摘要
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.
作者
黎秋曦
贾健锋
黄锐
Li Qiuxi;Jia Jianfeng;Huang Rui(Department of Surgery,Medical Center,Dujiangyan 611830,Sichuan Province,China)
出处
《实用肝脏病杂志》
CAS
2019年第5期732-735,共4页
Journal of Practical Hepatology
基金
四川省科技厅科研基金资助项目(编号:2012SZ0208)
关键词
肝海绵状血管瘤
经皮微波消融术
血红蛋白尿
处理
Hepatic cavernous hemangioma
Percutaneous microwave ablation
Hemoglobinuria
Manegement