成人肝血管瘤分别实时超声引导下经皮射频消融和外科手术切除疗效观察

Clinical analysis of real -time ultrasound-guided percutaneous radiofrequency ablation and surgical resection for adult hepatic haemangioma

目的:探讨成年人肝血管瘤利用实时超声引导下经皮射频消融术和外科手术切除的临床效果。方法:回顾性分析79例成人肝血管瘤分别利用实时超声引导下经皮射频消融术和肝部分切除术的临床资料。结果:11例肝血管瘤18个病灶成功实施了实时超声引导下经皮射频消融术,68例实施了外科手术切除。79例肝血管瘤均安全完成外科手术,术后无手术死亡。经皮射频消融组(PRFA组)及外科手术切除组(SR组)平均手术时间为(67.2±23.2)min及(108.4±26.3)min(P<0.05),术后平均住院时间为(5.5±1.5)d及(11.5±2.5)d(P<0.05)。PRFA组术中无出血,术后未输血,SR组术中平均出血量(380.2±104.3)mL,术后21例输血。PRFA组与SR组术后血清转氨酶均一过性升高,术后第1天ALT分别为(78.3±16.7)mmol/L及(108.4±24.6)mmol/L(P<0.05),AST分别为(62.4±13.2)mmol/L及(88.3±18.5)mmol/L(P<0.05)。随访6～30个月(中位数12个月),PRFA组病灶坏死完全,SR组无病灶残留。PRFA组9例症状完全消失,2例症状明显改善,SR组5例轻度上腹不适。结论:掌握好适应证,肝血管瘤外科手术治疗安全可行,肝部分切除术是目前治疗较大肝血管瘤最有效的方法;实时超声引导下经皮射频消融术治疗肝血管瘤疗效肯定,具有创伤小、肝损害轻、出血少、费用低及住院时间短等优点。

Objectives： To investigate the feasibility, safety, indication, and clinical effect of real-time ultrasound-guided percutaneous radiofrequency ablation and surgical resection for adult hepatic haemangioma. Methods： The clinical data of real-time ultrasound- guided percutaneous radiofrequency ablation and partial hepatectomy for 79 patients with adult hepatic haemangioma between July, 2005 and June 2008 were retrospectively analyzed. Results： The real-time ultra-sound-guided percutaneous radiofrequency ablation was safely carried out in 18 lesions of 11 patients with hepatic haemangioma. The Surgical resections were done for 68 patients. The surgical procedures were safely carried out in all 79 cases of adult hepatic haemangioma. No one died after operations. The average operation time were （67.2 ± 23.2）min and （108.4 ± 26.3）min in percutaneous radiofrequency ablation group（PRFA） and surgical resection group（SR） respectively （P〈 0.05）. The average postoperative stay were （5.5 ± 1.5）d and （11.5 ± 2.5）d, respectively, （P 〈 0.05）. Non-hemorrhage in operation and blood transfusion post-operation occurred in PRFA group. The intraoperative average hemorrhage volume was （380.2 ± 104.3）mL, and blood transfusion post-operation was performed for 21 in SR group. The serum transaminase rised provisionally in both groups. On the 1st day after operation, ALT were（78.3 ±16.7）mmol/L and （108.4 ±24.6）mmot/L in two groups respectively （P 〈 0.05）, and AST were （62.4 ± 13.2）mmol/L and （88.3 ± 18.5）mmol/L（P 〈 0.05）. The median follow-up time was 12 months （range 6-30 months）. Lesions necrosed throughly in PRFA group. There were not residual lesions in SR group. The symptoms vanished completely in 9 cases, and improved obviously in 2 cases of PRFA group. The epigastric discomfort was slight in 5 cases of SR group. Conclusion： The surgical therapy for hepatic haemangioma is safe and feasible. The partial hepatectomy is the opeimal therapeutic method for biggish hepatic haemangioma nowadays. The treatment effectiveness of real-time ultrasound-guided percutaneous radiofrequency ablation on hepatic haemangioma is positive.