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目的探讨肝脏肿瘤患者射频消融术后感染相关并发症及其临床特征。方法回顾性分析2010年3月-2016年3月医院介入科行肝脏肿瘤射频消融术的患者781例;收集患者的临床资料、肿瘤大小、个数、位置、抗菌药物应用及术后感染发生情况,对有严重感染表现的患者行CT增强扫描,明确局部感染病灶之后,采用置管引流,并对引流液进行细菌学检查和药敏测试,以调整患者的抗菌药物使用。结果 781例患者行射频消融术957次,术后发生感染35例,感染率3.66%;发生严重感染患者的主要临床表现为发热、寒战、肝区疼痛、腹部疼痛;经CT增强证实病灶并引流培养后,检查分离细菌39株,高危因素为既往胆吻合术、多发性肝脏肿瘤、肿瘤比邻肠道和开腹射频消融术,所有患者经更换抗菌药物或加强抗感染治疗后感染均得以控制。结论肝脏肿瘤患者射频消融术治疗有效,但可能会并发肝脓肿、切口感染、胆汁瘤等感染相关并发症,CT增强扫描及细菌培养有助于明确感染相关并发症的诊断及其治疗。
Objective To investigate the infection-related complications and its clinical features after radiofrequency ablation in patients with liver tumors. Methods The clinical data of 781 patients with liver tumor radiofrequency ablation in our hospital from March 2010 to March 2016 were retrospectively analyzed. The clinical data, tumor size, number, location, antibacterial application and incidence of postoperative infection were collected , Patients with severe infection showed enhanced CT scan, clear local infection after the use of catheter drainage, and drainage fluid for bacteriological examination and susceptibility testing to adjust the patient’s use of antimicrobial drugs. Results 781 patients underwent radiofrequency catheter ablation for 957 times and postoperative infection occurred in 35 patients with an infection rate of 3.66%. The main clinical manifestations of severe infection were fever, chills, liver pain and abdominal pain. CT-confirmed lesions and drainage After culture, 39 strains of bacteria were isolated. The risk factors were previous choledocho-anastomosis, multiple liver tumors, tumor adjacent gut and open ablation. All patients were controlled by replacing antibiotics or enhancing anti-infection treatment. Conclusions Radiofrequency catheter ablation in patients with liver cancer is effective, but complications such as liver abscess, incisional infection and bile tumor may be complicated by CT scanning and bacterial culture. It is helpful to confirm the diagnosis and treatment of infection-related complications.