射頻燒灼術導致皮膚灼傷－病例系列及文獻回顧

Radiofrequency Ablation Related Skin Burn-Case Series and Literature Review

黃柏誠(Po-Cheng Huang) ； 楊永健(Endo-Kean Yeong)

《臺灣整形外科醫學會雜誌》 24卷1期 (2015/03) Pp. 84-91

摘要

背景：射頻燒灼術是一種新進的微創腫瘤治療方法，但其引起的併發症如皮膚灼傷卻很少被國內文獻報導。目的及目標：作者提出三例治療引起的皮膚灼傷，主要目的是希望國內醫師能重視射頻燒灼術的併發症，藉以提升醫療品質，減少醫療糾紛。材料及方法：［個案一］：59歲男性患有肝細胞癌，一般外科醫師利用開腹方式之射頻燒灼術以1540瓦特耗時16分鐘燒灼兩處腫瘤。術後右大腿產生一7×5公分，左大腿有兩處各2.5×2公分與1.5×1公分全層皮膚灼傷，灼傷位置均在射頻燒灼迴路電極片下。［個案二］：66歲男性肝細胞癌復發，放射科醫師利用電腦斷層導引方式之射頻燒灼術及經皮酒精注射治療肝腫瘤，於右側乳房下方穿刺燒灼處有一2×2公分全層皮膚灼傷。［個案三］：75歲男性罹患大腸癌併轉移至肝臟，在超音波導引之射頻燒灼術後，因迴路貼片連接線接觸不良，造成左大腿一8×3公分1至2度的皮膚灼傷。結果：射頻燒灼術引起的皮膚灼傷出現在電極燒灼處和迴路貼片處。前兩例病人之灼傷經移前皮瓣關閉傷口，最後一例病人則接受封閉式換藥方法至傷口完全癒合。結論：為防止皮膚灼傷的發生，提醒執行醫師注意術中射頻燒灼的功率，燒灼末期溫度，避免燒灼電極處過淺，並確認線路連接的完整性。

關鍵字

射頻燒灼術 ； 灼傷 ； 移前皮瓣

並列摘要

Background: Radiofrequency ablation (RFA) is a recently minimally invasive method for cancer treatment, but its complications, such as skin burn occurred in domestic indeed rarely reported in the literature. Aim and Objective: The main purpose reporting three skin burn related to the RFA is to alert the physicians beware of RFA complication in order to enhance quality of medical care and reduce disputes. Methods and Materials: [Case 1]: A 59-year-old male had hepatocellular carcinoma (HCC), general surgeon performed laparotomy RFA at two liver tumors by 1540 watt in 16 minutes. There were three full-thickness skin burn lesion, a 7×5 cm at right thigh, 2.5×2cm and 1.5×1cm at left thigh, then all were under the ground pads. [Case 2]: A 66-year-old male had recurrent HCC. Radiologist performed CTguide RFA and percutaneous alcohol injection for HCC treatment. A penetrated wound with 2×2 cm full-thickness skin burn was noted below the right nipple about 7 cm. [Case 3]: A 75-year-old male had colon caner with liver metastasis. After echo-guide RFA, the connector of ground pad was loss and there was a 8×3 cm 1~2 degree skin burn found at left thigh. Results: RFA related skin burn injury is found at ground pad site and electrode puncture site. The first two patients received wide excision and advanced flap for wound closure, and the last patient received occlusive dressing until wound healing. Conclusion: If we want to decrease the incidence of RFA related skin burn, we need to know the power of the procedure, beware of end point of temperature and complete connection of equipment.

並列關鍵字

radiofrequency ablation ； brun ； advacned flap