经皮微波消融术治疗的肝海绵状血管瘤患者血红蛋白尿发生及其处理

Efficacy of percutaneous m icrowave ablation in patients with hepatic cavernous hemangioma and management of hemoglobinuria

目的探讨经皮微波消融术治疗肝海绵状血管瘤(HCHs)患者的疗效,并探讨术后血红蛋白尿发生及处理方法。方法2012年2月~2017年12月我院诊治的HCHs患者54例,病灶数80个。采用在超声引导下经皮微波消融术治疗。采用联苯胺试验检测血红蛋白尿。术后随访6~12 m。结果在54例HCHs患者的80个病灶中,经皮微波消融术治疗后,78个肿瘤完全被消除,2例被大部分消融;术后6~12个月对患者进行超声造影和CT检查随访,所有患者血管瘤均缩小,其中瘤体完全消失者41例(75.9%),瘤体缩小超50%者8例(14.8%),瘤体缩小大于25%但小于50%,但未见肿瘤复发者4例(7.4%),瘤体缩小小于25%,但是未见肿瘤复发者1例(1.9%);术中未出现严重的肝肾功能损害,术后3~4 h有8例(14.8%)患者出现血红蛋白尿,经水化和碱化尿液处理2 d后,尿色恢复正常;2例(3.7%)出现腹水,经内科综合治疗后消退;5例(9.3%)出现右上腹轻微的疼痛,未经干预自行缓解;7例(12.3%)出现恶心呕吐,经止吐处理后缓解。结论经皮微波消融术是一种疗效确切、创伤小的治疗HCHs患者的方法,选择合适的患者进行治疗,可以达到微创治疗的目的。对少数发生的血红蛋白尿,经对症处理,预后良好,但应总结其发生的原因,予以避免。

Objective To investigate the efficacy of percutaneous microwave ablation in patients with hepatic cavernous hemangioma(HCHs)and to summarize the experience of management of hemoglobinuria.Methods Fifty-four patients with HCHs and 80 lesions were rectuited in our hospital between February 2012 and December 2017,and all patients were treated by ultrasound-guided percutaneous microwave ablation.All patients were followed-up for 6 to 12 months.Postoperative complications,especially the management of hemoglobinuria were presented.Results Out of the 80 lesions from the 54 patients with HCHs,78 disappeared after ablation,and 2 were destroyed largely because of the special occupation;at the end of followed-up,the CT and/or ultrasound showed that all lesions were shrunk,and totally disappeared in 41(75.9%),shrank greater than 50%in 8(14.8%),shrank less than 50%,but greater than 25%in 4(7.4%),shrank less than 25%in 1(1.9%);on one with post-operational liver or renal function abnormality was found in our series,and 3 to 4 days after the operation,8 patients 14.8%)had hemoglobinuria,and turned to normal two days after symptomatic management;2(3.7%)had ascites,5 had right upper quadrant of abdominal pain,and 7(12.3%)had nausea and vomiting,all subsided after appropriate management.Conclusion Percutaneous microwave ablation is an efficacious,relatively simple and safe in treatment of patients with HCHs.The hemoglobinuria is a common complications after operation because of thermal effect and injuries,which should be taken into consideration after microwave ablation therapy in clinical practice.