射频消融治疗肝脏巨大血管瘤的疗效及安全性  

The safety and efficacy of radiofrequency ablation for treating large hepatic hemangiomas

作　　者：王劭宏[1] 高君[1] 柯山[1] 丁雪梅[1] 周意明[2] 钱晓军[2] 孙文兵[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肝胆胰脾外科,100043 [2]首都医科大学附属北京朝阳医院放射科,100043

出　　处：《中华普通外科杂志》2014年第3期172-176,共5页Chinese Journal of General Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养基金资助项目

摘　　要：目的研究射频消融（radiofrequency ablation，RFA）治疗巨大肝血管瘤（直径≥5cm）的安全性和有效性。方法回顾性分析2007年10月至2012年12月射频消融治疗50例大肝血管瘤患者的临床资料。根据血管瘤大小分为2组，5～10cm组和≥10cm组，比较2组的疗效及安全性差异。结果50例患者共有55个肝血管瘤，其中32例患者有36个大血管瘤（直径5～10cm），18例患者有19个巨大血管瘤（直径≥10cm）。2组血管瘤平均直径分别为（7．1±1．2）cm与（13．2±2．4）cm（t=-12．57，P〈0．01）；2组技术成功率均为100％；7例大肝血管瘤和18例巨大肝血管瘤患者分别出现了13个和61个RFA相关并发症，并发症发生率分别为21．88％和100％（χ^2=28．13，P〈0．01）；94．55％血管瘤（52/55）获得完全消融，其中，大血管瘤的完全消融率为100％（36/36），巨大血管瘤的完全消融率为84．21％（16/19）（Fisher，P=0．04）。RFA后1个月，2组消融灶的平均直径分别降至（5．3-4-1．0）cm和（10．62±1．8）cm（t=-14．30，P〈0．01），未发现消融灶增大、复发。结论RFA治疗5～10cm大肝血管瘤是安全、有效的，而RFA治疗≥10cm巨大肝血管瘤并发症发生率高，其可行性尚待进一步研究。Objective To assess the safety and efficacy of radiofrequency ablation （RFA） for the treatment of large ≥5 cm in diameter） hepatic hemangiomas. Methods Clinical data of 50 patients with large hepatic hemangiomas （ ≥5 cm in diameter） treated with RFA between October 2007 and December 2012 were analyzed. Patients were divided into two groups （5 - 10 cm and ≥ 10 cm） according to tumor size. Results Thirty-two patients had 36 hemangiomas of 5 - 10 cm in diameter and 18 patients had 19 hemangiomas of≥ 10 cm in diameter. Technical success, complications related to RFA, completed ablation, symptom relief, change in size of ablation zone and recurrence of the residual tumor were analyzed. The average diameters of the two groups were 7. 1 ± 1.2 cm and 13.2 ± 2.4 cm separately （ t = - 12. 57, P 〈 0. 01 ） ; the technical achievement ratios of the two groups were both 100% ; Seven of 32 patients with hemangiomas 5 - 10 cm and all the 18 patients with hemangiomas 〉I 10 cm had 13 and 61 complications related to RFA, the incidence of complications were 21.88% and 100% respectively （X^2 = 28.13, P 〈 0.01）; 94.55% hemangiomas （52/55） acquired complete ablation, the complete ablation rates of 5 -10 cm hemangiomas and ≥ 10 cm hemangiomas were 100% （36/36） and 84. 21% （16/19）respectively （P = 0. 014 ）. The mean diameters of ablation zone were respectively decreased to 5.3 ± 1.0 cm and 10. 62 ± 1.8 cm （t = - 14. 30, P 〈 0. 01 ） . Conclusions RFA for hepatic hemangiomas 5 - 10 cm in diameter is safe and effective ; while its complication for ablation of hemangiomas ≥10 cm is high.

关 键 词：血管瘤 脉冲射频术 肝 

分 类 号：R735.7[医药卫生—肿瘤]