腹腔镜与CT引导下射频消融治疗横膈下肝血管瘤的对比研究

Radiofrequency ablation for hepatic hemangiomas abutting the diaphragm： a comparison of computed tomography guided versus laparoscopic approach

目的 比较CT和腹腔镜路径射频消融（radiofrequency ablation,RFA）治疗横膈下方肝血管瘤的安全性和有效性.方法 回顾性分析RFA治疗43例患者的43个膈下肝血管瘤的临床资料,19例接受CT引导下经皮RFA治疗（CT组）,24例接受腹腔镜路径RFA治疗（腹腔镜组）.结果 43例肝血管瘤的直径为6.0～11.8cm,平均（9.4±1.7 cm）.2组患者血管瘤直径差异无统计学意义（t=0.42,P＞0.05）.所有患者均顺利完成RFA治疗,无技术失败.两组消融时间差异无统计学意义（t=0.07,P＞0.05）.CT组和腹腔镜组完全消融率分别为94.7％（18/19）和91.7％（22/24）（Fisher,P＞0.05）.RFA治疗后,15例患者发生21例次胸部并发症,其中CT组13例患者（68.4％,13/19）,腹腔镜组2例患者（8.3％,2/24）（Fisher,P＜0.05）.2例出现严重并发症（胸腔积液和膈肌破裂,Ⅲ级）,均发生在CT组,其余为轻微并发症（Ⅰ级）.所有轻微并发症经保守治疗痊愈,2例严重并发症分别通过胸腔引流和胸腔镜手术治愈.结论 腹腔镜路径下RFA治疗膈下肝血管瘤可明显降低胸部并发症发生率,是膈下肝血管瘤首选的治疗方案.

Objective To compare the safety and therapeutic efficacy of computed tomography （CT） guided versus laparoscopic RF ablation for hepatic hemangiomas abutting the diaphragm.Methods 43 cases of hepatic hemangiomas abutting the diaphragm were divided into two groups receiving respectively CT guided （19 cases） or laparoscopic RF ablation （laparoscopic ablation group,24 cases）.Results The mean diameter of the 43 hemangiomas was （9.4 ± 1.7） cm （6.0-11.8 cm）.There was no difference in the diameter of hemangiomas between the two groups （t =0.42,P ＞ 0.05）.RF ablation was performed successfully for all patients.There was no difference in ablation times between groups （t =0.07,P ＞0.05）.There were 21 thoracic complications in 15 patients,including 13 （68.4％,13/19） patients in the CT-guided ablation group and 2 （8.3％,2/24） patients in the laparoscopic ablation group （Fisher,P ＜ 0.05）.According to the Dindo-Clavienclassification,2 complications （pleural effusion and diaphragmatic rupture,Grade Ⅲ） were severe and the remaining were minor （Grade Ⅰ）.All the 2 major complications were in the CT-guided ablation group.All the minor complications were treated successfully with conservative measures,and the 2 major complications received chest tube drainage and thoracoscopic surgery respectively.Complete ablation was achieved in 94.7 ％ （18/19） and 91.7％ （22/24） in the CT-guided ablation group and the laparoscopic ablation group,respectively （Fisher,P ＞ 0.05）.Conclusions Laparoscopic RF ablation therapy should be used for the first line treatment option for hepatic hemagioma abutting the diaphragm,which can avoid thermal injury to the diaphragm effectively and reduce the thoracic complications.