Reasons and Preventions of Bleeding after Percutaneous Microwave Ablation for Liver Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TANG Yufu , JIANG Xiaofeng , ZHAO Yu , LIN Lin , GUO Dawei ,  LIANG Jiang .

Department of Hepatobiliary Surgery, The Fourth Hospital of China Medical University, Shenyang 110032, China;

Corresponding author：

LIANG Jiang ., Email: liangj63110@vip.sina.com

Keywords：

Microwave ablation; Liver cancer; Bleeding; Prevention

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Objective To investigate the reasons and preventions of bleeding after percutaneous microwave ablation for liver cancer. Methods The data of 156 patients with liver cancer between September 2006 and December 2009 treated with percutaneous microwave ablation (226 times) were recorded. The reasons and preventions of bleeding after percutaneous microwave ablation were analyzed. Results Eleven patients (11 times) suffered from bleeding. The rate of bleeding is 4.87% (11/226), including 2 cases of biliary bleeding, 9 cases of intraperitoneal hemorrhage. All patients who suffered from bleeding firstly received medical therapy to control bleeding, 5 cases were successful; in the other 6 cases who failed in medical therapy, 1 case was stopped bleeding with opening procedures, 4 cases received transcatheter embolization to stop bleeding with gelatin sponge, 1 case died due to excessive blood loss. According to Chi-square test result, the bleeding was significantly related with liver cirrhosis, lower platelet count, obvious prolongation of prothrombin time, subcapsular tumor, Child-Pugh B/C grade, and re-ablation （P=0.044, 0.041, 0.028, 0.001, 0.016, 0.016）. The multiple variables logistic regression analysis showed that liver cirrhosis, platelet count, prothrombin time, location of tumor, and Child-Pugh grade were the influential factors of bleeding after microwave ablation （OR=5.273, P=0.036; OR=8.534, P=0.043; OR=4.893, P=0.045; OR=7.747, P=0.010; OR=6.882, P=0.015）. Conclusions There were some factors were significantly related with the bleeding after percutaneous microwave ablation: liver cirrhosis, abnormal blood clotting function （lower platelet count and prolongation of prothrombin time）, tumor located on the surface of liver, and Child-Pugh C grade. When failed to stop bleeding with medical therapy, transcatheter embolization is an effective method to control bleeding.

Citation： TANG Yufu,JIANG Xiaofeng,ZHAO Yu,LIN Lin,GUO Dawei,LIANG Jiang .. Reasons and Preventions of Bleeding after Percutaneous Microwave Ablation for Liver Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(12): 1294-1298. doi: Copy

1.	Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178.
2.	Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454.
3.	Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337.
4.	Murakami R, Yoshimatsu S, Yamashita Y, et al. Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation [J]. AJR Am J Roentgenol, 1995; 164(5): 1159-1164.
5.	Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137.
6.	Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives [J]. J Chin Med Assoc, 2005; 68(4): 155-159.
7.	郭大伟，魏云涛，侯学忠，等. 肝癌微波治疗术中出现血红蛋白尿的影响因素 [J]. 现代肿瘤医学, 2009; 17（3）： 504-507.
8.	肖朝辉，文天夫. 肝切除术后死亡因素及其防治 [J]. 中国普外基础与临床杂志， 2008； 15（2）： 143-146.
9.	Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J]. Liver Transpl, 2004; 10(2 Suppl 1): S39-S45.
10.	Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26.
11.	Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451.
12.	戴莹，陈敏华. 射频消融在肝肿瘤治疗中的并发症 [J]. 中华外科杂志， 2004； 42（19）： 1193-1195.
13.	翟博，徐爱民，盛月红, 等. 肝癌射频消融后针道出血防治21例 [J]. 世界华人消化杂志, 2008; 16(21): 2423-2427.
14.	夏景林，任正刚，叶胜龙, 等. 肝癌射频消融治疗严重或少见并发症分析 [J]. 中国微创外科杂志, 2005; 5（4）： 268-270.
15.	郑加生，李建军，崔雄伟, 等. 肝动脉化疗栓塞联合CT引导下射频消融术治疗肝癌的疗效分析 [J]. 介入放射学杂志, 2009; 18（5）: 324-327.
16.	李绍钦，倪才方，蒋国民, 等. 射频消融联合肝动脉栓塞治疗兔肝癌的安全性 [J]. 世界华人消化杂志, 2008; 16(32): 3677-3680.
17.	Yu HC, Cheng JS, Lai KH, et al． Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy [J]． World J Gastroenterol, 2005; 11(10): 1439-1444.
18.	Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]． Ann Surg Oncol, 2005; 12(8): 616-628.
19.	Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209.
20.	Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271.
21.	陈敏华，严昆，戴莹, 等. 肝肿瘤经皮射频消融治疗中腹腔出血的处理-附3例临床报告 [J]. 中华外科杂志, 2004; 42（17）: 1083-1084.
22.	Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403.
23.	Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134.
24.	Carrafiello G, Laganà D, Ianniello A, et al． Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]． Eur J Radiol, 2007; 61(2): 351-355.
25.	Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869.

1. Martin RC, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience [J]. Ann Surg Oncol, 2010; 17(1): 171-178.
2. Dong BW, Liang P, Yu XL, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study [J]. AJR Am J Roentgenol, 1998; 171(2): 449-454.
3. Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy [J]. Radiology, 2002; 223(2): 331-337.
4. Murakami R, Yoshimatsu S, Yamashita Y, et al. Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation [J]. AJR Am J Roentgenol, 1995; 164(5): 1159-1164.
5. Shimada S, Hirota M, Beppu T, et al. Complications and management of microwave coagulation therapy for primary and metastatic liver tumors [J]. Surg Today, 1998; 28(11): 1130-1137.
6. Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives [J]. J Chin Med Assoc, 2005; 68(4): 155-159.
7. 郭大伟，魏云涛，侯学忠，等. 肝癌微波治疗术中出现血红蛋白尿的影响因素 [J]. 现代肿瘤医学, 2009; 17（3）： 504-507.
8. 肖朝辉，文天夫. 肝切除术后死亡因素及其防治 [J]. 中国普外基础与临床杂志， 2008； 15（2）： 143-146.
9. Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J]. Liver Transpl, 2004; 10(2 Suppl 1): S39-S45.
10. Didolkar MS, Fitzpatrick JL, Elias EG, et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure [J]. Surg Gynecol Obstet, 1989; 169(1): 17-26.
11. Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study [J]. Radiology, 2003; 226(2): 441-451.
12. 戴莹，陈敏华. 射频消融在肝肿瘤治疗中的并发症 [J]. 中华外科杂志， 2004； 42（19）： 1193-1195.
13. 翟博，徐爱民，盛月红, 等. 肝癌射频消融后针道出血防治21例 [J]. 世界华人消化杂志, 2008; 16(21): 2423-2427.
14. 夏景林，任正刚，叶胜龙, 等. 肝癌射频消融治疗严重或少见并发症分析 [J]. 中国微创外科杂志, 2005; 5（4）： 268-270.
15. 郑加生，李建军，崔雄伟, 等. 肝动脉化疗栓塞联合CT引导下射频消融术治疗肝癌的疗效分析 [J]. 介入放射学杂志, 2009; 18（5）: 324-327.
16. 李绍钦，倪才方，蒋国民, 等. 射频消融联合肝动脉栓塞治疗兔肝癌的安全性 [J]. 世界华人消化杂志, 2008; 16(32): 3677-3680.
17. Yu HC, Cheng JS, Lai KH, et al． Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy [J]． World J Gastroenterol, 2005; 11(10): 1439-1444.
18. Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis [J]． Ann Surg Oncol, 2005; 12(8): 616-628.
19. Zagoria RJ, Chen MY, Shen P, et al. Complications from radiofrequency ablation of liver metastases [J]. Am Surg, 2002; 68(2): 204-209.
20. Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients-mathematic model, overlapping mode, and electrode placement process [J]. Radiology, 2004; 232(1): 260-271.
21. 陈敏华，严昆，戴莹, 等. 肝肿瘤经皮射频消融治疗中腹腔出血的处理-附3例临床报告 [J]. 中华外科杂志, 2004; 42（17）: 1083-1084.
22. Mitsuzaki K, Yamashita Y, Nishiharu T, et al. CT appearance of hepatic tumors after microwave coagulation therapy [J]. AJR Am J Roentgenol, 1998; 171(5): 1397-1403.
23. Rhim H, Yoon KH, Lee JM, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings [J]. Radiographics, 2003; 23(1): 123-134.
24. Carrafiello G, Laganà D, Ianniello A, et al． Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization [J]． Eur J Radiol, 2007; 61(2): 351-355.
25. Bowles BJ, Machi J, Limm WM, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors [J]. Arch Surg, 2001; 136(8): 864-869.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Reasons and Preventions of Bleeding after Percutaneous Microwave Ablation for Liver Cancer

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