超声造影及抽吸瘤内血液辅助下经皮微波消融治疗巨大肝海绵状血管瘤

Percutaneous microwave ablation for huge liver cavernous hemangiomas assisted by focal blood extraction under contrast-enhanced ultrasound guidance

目的探讨经皮微波消融治疗巨大肝海绵状血管瘤的安全性与疗效,阐述主动抽吸瘤体内淤滞血液对消融过程的意义。方法使用频率2450MHz水冷式微波针在超声造影引导和监测下对19例多发且至少有1枚最大径大于6cm的巨大肝海绵状血管瘤患者全身麻醉后进行消融治疗,对其中10例患者的20枚瘤体在最大径配对后分别采用和不采用主动抽吸瘤体内血液的策略,评价消融过程中制约安全性与耗时长短的因素、消融的彻底性及并发症发生率等。结果 19例患者消融总耗时39～163min,平均每例患者需(93±39.85)min;瘤体最大径相近时,主动抽吸瘤内血液组平均每瘤消融耗时(29.61±14.07)min,不抽吸血液组则为(41.57±14.93)min(P<0.05);除丙氨酸转氨酶(ALT)轻度升高[(133.58±46.29)U/L]外,无出血、胆漏、血红蛋白尿等并发症;平均住院(4±0.95)d;经(2.75±0.87)次随访,所有瘤体均缩小,最大径缩小幅度最高达82.54%。所有患者的血管瘤相关症状均得到缓解。结论超声造影引导和监测下经皮穿刺微波消融治疗巨大肝海绵状血管瘤技术可行、过程安全、疗效明显,可部分替代外科手术治疗高危部位的瘤体;而主动抽吸瘤体内淤滞血液可降低瘤体破裂的潜在风险及显著缩短消融耗时。

Objective To investigate the safety and efficacy of percutaneous microwave ablation（PMWA）for huge liver cavernous hemangiomas（LCHs）,and to assess the potential advantages of extracting blood from the hemangioma during the ablation procedures.Methods A water-cooled microwave antenna named KY-2100compatible with a frequency of 2,450MHz generator was used to perform heating ablation in 19patients for their LCHs guided by contrast-enhanced ultrasound under general anesthesia;the patients had multiple LCHs,at least with one having a diameter longer than 6cm.Twenty lesions matched in their maximal size in 10 patients were ablated assisted with or without extracting blood from the hemangiomas.The relevant factors for the safety and ablation duration,thoroughness of ablation,and complications were comprehensively assessed.Results The ablation durations varied from 39to 163min in the 19patients,with an average of（93±39.85）min.For those maximum-length matched lesions,blood extraction significantly shortened the ablation duration compared to non-blood extraction group（[29.61±14.07]min vs[41.57±14.93]min, P〈0.05）.Except for slight elevation of serum ALT level（[133.58±46.29]U/L）in 75%patients,there were no other complications such as intra-peritoneal bleeding,bile leakage,or hemoglobinemia.The average hospital stay was（4±0.95）days.All the ablated LCHs shrank markedly,with the maximal diameter decreased by 82.54%.The hemangioma-induced symptoms were relieved in all patients. Conclusion PMWA is technically feasible,safe and effective for treating LCHs.It can be an attractive alternative for surgical resection of hemangiomas at high-risk locations.And prompt extraction of focal blood can reduce the bleeding risk and shorten ablation duration.