腹腔镜射频消融与外科切除治疗巨大肝脏海绵状血管瘤的临床对照研究  

Comparison of laparoscopic radiofrequency ablation with surgical resection for treatment of giant hepatic cavernous hemangioma

作　　者：范瑞芳[1] 柴福录[1] 卫立辛[2] 贺冠宪[1] 万维喜[1] 白明东[1] 雍召生[1] 柴凡[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,兰州市730050 [2]第二军医大学东方肝胆外科医院,上海市200438

出　　处：《中华肝胆外科杂志》2006年第10期676-679,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的比较分析腹腔镜射频消融(RFA)与外科切除治疗巨大肝脏海绵状血管瘤(HCH)的疗效、并发症及各临床参数。方法2001年3月至2005年2月,31例病人共39个HCH病灶在全麻下进行了腹腔镜RFA治疗或外科切除术。男7例,女24例,平均年龄(47．7±8．6)岁。病人均表现为上腹部不适、疼痛或腹胀等症状。术前经超声、螺旋CT及MRI检查获得确诊,平均最大肿瘤直径(9．6±1．4)cm。结果17例HCH成功实施了腹腔镜RFA治疗,14例进行了外科切除术。腹腔镜RFA组及外科切除组的平均出血量分别为(192．4±85．0)ml及(714．3±276．3)ml(P< 0．01),平均手术时间为(107．5±34．4)min及(115．4±23．7)min(P>0．05),平均术后住院日为(4．9±1．2)d及(11．6±3．0)d(P<0．01)。腹腔镜RFA组均未输血,外科切除组中10例输血。腹腔镜治疗组中,2例出现一过性血红蛋白尿;外科切除组中,1例出现术后腹腔渗血,另1例肺部感染。所有病例术后均出现血清转氨酶(ALT及AST)一过性升高。随访6～35个月(中位21个月),腹腔镜RFA治疗组病灶完全坏死率达100％,外科切除组均未见残留病灶。腹腔镜RFA治疗组中,15例症状完全消失,2例症状明显改善;外科切除组中,13例无症状,1例右上腹轻度不适。结论外科切除仍然是巨大HCH最有效的治疗方法。腹腔镜RFA治疗巨大HCH具有微创、避免输血、缩短住院日等优点,治疗效果肯定,适用于病灶位于肝脏表面或临近胆囊等空腔脏器的病人,术中超声的应用可有效避免相关并发症的发生。Objective To compare the therapeutic efficacy, complications and clinical data of laparoscopic radiofrequency ablation （RFA） with surgical resection （SR） for treatment of giant hepatic cavernous hemangioma （HCH）. Methods From March 2001 to February 2005, a total of 31 patients with 39 liver lesions were treated by laparoscopic RFA or SR in our hospital. Of the 31 patients with a mean age of 47.7±8. 6 years, 7 were male and 24 female. All the patients had typical symptoms such as abdominal discomfort, pain and swelling. Preoperative diagnosis of HCH was established by means of ultrasonography, helical CT and MRI. The mean maximal diameter of the tumors was 9. 6±1.4 cm. Results Laparoscopic RFA was successfully performed in 17 patients and SR was conducted in 14. The mean blood loss, mean operative duration, mean duration of hospitalization after operation in the laparoscopic RFA group and SR group were 192. 4±85.0 ml vs. 714.3±276.3 ml （P〈0. 01）, 107.5±34. 4 min vs. 115.4±23.7 min （P〉0.05）, and 4.9±1.2 d vs. 11.6±3.0 d （P〈0. 01）, respectively. Ten patients required blood transfusion （400-1000 ml, median： 600 ml） in SR group. However, no patient required blood transfusion in the laparoscopic RFA group. In the laparoscopic RFA group, a transient hematuria occurred in 2 patients and no specific complications developed during or after the treatment. In SR group, hemorrhage in abdominal cavity occurred in 1 patient and pulmonary infection in another. The follow-up for an average of 21 months （6-35 months） showed that a complete lesion necrosis was achieved in the laparoscopic RFA group and no remnant tumor tissue was seen in SR group. During the follow-up, 15 patients were free of upper abdominal pain and 2 obtained significant amelioration in symptoms in the laparoscopic RFA group, and 13 patients were symptom-free and 1 had mild discomfort in the right upper abdomen in SR group. Conclusions SR remains the most effective method for treatment of giant HCH. Laparoscopic RF

关 键 词：腹腔镜术 肝脏 海绵状血管瘤 射频消融术 外科切除术 

分 类 号：R735.7[医药卫生—肿瘤]