原发性肝癌射频消融后综合征的临床观察

目的研究原发性肝癌（HCC）经皮射频消融术（RFA）后出现消融后综合征的发生率，分析其发生的原因。方法2002年7月至2006年4月，37例HCC采用经皮RFA技术进行治疗。治疗前后分别行实验室及影像学检查。观察治疗后出现的各种临床症状及持续时间。结果37例均顺利完成RFA治疗。32．4％（12／37）病人出现消融后迟发性症状。其中发热12例、寒战1例、全身不适7例、消融部位疼痛9例、恶心5例、呕吐2例、呃逆2例。治疗后3d症状最明显，均在对症处理后14d内消失。消融后症状的发生与肿瘤体积、消融区体积、射频治疗时间及血清转氨酶（AST、ALT）水平呈明显相关性（P〈0．01）。肿瘤体积〈50cm^3（直径4．5cm）共19例，均未发生消融后综合征；肿瘤体积〉50cm^3共18例，66．7％（12／18）病人发生消融后综合征。结论HCC经皮RFA治疗后，约1／3病人可发生消融后综合征，其发生率与病灶大小相关，对症处理后2周内可自行消失。

Postablation syndrome after percutaneous radiofrequency ablation for treatment of hepatocellular carcinoma:a retrospective study

Objective To retrospectively investigate the incidence of postablation syndrome after percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and analyze its cause. Methods Between July 2002 and April 2006, 37 patients with HCC were treated by percutaneous RFA in our hospital. Pre- and postablation laboratory tests and imaging studies were performed in all patients. After RFA therapy, the delayed symptoms and their durations were observed and recorded. Results Percutaneous RFA was successfully performed in all the 37 patients. Delayed postablation symptoms occurred in 12 patients, they included fever in 12, chills in 1, systemic malaise in 7, pain at the site of ablation in 9, nausea in 5, vomiting in 2 and singultus in 2. Symptoms peaked on day 3 and resolved by conservative treatment within 14 days after onset of symptoms. The incidence of postablation symptoms were related significantly with the tumor volume, the ablated region volume, the length of time for RFA and serum AST and ALT levels (P<0. 01). Postablation syndrome developed in 12 out of the 18 patients with tumor volume > 50 cm3 (4. 5 cm diameter) and not in all of the 19 patients with tumor volume < 50 cm3. Conclusions Approximately one-third of patients with HCC undergoing percutaneous RFA therapy develop delayed postablation symptoms which are significantly related to the volume of ablated tissue, and these symptoms can be self-limiting within 2 weeks after appropriate management for the affected patients.