冷凍消融術(cryoablation)是治療原發性及轉移性肝癌的微創技術之一，藉由極低溫凍結病灶細胞，達到局部腫瘤控制的效果。此技術在臨床上逐漸被廣泛應用，尤其對於不適合手術切除的病人。然而，儘管冷凍消融術相對安全，仍存在潛在的併發症風險，包括感染、出血、肝功能異常、血小板低下、及更罕見的冷休克等併發症。
本篇個案為接受肝癌冷凍消融術後併發冷休克(cryoshock)的罕見病例。冷休克為冷凍消融術後少見且致命的併發症，其典型特徵包括急性低血壓、器官灌注不良及代謝性酸中毒。其致病機轉尚未完全明確，可能與細胞因子如TNF-α、IL-1及IL-6的釋放有關。本病例經積極治療後成功恢復，顯示早期辨識與及時治療對於冷休克患者的重要性。
本文除了探討該病例外，並對現有文獻進行回顧，以總結冷凍消融術相關的併發症與冷休克的處置經驗，期望為臨床醫師提供早發現並處理此類併發症的參考依據，進而提高冷凍消融術的安全性。
(台灣家醫誌2025; 35: 59-66) DOI: 10.53106/168232812025033501006
 
關鍵詞：肝細胞癌、冷凍消融術、冷休克。

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¹臺北榮民總醫院家庭醫學部
²臺北榮民總醫院放射線部
受理日期：114年1月9日 修改日期：114年1月24日 同意刊登：114年2月18日
^*通訊作者：韓宇軒 地址：112臺北市北投區石牌路二段322號 臺北榮總家庭醫學部
E-mail：naxh.med@gmail.com

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Cryoshock Following Cryoablation in Hepatocellular Carcinoma: A Case Report and Literature Review
 
Yu-Hsuan Han^1*, Chien-An Liu² and Hsiao-Ting Chang¹
 

Cryoablation is a minimally invasive technique for treating primary and metastatic liver cancer by freezing tumor cells at extremely low temperatures to achieve local tumor control. This procedure has been increasingly adopted in clinical practice, particularly for patients ineligible for surgical resection. While relatively safe, cryoablation carries the risk of potential complications, including infection, bleeding, liver dysfunction, thrombocytopenia, and, more rarely, cryoshock. This report details a rare case of cryoshock, a serious but uncommon complication following cryoablation for liver cancer.
Cryoshock is characterized by acute hypotension, poor organ perfusion, and metabolic acidosis. Although the exact pathophysiology of cryoshock remains unclear, it is believed to be related to the release of cytokines such as TNF-α, IL-1, and IL-6. The patient in this case recovered after prompt and aggressive treatment, underscoring the importance of early recognition and timely intervention in managing cryoshock.
In addition to presenting the case, this article reviews the literature on cyroablation-related complications and the management of cryoshock with the goal of providing clinicians with valuable insights for addressing such complications and enhancing the safety profile of cryoablation procedures.
(Taiwan J Fam Med 2025; 35: 59-66) DOI: 10.53106/168232812025033501006
 
Key words: cryoablation, cryoshock, hepatocellular carcinoma

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¹Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
²Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
Received: January 9, 2025; Revised: January 24, 2025; Accepted: February 18, 2025.
^*Corresponding author