射频消融治疗肝血管瘤100例分析

Radiofrequency ablation for treating hepatic hemangioma: a retrospective analysis of 100 cases

目的总结射频消融(radiofrequency ablation,RFA)治疗肝血管瘤的临床经验。方法回顾性分析新疆军区总医院2013年3月至2017年10月采用RFA治疗的100例共101个肝血管瘤结节的病例资料。对RFA治疗前后最大瘤体直径的变化及治疗后出血、血尿、肾功能损害等并发症情况进行统计分析。结果 101个结节中88个结节经RFA后完全毁损,完全毁损率87.1%;其中直径≤4cm的血管瘤完全消融率92.1%(35/38),直径> 4 cm的血管瘤完全消融率84.1%(53/63)。RFA术后1个月所有瘤体平均直径由从术前的(4.2±1.8)(2-11)cm降为术后的(2.1±1.8)(0-6)cm,差异有统计学意义(P=0.03)。一个血管瘤治疗前直径为11 cm,经RFA治疗后缩小54.5%。术后52%(52/100)的患者出现发热,体温37.5-38.5℃,物理降温后体温均可正常。未经抗生素处理,术后3-5 d后均未出现发热,未出现术后严重并发症。结论射频消融治疗肝血管瘤安全、有效,特别是对于瘤体较小的血管瘤效果更明显。需要注意的是应该根据血管瘤的大小、局部毗邻关系及分布特点采用个体化的射频治疗方式。

Objective To investigate the clinical effect and experience of radiofrequency ablation (RFA) on the treatment of hepatic hemangioma. Methods Clinical data of 100 patients with a total of 101 hepatic hemangiomas treated by RFA from Mar. 2013 to Oct. 2017 in General Hospital of Xinjiang Military Area Command were retrospectively analyzed. Pre-and-post-RFA maximum diameter of tumor and postoperative complications of hemorrhage, hematuria, renal dysfunction and others were statistically analyzed. Results Among 101 hepatic hemangiomas, 88 were completely ablated, with a complete ablation rate of 87.1%;hemangiomas with diameter ≤4 cm had a complete ablation rate of 92.1%(35/38) and with diameter >4 cm had a complete ablation rate of 84.1%(53/63). One month after RFA, average diameter of all hemangiomas was decreased from (4.2±1.8)(2- 11) cm to (2.1±1.8)(0-6) cm, with statistically significant difference (P=0.03). Maximum diameter of a hemangioma with diameter of 11 cm was reduced by 54.4% after RFA. And 52% patients (52/100) had fever, with the highest body temperature of 37.5-38.5 ℃, which became normal after physical cooling without antibiotic treatment. Three to five days later, no fever occurred;no serious complications occurred. All patients had no serious postoperative complication. Conclusion RFA is a safe and effective way for treating hepatic hemangiomas, especially with more obvious effectiveness for small-size hepatic hemangiomas. But the individualized RFA should be adopted according to hepatic hemangiomas’ size, local relationship and distribution characteristics.