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目的探讨经皮射频治疗近消化管肝肿瘤时肠灼伤、肠穿孔发生的原因及预防策略,评价临床应用效果。方法对有手术切除史或其他治疗等原因不宜接受再手术的邻近消化道肿瘤55例59个病灶,制定相应的附加方法及治疗后预防措施进行治疗,并进行超声、CT随访。结果经皮射频治疗后3～72h内持续不同程度腹痛者占38.2%(21/55例),其中48例治疗后7天内行超声或CT检查,右上腹显著疼痛、肠壁增厚水肿者占25%(12/48例),12.5%(6/48例)肠壁增厚显著,并在肝肠之间有少量积液;12例有右上腹手术或邻近肠管区域肿瘤的2～3次射频治疗病史,其中2例为胆肠吻合术后。2～3周后10例疼痛症状缓解,2例持续性右上腹不适隐痛达4～6个月。3个月后超声或CT检查,8例(14.5%)显示肠粘连,无1例发生肠穿孔。本组病例肿瘤1次射频消融成功率达89.8%(53/59灶),治疗后复发率达15.3%(9/59灶),其后有11例(11/55,20.0%)采用手术切除或术中RF等方法再治疗。结论右上腹手术及邻近肠管区域局部反复射频治疗是RF易发生肠壁灼伤的危险因素;重视预防策略,可有效减少肠穿孔并发症的发生。
Objective To investigate the causes of intestinal perforation and prevention of enteric perforation when transcutaneous radiofrequency (RF) is used in the treatment of proximal gastrointestinal cancer and to evaluate the clinical effect. Methods Fifty-five lesions of 55 patients with adjacent digestive tract tumors who had no history of surgical resection or other reasons were enrolled. Corresponding additional methods and post-treatment prophylaxis were established and were followed up by ultrasound and CT. Results 38.2% (21/55) of patients with different degrees of intra-abdominal pain sustained within 3 ~ 72h after percutaneous radiofrequency ablation. Among them, 48 patients underwent ultrasound or CT examination within 7 days after treatment, with significant pain in the right upper quadrant and thickening and edema in the intestinal wall 25% (12/48 cases), 12.5% (6/48 cases) of intestinal wall thickening significantly, and a small amount of effusion between the liver and intestine; 12 cases of right upper quadrant surgery or adjacent bowel region tumors 2 to 3 times RF Treatment of history, of which 2 cases after cholangioenterostomy. Two to three weeks after the pain relief in 10 cases, 2 cases of persistent right upper quadrant discomfort pain for 4 to 6 months. After 3 months ultrasound or CT examination, 8 cases (14.5%) showed intestinal adhesion, no intestinal puncture occurred in 1 case. The success rate of radiofrequency ablation in one group was 89.8% (53/59) after treatment, and the recurrence rate was 15.3% (9/59) after treatment. In the subsequent 11 cases (11/55, 20.0%), the surgical resection Or intraoperative RF and other methods of re-treatment. Conclusion The right upper quadrant radiofrequency ablation and local repeated radiofrequency in the adjacent intestinal region are the risk factors for the prone to enteric wall burns in RF. Paying attention to prevention strategies can effectively reduce the incidence of intestinal perforation complications.