Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion: Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.
目的： 探讨肝癌射频消融后即刻增强CT扫描发生造影剂外溢与术后临床严重出血的关系，分析其发生的风险因素。 方法： 回顾性分析自2016年1月至2017年1月行肝癌射频消融治疗的肝癌患者199例，共行消融治疗232例次，根据术后增强CT扫描穿刺针道或肝周是否存在造影剂外溢分为2组，一组为造影剂外溢组，另一组为无造影剂外溢组，统计其基本临床资料、出血风险相关的实验室资料以及影像学资料以分析其对临床治疗的影响及其发生的风险因素。据资料不同分别采用t检验、χ(2)检验或logistic回归检验进行统计学分析。 结果： 199例患者，共行消融治疗232例次，其中男性138例，女性61例，病灶平均直径（3.42±2.30）cm。消融后即刻增强CT扫描穿刺针道发生造影剂外溢共30例次（12.93%），患者术后均无严重出血，未行特殊临床干预；其余202例次患者为无造影剂外溢组，但其中2例患者发生严重出血进行了相应临床干预。单因素分析可见两组患者：是否经胸腔穿刺(P = 0.019)、合并有肝硬化(P < 0.001)、肝癌病理类型(P = 0.013)差异有统计学意义，其余临床资料（年龄、病灶大小、肝功能Child-Pugh分级、术前血红蛋白、血小板计数、凝血酶原时间、活化部分凝血活酶时间、国际标准化比率以及穿刺针数、穿刺道长度）差异均无统计学意义。两组患者术后血红蛋白（P = 0.160）、术前-术后血红蛋白变化值（P = 0.999）以及住院天数（P = 0.730）差异亦无统计学意义。Logistic回归分析显示合并有肝硬化（OR = 5.59，P < 0.001）、经胸膜腔穿刺（OR = 2.67，P = 0.021）可能为肝癌射频消融术后即可CT增强扫描发生造影剂外溢的风险因素。 结论： 造影剂外溢在消融后即刻增强CT疗效评价中并不少见，对于术后严重出血的发生并无预测意义且无需过度临床干预，肝硬化及经胸膜腔穿刺可能是其发生的风险因素。对于术后无造影剂外溢的患者也不可忽视其术后发生严重出血的风险。.
Keywords: Carcinoma, hepatocellular; Computed tomography; Contrast agent extravasation; Hemorrhage; Radiofrequency ablation.