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目的观察肝癌患者多点射频消融术(2～4针)后肝功能和并发症情况,探讨其安全性及术前肝功能Child分级与术后并发症的关系。方法选择我院2008年2月—2012年2月就诊的符合条件的肝癌患者43例,记录所有患者术前及术后第5天肝功能指标、术后5 d内出现的并发症及其与术前肝功能Child分级的关系及术后第5天肝功能Child分级。结果术后第5天患者ALT水平较术前平均升高(18±32)U/L,AST水平平均升高(22±31)U/L,差异均有统计学有意义(t值分别为-3.689和-4.767,P<0.05);ALB水平较术前平均下降(4.04±2.33)g/L,差异有统计学意义(t=11.381,P<0.05);DBiL水平较术前平均升高(0.40±1.22)μmol/L,IBiL水平较术前平均升高(1.18±3.99)μmol/L,差异均无统计学意义(t值分别为-0.213和-1.942,P>0.05)。术后5 d内发生肝区疼痛40例次,发热36例次,腹胀20例次,恶心5例次,电极板处皮肤灼伤2例次,呕吐1例次,胸腔积液1例次,针道感染1例次。肝功能Child分级,术前A级38例,B级5例;术后A级33例,B级10例。患者术后5 d内并发症除腹胀和胸腔积液在不同术前Child分级间差异有统计学意义,余比较差异均无统计学意义(P>0.05)。结论多点射频消融术治疗肝癌安全有效,术前评价和改善肝功能十分重要。射频消融术后患者并发症主要为肝区疼痛、发热、腹胀、恶心。术前肝功能Child B级患者多点射频消融术后更容易出现腹胀,术前应积极改善肝功能,提高肝脏储备能力,以减少术后并发症的发生,进一步提高多点射频消融术的安全性。
Objective To observe the liver function and complications after radiofrequency catheter ablation (2 ~ 4 pins) in patients with hepatocellular carcinoma (HCC) and to explore the relationship between the safety and preoperative liver function Child grading and postoperative complications. Methods Forty-three patients with hepatocellular carcinoma (HCC) were selected from February 2008 to February 2012 in our hospital. The liver function indexes of all patients before and 5 days after operation were recorded. The complication occurred within 5 days after operation and its correlation with Preoperative liver function Child grading and liver function on the 5th day after Child classification. Results The ALT level was significantly higher than that before operation (18 ± 32) U / L and AST level was (22 ± 31) U / L on the 5th postoperative day (t = -3.689 and -4.767, respectively, P <0.05). The ALB level was lower than the preoperative average (4.04 ± 2.33) g / L, the difference was statistically significant (t = 11.381, P < (0.40 ± 1.22) μmol / L and IBiL (1.18 ± 3.99) μmol / L respectively (t = -0.213 and -1.942, respectively; P> 0.05). Within 5 days after operation, there were 40 cases of liver pain, 36 cases of fever, 20 cases of abdominal distension, 5 cases of nausea, 2 cases of skin burns on electrode plate, 1 case of vomiting and 1 case of pleural effusion. Road infection in 1 case. Liver function classification, preoperative 38 cases of A grade, B grade in 5 cases; A grade in 33 cases, B grade in 10 cases. Complications within 5 days after operation in patients with abdominal distension and pleural effusion in different preoperative Child classification differences were statistically significant, the difference was not statistically significant (P> 0.05). Conclusions Multi-point radiofrequency ablation for the treatment of liver cancer is safe and effective, and it is very important to evaluate and improve the liver function preoperatively. Complications after radiofrequency ablation are mainly liver area pain, fever, bloating and nausea. Preoperative liver function Child B-class patients more prone to abdominal distension after radiofrequency ablation, preoperative positive and should improve liver function, improve liver reserve capacity to reduce the incidence of postoperative complications and further improve the safety of multi-point radiofrequency ablation Sex.