肝癌经皮射频消融术后并发胆汁瘤的原因分析与护理

目的探讨肝癌经皮射频消融治疗(percutaneous radio-frequency ablation,PRFA)术后并发胆汁瘤的临床特点和护理体会。方法回顾性分析2005年8月至2012年1月行经皮RFA术后并发胆汁瘤的9例肝癌患者的临床资料,总结并发胆汁瘤的原因及护理对策。结果肝癌RFA术后并发胆汁瘤与基础疾病及机构损伤等有关。9例患者中,7例行经皮肝穿刺胆道引流(percutaneous transhepatic catheter drainage,PTCD)后治愈;1例患者行PTCD减轻黄疸后,在B超引导下行胆汁瘤穿刺引流结合引流管内抗生素冲洗后治愈;1例患者多次行PTCD后肝功能无明显改善,感染无法控制,最终死于肝功能衰竭、肝肾综合征。结论 PTCD和抗生素冲洗是相对有效的治疗方法,术后积极控制感染、加强生命体征及血糖监测、做好营养支持与心理护理等是防治RFA术后并发胆汁瘤的有效措施。

Reason Analysis and Nursing Interventions of Radiofrequency Ablation Complicated with Biloma in Patients with Liver Cancer

Objective To explore the clinical characteristics of liver biloma and main nursing experiences after percutaneous radiofrequency ablation （PRFA） for liver cancer. Methods Among all the cases of hepatic carcinoma taken PRFA between August 2005 and February 2012,there were 9 cases complicated with liver hiloma. The diagnostic ways of liver biloma and main nursing points were summarized. Results Percutaneous transhepatic catheter drainage（PTCD） was performed in nine cases of liver biloma, seven cases were cured. And one case was cured after percutaneous transhepatic catheter drainage plus lavage or swash with antibiotic, but the other one case who received PTCD died. Eight patients survived and one died. Conclusion Percutaneous transhepatic catheter drainage plus lavage or swash with antibiotics is a relatively effective therapeutic measure. The strengthened monitoring and nursing of postoperative, active treatment are the effective interventions to prevent complication such as liver biloma after PRFA.