| Object:(1)To study the occurrence of kidney and other organ complications and the related influencing factors after ultrasound-guided microwave ablation for liver tumors.(2)To optimize the measures related to microwave ablation treatment of liver tumors through the analysis of risk factors and reduce the damage to kidneys and other organs after microwave ablation.Method:To collect cases that met the inclusion and exclusion criteria for hospitalization in the Department of Hepatology of the First Hospital of Jilin University from August 2014 to October 2020 for microwave ablation of liver tumors,we first conducted an exploratory study of cases included from 2014-2019,based on which we conducted a validation study of medical records included after October 2019,with cases included until October 2020.By reviewing the patient case information system,basic clinical information and preoperative laboratory laboratory test indexes were collected,relevant data and information were compiled,and the basic analysis of general clinical information was performed by statistical software,and then the basic characteristics of various serious complications and their risk factors for emergence were analyzed,focusing on the renal function of the patients to explore whether there were differences between clinical information and laboratory test results.Then single-factor logistic regression analysis and multi-factor logistic regression analysis were used to explore the risk factors for the occurrence of serious complications and acute kidney injury;the diagnostic value of different indicators of postoperative acute kidney injury was analyzed.Finally,the diagnostic value of the risk factors was verified.Results:Exploratory study of serious complications after microwave ablation(1)In this study,a total of 1142 patients underwent microwave ablation in our department,and we conducted an exploratory study on the occurrence of serious postoperative complications in patients before October 2019;according to the inclusion and exclusion criteria,847 patients were included in the study,including 624 male patients,accounting for74.0%,223 female patients,accounting for 26.0%;180 patients aged>65 years,accounting for 21.0%,age≤65 years old 667 cases,accounting for 79.0%,the youngest patient age 23years old,the oldest patient age 83 years old;primary liver cancer 819 cases,accounting for96.7%,metastatic liver cancer 26 cases,accounting for 3.1%,benign tumor 2 cases,accounting for 0.2%;microwave ablation patients year by year largely increased trend:19patients treated in 2014,56 cases in 2015,120 cases in 2016,120 cases in 2017.In 2016,120cases,150 cases in 2017,282 cases in 2018 and 220 cases in 2019.(2)There were 57 cases of serious complications after ultrasound-guided microwave ablation,with an incidence of 6.73%(57/847),mainly acute kidney injury in 30 cases(3.5%),bleeding in 15 cases(1.8%),infection in 7 cases(0.8%),injury to adjacent organs in 1 case(0.1%),and other complications in 4 cases(0.5%),namely hepatic encephalopathy in 1 case,cardiac arrhythmia-Atrioventricular block 1 case,incomplete small bowel obstruction 2 cases.(3)There were 57 cases of serious postoperative complications in patients treated with microwave ablation,among which there were more men than women,including 45 cases of men and 12 cases of women;most of them were under 65 years of age,including 41 cases of age≤65 years of age and 16 cases of age>65 years of age;most of the tumors were single lesions,including 36 cases of single tumor lesions and 21 cases of multiple tumor lesions;in terms of the type of liver cancer,primary liver cancer was the most frequent Among them,54cases were primary liver cancer,2 cases were metastatic liver cancer,and 1 case was benign liver tumor;the maximum diameter of tumor was mostly below 30 mm,among which 34 cases were≤30 mm,20 cases were between 30 and 50 mm,and 3 cases were>50 mm;Child-Pugh classification was mostly A grade,35 cases were A grade and 22 cases were B grade.(4)According to the inclusion criteria,i.e.whether there were serious complications after microwave ablation,the patients were divided into complication group and no complication group,and the general clinical data and laboratory laboratory indexes of the included patients were statistically analyzed,including age,gender,maximum tumor diameter,number of tumors,ablation energy,ablation time,Child-Pugh grade,preoperative laboratory indexes(AFP,AST,ALT,ALB,TBil,K+,Na+,WBC,RBC,Hb,PLT,PT,INR,PTA,FBG);the results of the analysis of general clinical data suggested that there were differences in the nature of tumors between the two groups,which were statistically significant(P<0.05);the maximum tumor diameter,ablation energy and ablation time were significantly higher in the group with complications than in the group without complications(P<0.05).The results of preoperative laboratory index analysis suggested that the Na+level in the group with complications was significantly lower than that in the group without complications(P<0.05).(5)To further investigate the risk factors for the occurrence of complications after microwave ablation,the results of the above statistical analysis showed that tumor nature,maximum tumor diameter,ablation time,ablation energy,and serum sodium were statistically significant for the occurrence of serious postoperative complications.Multi-factor logistic regression analysis was performed,and the dominance ratio(OR)and 95%confidence interval(CI)were estimated by using the backward method,and the results showed that ablation time and serum sodium level were the risk factors for the occurrence of serious complications after microwave ablation,i.e.,long ablation time and low serum sodium level had a high risk of serious complications after microwave ablation.(6)In this study,there were 2 patients who died after microwave ablation,with a mortality rate of 0.24%(2/847).2.An exploratory study of acute renal injury after microwave ablation(1)Among the 841 patients with severe complications after microwave ablation,those with intact renal function tests were analyzed for acute kidney injury.According to the inclusion and exclusion criteria,486 cases were included in this study.These included 354cases(72.8%)in men and 132 cases(27.2%)in women;376 cases(77.4%)aged≤65 years,110 cases(22.6%)aged>65 years,with a minimum age of 23 years and a maximum age of 87years;330 cases(67.9%)with single tumor and 157 cases(32.1%)with multiple tumors;463cases(95.3%)with primary hepatocellular carcinoma The maximum tumor diameter was≤30mm in 36 cases(74.7%),between 30 mm and 50 mm in 110 cases(22.6%),>50 mm in 13cases(2.7%);Child-up grade A in 309 cases(63.6%),grade B in 177 cases(36.4%).(2)Post-microwave ablation(2)There were 30 patients who developed acute kidney injury after microwave ablation,and the incidence of acute kidney injury was 6.17%(30/486).(3)The general clinical data and laboratory indices of the included patients before ablation treatment were compared in groups.The results of the analysis of general clinical data showed that there were statistically significant differences between the acute kidney injury group and the non-acute kidney injury group in terms of tumor nature and maximum tumor diameter(P<0.05);the acute kidney injury group had higher ablation energy and longer ablation time than the non-acute kidney injury group.In the analysis of preoperative laboratory test results,the levels of RBC,Hb and PTA in the acute kidney injury group were higher than those in the non-acute kidney injury group.(4)To further investigate the risk factors of acute kidney injury after microwave ablation,a logistic one-way analysis was first performed,and the results suggested that there were differences in the maximum tumor diameter,ablation time(lg),ablation energy(lg),preoperative red blood cells,and hemoglobin on the occurrence of postoperative acute kidney injury,which were statistically significant;then a backward method was used to incorporate logistic multi-factor regression analysis,the results indicated that high ablation energy and high preoperative hemoglobin level were independent risk factors for the occurrence of acute kidney injury.(5)The diagnostic value of ablation energy and preoperative hemoglobin was compared by applying the subject operating characteristic curve(ROC curve),and the area under the curve of ablation energy(lg)was 0.731 and 0.661,respectively,and the ablation energy had better predictive value.3.Validation study of acute kidney injury after microwave ablation(1)The results of the above study suggest that the cut-off value of ablation energy(lg)is4.927.In this study,the integer 5 was selected as the basis for grouping,and the included patients were divided into two groups:ablation energy(lg)≤5 and ablation energy(lg)>5;to observe whether acute kidney injury occurred after surgery in the two groups of patients who underwent ultrasound-guided microwave ablation of liver tumors during 2019.10-2020.10 The study included 294 patients,219 males and 75 females,227 aged≤65 years,76aged>65 years,211 with single tumor lesions and 83 with multiple tumor lesions;189 with Child-Pugh grade A and 105 with grade B;272 with primary liver cancer,18 with metastatic liver cancer,and 3 with benign nodules;the maximum tumor diameter was≤30 mm 222 cases,between 30 and 50 mm 69 cases,>50 mm 3 cases.(2)Statistical analysis of the general clinical data and preoperative laboratory indexes of the included 294 patients indicated that there were differences in the number of tumors,history of diabetes,maximum tumor diameter,tumor type,and ablation time between the two groups,and the number of single tumors in the ablation energy(lg)>5 group was significantly lower than that in the ablation energy(lg)≤5 group;the number of tumors in the ablation energy(lg)>5 group was lower than that in the ablation energy(lg)≤5 group,and the number of tumors in the ablation energy(lg)>5 group was lower than that in the ablation energy(lg)≤5 group.The ablation energy(lg)>5 group had less history of diabetes,larger maximum tumor diameter and longer ablation time compared with the ablation energy(lg)≤5 group(P<0.05).(3)The proportion of postoperative acute kidney injury occurred in the ablation energy(lg)>5 group(10.0%)was significantly higher than that in the ablation energy(lg)≤5 group(1.5%);for statistical analysis,P=0.025,indicating that ablation energy(lg)can be used to predict the risk of postoperative acute kidney injury.(4)The sensitivity of ablation energy(lg)as a diagnostic criterion was 0.429,and the specificity was 0.906.Conclusion:Ultrasound-guided microwave ablation of liver tumors was found to be relatively safe,but there were still some complications,some of which were life-threatening in severe cases.Long ablation time and low Na~+level are the main risk factors for complications after microwave ablation.The incidence of acute renal injury after ablation was higher,and the increased ablation energy and preoperative hemoglobin were independent risk factors for the occurrence of acute renal failure.Ablation energy(lg)is better than preoperative hemoglobin in predicting acute kidney injury after microwave ablation. |
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