术前预置鼻胆管引流在肝门部小肝癌射频消融治疗中的作用

目的探讨术前预置鼻胆管引流在肝门部小肝癌射频消融中的作用。方法选择我院在2014年6月~2017年6月期间收治的7例肝门部小肝癌患者,所有患者均为在肝门部小肝癌中射频电极针穿刺进入肝癌时容易误损伤肝门部胆管的病例,术前预置鼻胆管,术中行鼻胆管注水可扩张胆管便于术中辨识及避免误穿刺,部分病例术中损伤胆管后,通过术后鼻胆管引流避免阻塞性黄疸或肝门部胆汁瘤的发生。结果患者治疗有效率为100%(7/7),术后1 d复查血生化、血常规、肝功能等,术后30~60 d复查肝脏CT或者MRI,其中发生预置鼻胆管后轻型胰腺炎l例,并发症发病率为14.3%,远期治疗效果良好,未见肿瘤复发。结论对于肝门部小肝癌,采用术前预置鼻胆管引流技术,可在射频消融治疗过程中明显观察到胆管走向,有效避免胆管误伤。

Effect of preoperative preplacement of nasobiliary drainage in radiofrequency ablation of small hepatocellular carcinoma at hepatic portal

Objective To investigate the effect of preoperative preplacement of nasobiliary drainage in radiofrequency ablation of small hepatocellular carcinoma at hepatic portal. Methods 7 patients with small hepatocellular carcinoma who were admitted to our hospital from June 2014 to June 2017 were selected. All patients were the cases who were prone to injure the bile duct at hepatic portal upon the radiofrequency electrode needle entering liver cancer in the small hepatocellular carcinoma at hepatic portal. The nasal bile duct was pre-placed preoperatively, and infusion of water into nasobiliary bile duct was conducted to expand the bile duct for intraoperative identification and avoiding false puncture. In some cases, after intraoperative bile duct injury, postoperative nasobiliary drainage was given to avoid obstructive jaundice or the occurrence of bile tumor at hepatic portal. Results The treatment effective rate in the patients was 100% (7/7). Blood biochemistry, routine blood test, liver function were re-examined after surgery. Liver CT or MRI was reexamined 30 to 60 d after surgery. After the preplacement of nasal biliary, there was one case of pancreatitis,with the incidence rate of complications of 14.3%. The long-term treatment effect was favorable, without tumor recurrence. Conclusion For small hepatocellular carcinoma at hepatic portal, preoperative preplacment of nasobiliary drainage is used, and the direction of the bile duct during radiofrequency ablation can be clearly observed, so as to effectively avoid the bile duct injury.