肝肿瘤射频消融术后感染性并发症的处理

目的分析肝恶性肿瘤经皮射频消融术(RFA)后感染性并发症的临床特点及处理方法。方法回顾性分析于我科接受RFA治疗的356例肝脏恶性肿瘤患者,其中原发性肝癌296例,肝转移癌60例。对于术后有严重感染表现的患者进行即刻腹部超声和(或)CT增强扫描。明确肝内局部脓肿形成后,采取置管引流、使用抗生素等干预措施,并随访1年。全部脓肿引流液均行细菌学检查并根据药敏结果调整抗生素用药。结果 356例RFA术后共5例患者发生局部严重感染,其中3例为肝脓肿,1例胆汁瘤合并感染,1例为腹壁脓肿。1例肝脓肿患者肝内局部病灶与结肠肝曲形成窦道且经久不愈,经外科手术局部修补+肝内脓肿置管引流后局部及全身症状有所缓解,但于RFA术后8个月死于全身衰竭。1例腹壁脓肿患者经抗感染、置管引流、局部换药处理后局部及全身症状有所缓解,但于RFA术后6个月死于肿瘤进展。1例肝脓肿和1例胆汁瘤合并感染患者经单纯病变部位置管引流+抗生素治疗后临床症状明显缓解,随诊1年达到临床治愈。1例肝脓肿患者经病变部位置管引流+抗生素治疗后,感染灶痊愈,但随访至9个月时死于肝内肿瘤转移导致的多脏器功能衰竭。结论 RFA术后严重感染性并发症并不少见,感染途径可来自肠道菌群逆行感染,Whipple术等导致Oddi括约肌无功能的RFA术后继发严重感染的明确诱因。除根据药敏实验应用敏感抗生素外,及时行脓腔穿刺引流、外科干预等综合治疗是针对RFA术后局部感染性并发症的有效方法。

Clinical analysis of infectious complications after radiofrequency ablation of liver tumor

Objective To analyze the clinical manifestations and treating methods in infectious complications after radiofrequency ablation(RFA) of liver malignant tumors. Methods Totally 356 patients with liver malignant tumors were treated with RFA. If clinical signs of infection were persist, ultrasound and(or) enhanced CT scan was performed. If signs of abscess were found, percutaneous drainage and antibiotics was given immediately, and the follow up was performed for 1 year. Antibiotics was adjusted according to the antimicrobial susceptibility test. Results Five cases of sever infectious complications had been diagnosed. Three of them developed liver abscess, one patient got infectious biloma, another patient got abdominal wall abscess. By the end of the follow up, one liver abscess patient undertook surgery because of the formation of a persist fistula between the liver abscess and the colon, and died from deterioration of the general conditions 8-month later; one patient with abdominal wall abscess was cured by percutaneous drainage+antibiotics, but died from further tumor invasion; 1 liver abscess patient and 1 infectious biloma patient were cured by percutaneous abscess drainage+antibiotics; one liver abscess patient was cured by percutaneous drainage+antibiotics, but died from multi-organ failure because of tumor metastasis. Conclusion Infectious complications after RFA are not rare. Patients who have Whipple or other surgical process which result in a defunctional sphincter of Oddi have a high risk of developing liver abscess after RFA. Once liver abscess after RFA has been diagnosed, percutaneous drainage as well as proper antibiotics should be given in time. Surgical treatment should be also considered in some particular situation.