肝脏海绵状血管瘤射频消融后综合征的前瞻性研究

A prospective study of postablation syndrome after laparoscopic radiofrequency ablation of hepatic cavernous hemangioma

目的:研究肝脏海绵状血管瘤(HCH)经腹腔镜射频消融术(RFA)后出现消融后综合征的发生率,分析其发生的可能因素。方法:对30例HCH经腹腔镜RFA治疗的患者进行前瞻性研究。治疗前后分别行实验室及影像学检查。观察治疗后出现的各种临床症状及持续时间。结果:50%(15/30)患者出现了消融后迟发性症状。其中发热15例、寒战3例、全身不适13例、消融部位疼痛7例、恶心和(或)呕吐8例、血红蛋白尿3例。治疗后3 d症状最明显,对症处理后12 d内消失。消融后症状的发生与术前瘤体最大直径、术后消融区最大直径、射频治疗时间及血清转氨酶水平呈明显相关性(P<0.05)。结论:HCH经腹腔镜RFA治疗后,大约1/2患者可发生消融后综合征,术后2周内自行消失,对症处理对于症状的缓解可起到积极的作用。

Objective：To study the incidence of postablation syndrome after laparoscopic radiofrequency ablation （RFA） of hepatic cavernous hemangioma （HCH） and analyze its cause. Methods： A total of 30 patients with HCHs were treated by laparoscopic RFA. Pre- and postablation laboratory tests and imaging studies were performed in all patients. After laparoscopic RFA, the symptoms and their durations were observed prospectively. Results： Postablation symptoms occurred in 15 out of 30 patients, including fever in 15, chills in 3, systemic malaise in 13, pain at the site of ablation in 7, nausea and/or vomiting in 11, and transient hematoglobinuria in 4. Symptoms peaked on day 3 and resolved by conservative treatment within 12 days after onset of symptom. The incidence of postablation symptom was related significantly with the preoperative maximum diameter of lesions, the postoperative maximum diameter of ablated regions, the RFA time and serum aminotransferase levels （ P 〈 0.05 ）. Conclusions： Postablation syndrome occurs in approximately one - second of patients after laparoscopic RFA of HCHs and can be self - limiting within 2 weeks. Appropriate management is recommended for the affected patients.