性肝癌热消融术后并发膈疝的临床认识，达到术前预防、迅速诊断干预和降低病死率的目的。
- 肝肿瘤 /
- 消融技术 /
- 疝, 横膈, 创伤性 /
- 手术后并发症
Abstract: Thermal ablation, including radiofrequency ablation and microwave ablation, is a frequently used method for local treatment of primary liver cancer with a marked clinical effect, and it has been widely used in clinical practice in recent years. Diaphragmatic hernia is a rare complication of thermal ablation, but its incidence rate tends to gradually increase in recent years. This article reviews the cases of diaphragmatic hernia after thermal ablation for primary liver cancer in China and globally and elaborates on possible risk factors, diagnosis and treatment, and prevention strategies, so as to improve the understanding of diaphragmatic hernia after thermal ablation for primary liver cancer among clinicians and achieve the goal of preoperative prevention, rapid diagnosis and intervention, and reduced mortality rate.
- Liver Neoplasms /
- Ablation Techniques /
- Hernia, Diaphragmatic, Traumatic /
- Postoperative Complications

HTML全文

表 1 肝癌热消融术后并发膈疝23例病例报道

项目		例数	参考文献
年龄	＜60岁	5	[14][18][24][25][30]
	≥60岁	18	[14-17][19-23][26-29][31]
性别	男	14	[14-16][18-21][23-24] [28-30]
	女	9	[14][17][22][25-27][31]
基础疾病	乙型肝炎肝硬化	4	[22][25][27][30]
	丙型肝炎肝硬化	14	[14][16-17][20-21][24][26][28-29][31]
	酒精性肝硬化	3	[14][19][23]
	其他¹⁾	2	[15][18]
Child- Pugh分级	A	5	[14-15][19][25]
	B	5	[14][17][22][26]
	C	5	[14][16][28-29]
	未提及	8	[18][20-21][23-24][27][30-31]
病灶部位²⁾	S4	6	[14][18][20][23][26][31]
	S5	4	[17][19][25][29]
	S6	1	[14]
	S8	18	[14-16][19-25][27-31]
术后发生	7~10个月	3	[18-19][26]
膈疝时间	10~20个月	13	[14][16-17][20][22-25][27][30-31]
	20~30个月	4	[14-15]
	＞30个月	3	[21][28-29]
手术方式	MWA	1	[15]
	RFA	22	[14][16-31]
临床表现	腹痛	9	[14][18][21][24][27-29]
	呼吸困难	4	[14-16][22]
	腹痛+呼吸困难	5	[17][20][23][25][30]
	无症状	2	[19][26][31]
	未提及	3	[14]
治疗方法	开放手术	15	[14-15][20-24][27][29-30]
	腹腔镜修复	5	[16-18][25][28]
	保守治疗	2	[19][26]
	未提及	1	[31]
预后	预后良好	15	[14-17][19-21][23-28]
	死亡³⁾	5	[14][22][29]
	未提及	3	[18][30-31]
注：1)其他，1例为继发于遗传性血色病的慢性肝病，1例为慢性乙型肝炎；2)病灶部位，部分患者合并S4、S8或S5、S8；3)死亡，1例因肝癌破裂出血死亡，4例因肝衰竭死亡。

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参考文献(44)

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