腹腔镜射频消融治疗贴近肝门的海绵状血管瘤的安全性及疗效  

Safety and efficacy of laparoscopic radiofrequency ablation therapy for patients with hepatic cavernous hemangiomas adjacent to hepatic portal:A report of 8 cases

作　　者：范瑞芳[1] 柴福录[1] 贺冠宪[1] 万维喜[1] 李荣梓[1] 李红梅[1] 许淑梅[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,甘肃兰州730050

出　　处：《中国内镜杂志》2007年第6期561-563,共3页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜射频消融术(RFA)治疗贴近肝门的肝脏海绵状血管瘤(HCH)的可行性、安全性及疗效。方法2001年10月～2005年5月,8例贴近肝门的HCH在全身麻醉下进行了腹腔镜RFA治疗。男2例,女6例;平均年龄(47.0±6.8)岁。8个病灶平均瘤体直径(7.0±1.1)cm。所有病人均表现为上腹部不适、疼痛或腹胀,1例轻度黄疸。合并慢性结石性胆囊炎1例。结果8例在腹腔镜超声引导下均顺利完成腹腔镜RFA治疗,1例因胆囊结石同时行腹腔镜胆囊切除术(LC),另1例因瘤体累及胆囊床行LC。平均射频治疗时间(68.6±14.8)min,平均总手术时间(95.0±22.1)min,平均出血量(153.8±70.5)mL。所有病人均未输血。未出现胆囊灼伤、胃肠道损伤、胆漏、胆管狭窄、肝功能衰竭等并发症。术后均出现血清转氨酶(AST及ALT)一过性升高。术后1个月螺旋CT增强扫描证实,病灶完全坏死率达100%(8/8)。术后随访12～35个月,7例症状完全消失,1例症状明显改善。结论腹腔镜射频消融术治疗贴近肝门的HCH安全可行,治疗效果肯定,术中超声的应用对RFA电极针的放置、展开及减少并发症的发生起到了积极的作用。[Objective] To evaluate the feasibility, safety and efficacy of laparoscopic radiofrequency ablation （RFA） for patients with hepatic cavernous hemangiomas （HCH） adjacent to hepatic portal. [Method] From October 2001 to May 2005, 8 patients with symptomatic HCHs underwent laparoseopie RFA therapy under general anesthesia. There were 2 men and 6 women, with a mean age of （47.0±6.8） years. The mean tumor diameter was （7.0±1.1） em. All patients had obvious symptoms such as abdominal discomfort, pain and swelling, and 1 patient had mild obstructive jaundice. One patient had chronic calculous eholecystitis. [Results] Laparoseopie RFA was performed sueeessfully under laparoseopie ultrasound guidance in all the patients, and laparoseopie eholeeysteetomy was performed simultaneously for gallstones in 1 patient and for abutting of gallbladder from hemangioma in another patient. The mean RFA time was （68.6±14.8） min, the mean total operative time was （95.0±22.1） min, and the mean blood loss was （153.8±70.5） mL. No patient needed blood transfusion. No specific comPlications such as gallbladder injury, gastrointestinal tract damage, bile leakage, stricture of bile duct and liver function failure developed during and after RFA therapy. Transient elevation of serum transaminase （ALT, AST） levels was observed in all patients. A complete lesion necrosis was achieved in all patients on the contrast-enhanced helical CT scans 1 month after the procedure. During a median follow-up period of 19 months （range, 12～35 months）, 7 patients were symptom-free, and another obtained significant amelioration in symptoms. [Conclusions] Laparoscopie RFA therapy is a feasible, safe, and effective treatment modality for symptomatic HCHs adjacent to hepatic portal. Intraoperafive ultrasonography is a useful adjunct for offering more accurate targeting for RFA and reducing RFA-related complications.

关 键 词：肝脏肿瘤 海绵状血管瘤 腹腔镜 射频消融 肝门 

分 类 号：R735.7[医药卫生—肿瘤]