探讨凝血功能明显异常原发性肝癌（肝癌）患者热消融治疗安全性。

回顾性分析2016年3月至2018年8月中山大学附属第三医院行热消治疗的37例肝癌患者临床资料。其中男31例，女6例；年龄28～85岁，中位年龄55岁；患者PT延长时间超过3 s。患者均签署知情同意书，符合医学伦理学规定。术前使用胃镜处理食管胃底静脉曲张并使用抑酸剂；术中使用人工腹腔积液观察腹腔出血，并在超声造影引导下对针道出血进行止血及评估止血效果；术后观察患者并发症发生情况，并于术后1个月CT/MRI评价消融疗效。

37例患者共55个病灶成功实施热消融治疗。消融术后即时超声造影提示针道出血2例，均在超声造影引导下一次针道消融成功止血，术后未发生其他出血并发症。消融术后1个月CT/MRI提示所有患者病灶均消融完全。

在严格围手术期处理和密切观察下，凝血功能明显异常患者也可安全地进行热消融治疗，并取得良好疗效。

To investigate the safety of thermal ablation for primary liver cancer patients with evident abnormal coagulation function.

Clinical data of 37 primary liver cancer patients undergoing thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University from March 2016 to August 2018 were retrospectively analyzed. 31 cases were male and 6 were female, aged 28 to 85 years with a median age of 55 years. The prothrombin time (PT) was prolonged for more than 3 s. The informed consents of all patients were obtained and the local ethical committee approval was received. Before operation, the esophageal and gastric varices was treated with gastroscopy and acid inhibitors were also given. Intraoperatively, abdominal bleeding was observed by artificial ascites. The needle-tract bleeding was treated and the hemostatic effect was evaluated under the guidance of contrast-enhanced ultrasound (CEUS). The postoperative incidence was observed. At postoperative 1 month, the effect of ablation was evaluated by CT/MRI.

A total of 55 lesions in 37 patients were successfully treated by thermal ablation. Immediate CEUS indicated 2 cases of needle-tract bleeding after thermal ablation. Hemostasis was performed successfully in both cases by needle-tract ablation under the guidance of CEUS, and no other bleeding complications occurred after ablation. At 1 month after thermal ablation, CT/MRI demonstrated that all lesions were completely ablated.

Under the strict perioperative management and monitoring, liver cancer patients with obvious abnormal coagulation function can be treated with thermal ablation safely with favorable effect.