超声引导下聚桂醇与无水乙醇硬化治疗单纯性肝囊肿的疗效分析与对比研究

Clinical effect of ultrasound-guided injection of lauromacrogol versus anhydrous ethanol as sclerotherapy for simple hepatic cyst:a therapeutic effect analysis and comparative study

目的对比分析超声引导下经皮穿刺聚桂醇与无水乙醇注射硬化术治疗单纯性肝囊肿的临床疗效,不良反应发生率及术后肝功能、血常规等变化,以评价两种硬化剂治疗单纯性肝囊肿的优劣。方法收集2013年3月-2015年3月上海市浦东新区公利医院消化内科肝囊肿患者62例,随机分为观察组(聚桂醇组)与对照组(无水乙醇组),分别行超声引导下两种硬化剂治疗,比较两组患者术中、术后的不良反应发生率、治愈率及治疗前、后TBil、ALT、AST、胆碱酯酶、ALP的变化和术后24 h血常规等变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果观察组患者不良反应发生率及血乙醇浓度明显低于对照组(P值均<0.05)。观察组与对照组患者的治愈率(术后1个月与术后6个月)、术后24 h血常规变化差异无统计学意义(P值均>0.05)。单发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-3.680、-5.571,P值分别为0.001、<0.001)。多发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-2.156、-4.626,P值分别为0.040、<0.001)。结论超声引导下聚桂醇及无水乙醇硬化术治疗单纯性肝囊肿均安全、有效、损伤小、临床治愈率较高,但聚桂醇引起的不良反应明显少于无水乙醇,对肝功能的不良影响也明显较无水乙醇为轻。对于多发性肝囊肿及肝功能储备不佳患者,聚桂醇优势明显,应为首选治疗用硬化剂。

Objective To investigate the clinieal effect of ultrasound - guided injection of lauromacrogol versus anhydrous ethanol as the sclerotherapy for simple hepatic cyst, as well as the ineidence rates of adverse events and changes in liver function and the results of routine blood test after surgery, and to evaluate the advantages and disadvantages of these two sclerosing agents in the treatment of simple hepatic cyst. Methods A total of 62 patients with simple hepatic cyst who were treated in Department of Gastroenterology, Shanghai Pudong New Area Gongli Hospital were enrolled and randomly divided into observation group （lauromacrogol group） and control group （anhydrous etha- nol group）. The patients in these two groups were given uhrasound -guided injection of lauromaerogol and anhydrous ethanol, respectively. The incidence rates of intraoperative and postoperative adverse events, cure rate, changes in the serum levels of serum total bilirubin （TBil）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, eholinesterase （CHE）, and alkaline pbosphatase （ALP）, and changes in the results of routine blood test within 24 hours after surgery were compared between the two groups. The t - test was used for comparison of continuous data between groups, and the cbi - square test was used for comparison of categorical data between groups. Results Compared with the control group, the observation group had significantly lower incidence rates of adverse events and a significantly lower blood aleohol concentration （both P 〈 0.05）. The cure rate （ 1 and 6 months after surgery） and the changes in the results of routine blood test within 24 hours after surgery showed no significant differences between the two groups （both P 〉 0.05）. At 1 week after surgery, the serum levels of ALT and AST showed significant differences between the observation group and the control group for single hepatic cyst （ t = - 3. 680 and - 5.571, P = 0.001 and 〈 0. 001 ） , while the serum levels of ALT and AST showed significant differences between the obser- vation group and the control group for multiple hepatic cysts （ t = - 2. 156 and - 4. 626, P = 0. 040 and 〈 0. 001 ）. Conclusion Ultra- sound - guided injection of lauromacrogol or anhydrous ethanol as the sclerotherapy for simple hepatic cyst is safe and effective, with mild in- jury and a relatively high clinical cure rate. However, compared with anhydrous ethanol, lauromacrogol causes significantly fewer adverse e- vents and milder adverse effects on liver function. As for patients with multiple hepatic cysts and poor hepatic functional reserve, lauromacro- gol has obvious superiority and can be used as the first - line sclerosing agent.