经皮肝穿刺射频消融治疗肝癌术后严重并发症的观察及护理

目的探讨经皮肝穿刺射频消融治疗肝癌术后严重并发症的临床观察及护理对策。方法 2006年1月至2009年12月收治939例经病理或临床证实为原发性肝癌或转移性肝癌的患者,共行1 098例次经皮肝穿刺射频消融治疗,术后定期随访,了解发生严重并发症的原因并给予针对性护理措施。结果发生严重并发症9例,发生率为0.82%(9/1 098),并发症相关死亡率为11.1%(1/9);其中胆道损伤4例(胆道出血1例)、胸腔内出血2例、腹腔内出血3例(1例死亡)。结论经皮肝穿刺肝癌射频消融术虽然创伤小、安全性高、疗效好,但对于肿瘤位于肝门区、凝血功能较差的患者,射频消融治疗可能发生严重并发症(如胆道损伤及胸腹腔内出血),围术期护理应加强相关症状的观察,做到早发现、早干预,以改善患者预后。

Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma:Serious Complications and Nursing Observation

Objective To analyze the clinical observation of serious complications and nursing counter- measures of percutaneous radiofrequency ablation for liver cancer. Methods From January 2006 to Decem- ber 2009,939 patients with pathologically or clinically confirmed primary liver cancer, metastatic liver cancer were treated with 1098 cases of sub-percutaneous radiofrequency ablation treatment, with regular follow-up, to understand the serious complications conditions and appropriate care measures. Results Serious complications occurred in 9 cases,including bile duct injury in 4 cases （biliary tract hemorrhage in 1 case）,pleural hemorrhage in 2 cases,abdominal hemorrhage in 3 cases （1 death）. The complication rate was 0. 82~ （9/1098） and complication-related mortality was 11. 1~ （1/9）. Conclusion Although percutaneous radiofrequency ablation of liver cancer is characterized with minimal trauma and higher safety and efficacy,radiofrequency ablation is still present with a certain risk when the tumor is located in hepatic portal areas with poor blood clotting function. Intensive perioperative care of patients with missionaries, close observation of changes in condition and timely detection and effective treatment can effectively prevent the occurrence of serious complications.