经皮肝穿刺硬化术与外科切除术治疗巨大肝血管瘤疗效及成本效益对比分析  

Comparative analysis of efficacy and cost-effectiveness of percutaneous transhepatic sclerotherapy and surgical resection for giant hepatic hemangioma

作　　者：夏咸成 魏宁 祖茂衡 徐浩 杨秋雨 李均彪 XIA Xiancheng;WEI Ning;ZU Maoheng;XU Hao;YANG Qiuyu;LI Junbiao(Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, P.R.China)

机构地区：[1]徐州医科大学附属医院介入放射科,江苏徐州221006

出　　处：《医学影像学杂志》2021年第5期814-817,841,共5页Journal of Medical Imaging

摘　　要：目的探讨对比分析经皮肝穿刺硬化术与外科切除术治疗巨大肝血管瘤的疗效及成本效益。方法回顾性分析2015年1月~2020年1月我院收治的66例巨大肝血管瘤患者的临床资料。其中男性19例,女性47例,平均年龄(49±9)岁。根据患者所选择手术方式不同,分为穿刺硬化组(29例)及外科切除组(37例)。比较两组患者一般资料、围手术期指标、住院治疗费用、有效率及术后并发症等情况。结果穿刺硬化组的累计手术时间、术中出血量、术中输血量、术后住院天数、住院费用的中位数(30 min、0 ml、0 ml、3天、12092元)均明显小于外科切除组(180 min、300 ml、400 ml、10天、53046元,P<0.01);穿刺硬化组术后1~3天ALT、白蛋白、总胆红素、PT、白细胞、血红蛋白、血小板等指标优于外科切除组(P<0.05)。穿刺硬化组治疗有效率为96.7%,与外科切除组比较差异无统计学意义;穿刺硬化组2例术后发生低热,1例3次术后均出现轻度腹痛,予以对症处理后恢复;外科切除组术后2例发生大量胸腔积液,1例发生肝周大量积液,予以外引流及对症处理后恢复,1例发生肝脓肿,予以穿刺引流及抗感染治疗后恢复。结论经皮肝穿刺硬化术治疗巨大肝血管瘤是一种安全、有效、经济的微创治疗方式,较外科切除术有明显优势。Objective To conduct a comparative analysis of efficacy and cost-effectiveness of percutaneous transhepatic sclerotherapy and surgical resection for giant hepatic hemangioma.Methods Clinical data of 66 patients with giant hepatic hemangioma admitted to our hospital from January 2015 to January 2020 were retrospectively analyzed.Among them,19 patients were male and 47 female,with a mean age of(49±9)years old.Patients were assigned to sclerotherapy group(29 cases)and surgical resection group(37 cases)according to different treatment methods.The general data,perioperative indicators,hospitalization expenses,effective rates and postoperative complications were compared between the two groups.Results Median of the cumulative operative time,intraoperative blood loss,intraoperative blood transfusion,postoperative hospitalization days,and total hospitalization expenses in the sclerotherapy group(30 min,0 ml,0 ml,3.0 days,12092 yuan)were significantly less than those in the surgical resection group(180 min,300 ml,400 ml,10 days,53046 yuan,P<0.01).ALT,albumin,total bilirubin,PT,white blood cells,hemoglobin and platelet in the sclerotherapy group were better than those in the surgical resection group 1~3 days after treatment(P<0.05).The effective rate of treatment in the sclerotherapy group was 96.7%,which was not statistically different from that in the surgical resection group.In the sclerotherapy group,two patients had low fever after therapy,and one patient had mild abdominal pain after three times of therapy,which were all improved after symptomatic treatment.In the surgical resection group,there were two cases of massive pleural effusion and one case of massive effusion around the liver,which recovered after external drainage and symptomatic treatment.One patient developed a liver abscess and recovered after external drainage and anti-infective treatment.Conclusion Percutaneous transhepatic sclerotherapy is a safe,effective and economical minimally invasive treatment for giant hepatic hemangioma,which has obvious adv

关 键 词：肝 血管瘤 治疗 穿刺硬化术 外科切除术 介入性 放射学 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]