Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure
Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure
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DOI：
10.1016/s0399-8320(06)73327-9
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发表时间：
2006-06-01
影响因子：
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通讯作者：
De Baere, Thierry
中科院分区：
文献类型：
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作者：
Elias, Dominique;Di Pietroantonio, Danielo;De Baere, Thierry
目的：肝肿瘤射频消融术（RFA）后肝脓肿的发生率可能在胆道引流术连接胆管系统和上胃肠道的患者中很高。然而，到目前为止，这个比率，这些脓肿的发病时间，以及胆管的先前状态从未在文献中报道过。方法：在接受RFA治疗超过8年的57A患者中，只有11例患者（13次RFA， 2例接受两次不同的RFA）在RFA时出现肠胆吻合或胆道支架置入术。这是一项前瞻性验证患者的回顾性研究。结果：在9例在RFA前行胆道手术的患者中，4例在RFA后13至62天出现了RFA部位的肝脓肿。尽管有不同类型的短期抗生素预防，它还是发生了。致病菌是典型的消化菌群。脓肿经皮引流后痊愈。同时行胆道分流术的4例患者均未出现脓肿。结论：当术前有胆道分流的患者行射频消融术时，发生肝脓肿的风险很高。目前，我们无法推荐任何预防性抗生素治疗。先前存在的胆道分流并不是RFA的绝对禁忌症，但发生肝脓肿的风险接近40-50%。当RFA与胆道转移同时进行时，肝脓肿的风险似乎消失了。
Aim - The rate of liver abscesses after radiofrequency ablation (RFA) of liver tumors is probably high in patients with a biliary tract drainage procedure connecting the biliary duct system to the upper gastrointestinal tract. And yet, to date this rate, the time of onset of these abscesses, and the prior status of the bile ducts have never been reported in the literature.Methods - Among 57A patients treated with RFA over 8 years, only 11 patients (with 13 sessions of RFA, 2 patients undergoing two different RFA sessions) presented with an enterobiliary anastomosis or biliary stenting at the time of RFA. This is a retrospective study of patients who were verified prospectively.Results - Among the 9 patients in whom a biliary tract procedure preceded RFA, 4 developed a liver abscess at the site of RFA, which emerged between 13 and 62 days after RFA. It occurred in spite of different types of short-term antibiotic prophylaxis. Pathogenic bacteria were typical of the digestive flora. Abscesses were cured after percutaneous drainage. No abscess occurred among the 4 patients in whom a biliary tract diversion was performed synchronously with RFA.Conclusion - When RFA is performed in a patient with a preexisting biliary diversion, the risk of developing a liver abscess is high. Currently, we are unable to recommend any kind of preventive antibiotherapy. A preexisting biliary diversion is not an absolute cantraindication for RFA, but the risk of developing a liver abscess is close to 40-50%. When RFA is performed synchronously with a biliary diversion, the risk of a liver abscess seems to disappear.