Clinical analysis and treatment of liver abscess formation after radiofrequency ablation

目的：总结分析肝癌RFA术后肝脓肿的成因及其治疗方法。方法收集2007年1月至2013年2月间310名患有原发性肝癌或继发性肝肿瘤患者，其中男239例，女71例，年龄23~85岁，其中原发性肝癌258例，肝转移瘤52例。32例原发性患者曾行肝部分切除术。肝转移癌患者治疗时均已行原发灶切除术。经皮肝穿刺射频消融（percutaneous radiofrequency ablation，RFA）均为B超及CT引导下进行。术后第2天常规检测血常规、生化，监测体温，并常规使用广谱抗生素。对长期发热或血WBC持续升高的患者行B超或CT检查。如证实脓肿存在，则加强抗生素使用，如病灶液化坏死明显则及时进行穿刺抽吸或引流术。结果共4例患者发生肝脓肿，其中3例患者曾行胆肠吻合术，另一例患者曾于既往TACE术后形成过肝脓肿。4例患者中1例经脓肿穿刺引流痊愈，1例经加强抗炎治疗痊愈，1例脓肿与结肠穿通形成肠瘘经手术及脓肿局部置管引流后痊愈。另一例肝脏表面脓肿形成自行破溃经局部换药结合抗生素治疗后痊愈。结论 Whipple术等导致Oddi括约肌无功能的手术为RFA术后发生肝脓肿的明确诱因。对曾发生肝脓肿的病人进行RFA应极为谨慎。对RFA术后肝脓肿的诊断应及时，除了应用敏感抗生素以外，及时行脓腔抽吸、引流，外科干预等综合治疗是针对RFA术后肝脓肿的有效治疗方法。Objective To investigate the possible causes of liver abscess formation after RFA. To summarize the criterion of treatment of liver abscess formation after RFA. Methods From Jan, 2007 to Feb 2013, 310 patients with liver malignances were treated with RFA. Male 239, female 71, age between 23 and 85. Among those patients, HCC were 258 cases, liver metastasis were 52 cases. 32 of patients with HCC had been surgically treated and recurrence was noted. All those had liver metastasis had been underwent the resection of the primary malignances. RFA was carried out by guidance of US or CT. Blood examination was carried out the next day to RFA. Broad antibiotics was given to all patients from the day of RFA. If a high fever persisted or WBC count was continuously elevated, US or enhanced CT was given . If sign of abscess was found either further antibiotics or percutaneous drainage were given accordingly. Results Four cases of liver abscess has been diagnosed. Three of the 4 patients had the biliary intestinal anastomosis. Another is a patient who has been cured from an original liver abscess from his initial TACE. They has been diagnosed to develop liver abscess after RFA according to their symptoms, blood check and image finds. Their liver abscess has been cured by percutaneous drainage , antibiotics, percutaneous drainage plus surgery and local disinfections separately. Conclusions patients who have Whipple or other surgical process which result in a dysfunctional sphincter of Oddi have a high risk of developing liver abscess after RFA. Also special notice should be given to those who had a liver abscess in history. Once liver abscess after RFA has been diagnosed, either percutaneous drainage or powerful antibiotics, or even surgical means should be given in time.0144-4