| Background and Objective: In recent years, the use of image-guided ablation to treat primary and secondary liver tumors has increased worldwide. Thermal ablation for treating liver cancer is a very safe,little invasive,effective method,especially for the patients who can't be treated by chemotherapy, radiotherapy and surgical therapy.Thermal ablation has been using more and more frequently, and this technology is a improvement of treating tumor unsurgically.Thermal ablation has become the third therapy for liver cancer after liver transplant and surgical therapy.Image-guided ablation is used to treat patients with unresectable malignant hepatic tumors that are limited in number and size.Postoperative hemorrhage is one of the major complications of thermal ablation of liver cancer,the objective of this study is to analyze the risk factors, prevention and treatment of bleeding after thermal ablation for hepatocellular carcinoma.Materials and Methods: In January 2002 to December 2014, 2356 cases were carried out for 1797 cases of patients with thermal ablation in our hospital, among which 1362 were male, 435 cases of women aged 25 to 92 years old, the average(58.9 + 9.7) years of age, with 1614 cases of primary liver cancer, 183 cases of metastatic carcinoma. Primary liver cancer is diagnosed by pathology and/or clinical diagnosis, diagnostic standard meets the specification of primary liver cancer diagnosis and treatment of ministry of health in our country(2011 edition).Secondary liver cancer with clear primary tumors is confirmed by two or more enhanced imaging examinations and tumor markers. Inclusion criteria: tumor diameter 6.0 cm or less, the number of 5 or less, without intrahepatic bile ducts, blood vessels,main branch and inferior vena cava invasion for the principle. This study retrospectively analyzed the clinical data of patients with relevant and related factors of bleeding complications occurred more factor analysis and summarizes the prevention and control measures. Application of SPSS 20.0 statistical software,adopts single factor Logistic regression analysis for the main factor that may affect the hemorrhage after thermal ablation:gender, age, tumor type, tumor number,tumor location,tumor diameter,number of thermal ablation of tumor,preoperative transcatheter arterial chemoembolization(TACE), platelet number, Child-pugh grade of liver function, prothrombin time,tumor classification, ascites around liver for the statistical analysis,the factors which have statistical significance can accept multiple factors Logistic regression analysis,screening influence independent risk factors for hemorrhage after thermal ablation. Difference was statistically significant(P < 0. 05).Results: A total of 3200 tumors were ablated during 2356 sessions. Among them,547 cases were handled by RFA and the rest were by MWA. The complication of hemorrhage occurred in eighteen patients, with the incidence of 0.76%. Six patients suffered from severe hemorrhage and twelve patients had a minor hemorrhage. The patients having coagulation disorders(platelet number<50×109/L?prothrombin time?18s), liver function at Child-pugh B or tumors near by the vessels are at high risk of procedure related hemorrhage.Conclusion: The thermal ablation of HCC is generally safe, as can be mirrored by low incidence of hemorrhage. In certain circumstance, however, hemorrhage can be a life-threatening complication. Attention should be given to the patients with the risk factors,namely,coagulation disorder(platelet number<50×109/L?prothrombin time?18s),liver function at Child-pugh B or the tumor close to the vessels,and do the preventive measures can make thermal ablation therapy more safer. |
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