肝癌病患接受射頻消融術後立即合併症之相關因素之探討

Immediate Complications and Related Factors in Patients with Hepatocellular Carcinoma after Radiofrequency Ablation

謝宜真(Yi-Chen Hsieh) ； 盧勝男(Sheng-Nan Lu)

《實證護理》 3卷2期 (2007/06) Pp. 129-138

https://doi.org/10.6225/JEBN.3.2.129

摘要

肝癌為我國癌症主要死因，其中約九成與B或C肝炎有關。定期追蹤慢性肝炎患者，可以早期發現肝癌，而接受射頻消融術(radiofrequency ablation, RFA)的治療對於早期肝癌為較有效的方式。本研究目的為探討接受RFA治療患者於術後24小時內併發症的發生率與燒灼劑量之相關性。自2004年1月至2006年3月，從本院接受RFA治療的住院病患中，選取診斷為原發性肝癌，且住院接受RFA治療期間僅一次在局部麻醉下以cool-tip針燒灼六分鐘以上者，共101人接受115次納入分析。採病歷回顧方式回溯抄錄個案醫療記錄，包括接受RFA術後24小時內生化學、超音波檢查、生命徵象、止痛藥使用及術後住院日數。結果顯示RFA術後兩日內出院者佔54.7%；無出院後非計劃返回門診或急診的個案；術後隔天AST(aspatate transaminase)、ALT(alanine transaminase)、Total Bilirubin較治療前上升的比率分別為89%、90.1%及60.4%，術後發燒比率為18.3%。非高血壓者（扣除本身為高血壓患者）因RFA治療後引起心搏過速、高血壓、低血壓比率分別為0.9%、14.7%、2.1%；隔日超音波顯示右肋膜積水與腹水比率為7.8%及4.3%；肝功能指數上升、高血壓、止痛藥使用及術後住院日數皆與燒灼劑量相關。期望本研究的結果，可作為擬定RFA治療後標準照護準則的參考。

關鍵字

肝癌 ； 射頻消融術

並列摘要

Hepatocellular carcinoma (HCC) is one of the major causes of cancer death in Taiwan. Around 90% of HCC cases are related to chronic hepatitis B and C. With periodic tracking of patients with chronic hepatitis B and C, HCC can be detected in the early stage. The number of patients receiving radiofrequency ablation (RFA) is therefore increasing. We conducted this retrospective study in order to explore the relationship between RFA dosage, and the incidence of complications in the first 24 hours after RFA. From January 2004 to March 2006, we recruited all HCC cases who were scheduled for RFA and treated by cool-tip system under local anesthesia for more than six minutes. A total of 115 sessions of treatment on 101 patients were analyzed. Biochemical data, ultrasonographic findings, vital signs and records of analgesic use within 24 hours after RFA were collected by reviewing medical records. The length of post-RFA hospital stay was also calculated. The proportion of patients discharged within two days of treatment was 54.7%. After discharge, no patient underwent an unexpected hospital return. The elevation rates for AST, ALT and total bilirubin after RFA were 89%, 90.1% and 60.4%, respectively. Hypertension, hypotension, tachycardia and fever were noted in 14.7%, 2.1%, 0.9% and 18.3% of patients after RFA, respectively. Only 7.8% and 4.3% of patients had right pleural effusion and ascites in ultrasonographic follow-up on the morning after RFA. The dosage of RFA was correlated with the elevated values of AST, ALT and total bilirubin, hypertension, fever, analgesic use and length of post-RFA hospital stay. The study reports the baseline data of post-RFA syndrome and should serve as an important reference in post-RFA care.

並列關鍵字

hepatocellular ； radiofrequency ablation RFA