Diaphragmatic Hernia after Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma-A Case Report and Literature Review

以射頻燒灼術（RFA）治療惡性肝腫瘤後所引發的橫膈膜疝氣：病例報告以及文獻回顧

陳皇吉(Huang-Chi Chen) ； 鄭清源(Ching-Yuan Chen) ； 紀炳銓(Bin-Chuan Ji) ； 林慶雄(Ching-Hsiung Lin)

《胸腔醫學》 28卷3期 (2013/06) Pp. 171-178

摘要

射頻燒灼術（RFA）目前被認為是針對無法切除的小型惡性肝腫瘤，或是再復發患者的第一線治療。因射頻燒灼術所引發的胸腔併發症，特別引起我們的注意。我們所報導的病例是一個少見的個案，他在接受惡性肝腫瘤的射頻燒灼術14個月後才出現橫膈膜疝氣。我們做了文獻回顧，發現用英文撰寫的5個病例中，導致問題的射頻燒灼術到出現橫膈膜疝氣的時間平均為13.8個月。我們發現肝腫瘤靠近橫膈膜是一個危險因子。之所以射頻燒灼術到橫膈膜疝氣出現的時間會這麼久，我們認為合理的解釋是：一剛開始只是熱燒灼的損傷，接著在腹腔與胸腔間的壓力差、腹內壓上升、或是局部腫瘤浸潤等多種因素影響下，小缺損逐漸進展到橫膈膜疝氣。因此如果要做射頻燒灼術，一些新發展出的輔助方法，比方說像在橫膈下注水或是造成一個人工的腹水，對於特定有橫膈附近惡性肝腫瘤的患者而言，可能是一個合理的選擇。

關鍵字

橫膈膜疝氣 ； 射頻燒灼術 ； 惡性肝腫瘤

並列摘要

Radiofrequency ablation (RFA) is now regarded as the first-line therapy for unresectable small-sized or recurrent hepatocellular carcinoma (HCC). The thoracic complications of RFA require our attention, especially when we treat HCC adjacent to the diaphragm. The case we report is that of a patient with an unusual presentation, who was diagnosed with diaphragmatic hernia 14 months after RFA for HCC. We reviewed the medical literature written in English and found that the mean value of time from culprit RFA till hernia diagnosis in 5 cases was 13.8 months. HCC near or adjacent to the diaphragm is a risk factor. One reasonable explanation for this delayed complication is that an initial thermal injury could then lead to progression of the diaphragm defect under the influence of a peritoneopleural pressure gradient, increased intra-abdominal pressure, or focal tumor infiltration. Therefore, newly developed adjuvant maneuvers for RFA, such as subphrenic water or artificial ascites, may be a reasonable choice for specifically selected patients with HCC near the diaphragm.

並列關鍵字

diaphragmatic hernia ； radiofrequency ablation ； hepatocellular carcinoma