动脉栓塞联合CT引导热消融治疗肝血管瘤

Transcatheter arterial embolization combined with CT-guided thermal ablation for the treatment of hepatic hemangiomas

目的 评价经动脉栓塞（TAE）联合CT引导热消融（射频消融/微波消融,RFA/MWA）治疗肝血管瘤的疗效及安全性。方法 回顾分析2008年11月至2013年7月TAE联合CT引导热消融治疗的肝血管瘤患者26例,其中单发14例,多发12例,有症状患者8例。病灶长径5.0-13.0 cm,平均（7.6±2.4）cm。先行TAE治疗,再行CT引导下RFA/MWA治疗,观察完全消融率、病灶缩小程度、手术并发症。结果 26例患者中行RFA治疗9例,MWA 17例,共消融病灶27个,行消融治疗28次。23个病灶实现了完全消融,病灶的完全消融率为85.2%（23/27）,病灶缩小12.9%-66.3%,平均（31.0±19.6）%。有症状患者经治疗后症状全部消失。消融治疗后出现肝包膜下出血1例、血红蛋白尿1例、胆汁瘤1例,经治疗后好转,总体并发症发生率为11.5%,无严重并发症及死亡患者。结论 TAE联合CT引导热消融治疗肝血管瘤疗效确切,无严重并发症及死亡患者,可作为肝血管瘤治疗的选择之一。

Objective To evaluate the efficacy and safety of transcatheter arterial embolization （TAE） combined with CT-guided thermal ablation in treating hepatic hemangiomas. Methods Between November 2008 and July 2013, a total of 26 patients with hepatic hemangioma were treated with combination therapy of TAE and CT-guided thermal ablation. Of the 26 patients, single lesion was seen in 14 and multiple lesions were found in 12. There were 8 symptomatic patients in this series. The diameter of the lesions was （5.0-13.0） em with a mean of （7.6±2.4 era）. TAE was performed first, which was followed by CT-guided thermal ablation therapy. The complete ablation rate, the reduction degree of lesion＇s volume, and the procedure-related complications were recorded. Results Of the 26 patients, CT-guided radiofrequency ablation （RFA） was carried out in 9 and microwave ablation （MWA） in 17. A total of 27 lesions were treated with 28 ablation procedures. Complete necrosis was achieved in 23 lesions, with a complete ablation rate of 85.2% （23/27）. The lesion＇s volume was reduced by 12.9%-66.3% （mean 31%±19.6%）. After the treatment the clinical symptoms disappeared in all symptomatic patients. Complications included hepatic subcapsular hemorrhage （n=1）, hemoglobinuria （n=1） and biloma （n=1）, which were improved after proper medication. The general incidence of moderate complications was 11.5%, no severe complications or death occurred. Conclusion For the treatment of hepatic hemangiomas, TAE combined with CT-guided thermal ablation is effective and reliable with no severe complications or death. Therefore, this technique can be regarded as one treatment choice for hepatic hemangiomas.