Pleural Effusion after Percutaneous Radiofrequency Ablation for Hepatic Malignancies

肝惡性腫瘤經皮射頻消融術後之肋膜積液表現

趙文綺(Wen-Chi Chao) ； 劉家源(Chia-Yuan Liu) ； 林慶忠(Ching-Chung Lin) ； 林俊昌(Jiunn-Chang Lin) ； 王鴻源(Horng-Yuan Wang) ； 蔡樹榮(Shu-Jung Tsai) ； 陳志仁(Chih-Jen Chen) ； 施壽全(Shou-Chuan Shih) ； 吳肇卿(Jaw-Ching Wu) ； 王蒼恩(Tsang-En Wang) ； 王勝永(Shen-Yung Wang)

《台灣癌症醫學雜誌》 2卷1期 (2015/03) Pp. 22-30

https://doi.org/10.6323/JCRP.2015.2.1.03

摘要

背景：射頻消融術在治療肝臟惡性腫瘤包括原發性肝癌與肝轉移癌皆有相當的角色。經皮射頻消融術式被認為是一個安全性高、有效、且微小侵襲性的治療。本研究的目的在探討單極經皮射頻消融術後之肋膜積液表現。方法：本研究共收入54位（28位男性與26位女性，平均年齡65.2歲）接受單極經皮射頻消融術患者。其中47位的診斷為肝細胞癌、4位為肝轉移癌、3位為其他肝臟惡性腫瘤。本研究收入總共115次的射頻消融術治療199顆肝腫瘤（每次治療平均消融1.73±1.02顆腫瘤）。腫瘤大小為0.8到5.0公分（平均2.31公分，標準差1.04公分）。在射頻消融術後24小時內，患者接受超音波追蹤評估是否有肋膜積液，存在肋膜積液的患者以胸部X光評估肋膜積液量。結果：本研究在14位患者共15次（13.0%）射頻消融術後觀察到有右側肋膜積液。其中1位患者積液量為大量，其餘皆為少量積液。5位患者肋膜積液有延遲性吸收。1位患者在一個月後仍有微量的右側肋膜積液。本研究患者並未觀察到有氣胸或治療後短期死亡病例。經分析後，年齡、性別、腫瘤數目、腫瘤大小、與腫瘤消融率在是否產生肋膜積液的兩個患者族群均相似。腫瘤是否位在靠近橫隔膜的肝臟分段或肝臟右葉並無與是否產生肋膜積液有顯著相關。唯較長的射頻消融術治療時間有邊際傾向產生肋膜積液的趨勢（p=0.051）。結論：在經皮射頻消融術治療肝惡性腫瘤後之右側肋膜積液並不罕見。這些肋膜積液大多數在短時間內會自動吸收而不需要抽吸，在一個月後仍存有肋膜積液的病例則極為少見。

關鍵字

射頻消融 ； 肋膜積液

並列摘要

Background and Aims: Radiofrequency ablation (RFA) can play an important role in the treatment of primary or metastatic liver tumors. Currently, percutaneous RFA is generally regarded as a safe, effective, and minimally invasive procedure. This study aimed to evaluate the presence and course of pleural effusion after monopolar RFA. Methods: From October 2008 to July 2013, a total of 54 patients (28 male and 26 female, mean age 65.2) treated with monopolar RFA were included in our study. 47 patients were diagnosed with hepatocellular carcinoma, 4 patients with hepatic metastasis, and 3 patients had other diagnoses. There were a total of 115 sessions of treatment and 199 liver tumors to be treated (1.73±1.02 tumors treated per session). The tumor size ranged from 0.8 cm to 5.0 cm (mean 2.31 cm, standard deviation 1.04 cm). Thereafter, a follow-up ultrasound was performed within 24 hours subsequent to ablation to evaluate the presence of pleural effusion. The degree of pleural effusion was assessed by chest X-ray. Results: Fifteen (13.0%) treatment sessions in 14 patients showed right-sided pleural effusion after ablations. One patient had a large amount of effusion, while other patients manifested a minimal to small amount of effusion. There were 5 patients that experienced delayed resolution of pleural effusion; one patient (0.87%) had a minimal amount of pleural effusion even after one month. Overall, there was no pneumothorax, or periprocedural morality. Age, gender, tumor numbers, tumor sizes, and complete ablation of target tumors were similar among groups presenting with or without pleural effusion. Tumor locations associated with S78 segments abutting the diaphragm or right lobe of the liver were not associated with development of pleural effusion. Only the duration of ablation time had a marginal trend toward significance (p=0.051). Conclusions: The transient appearance of right-sided pleural effusion after percutaneous RFA for hepatic malignancies was not infrequent. However, refractory pleural effusion was rare.

並列關鍵字

thermoablation ； pleural effusion