巨大肝血管瘤误诊为肝囊肿1例

病人 ,女 ,74岁 ,反复头昏、头痛 3年 ,上腹部不适 2年 ,加重 1 d。查血压 :2 6/1 2 k Pa(1 k Pa=7.5 mm Hg) ,双肺呼吸音粗 ,心尖区可闻 级收缩期吹风样杂音 ,向腋下传导 ,临床诊断 :高血压病 ;高血压性心脏病 ;二尖瓣关闭不全。 B超检查 :仪器为 Aloka SSD-63 0黑白超声诊断仪 ,探头为 3 .5 MHz腹部线阵式探头 ,病人取左侧卧位 ,在右肋缘下斜断扫查 ,于肝右叶探及 1 1 .8cm× 9.8cm无回声区 ,其边缘整齐、光滑、壁薄 ,与周围组织境界分明 ,后壁和深部组织回声增强。胆囊大小形态正常 ,壁增厚 ,毛糙、呈“双边”征 ,于腔内可见多个大…     

选择性肝动脉栓塞治疗巨大肝血管瘤

目的:研究和探讨经肝动脉栓塞治疗巨大肝血管瘤的价值和作用。方法:对12例巨大肝血管瘤进行超选择性肝动脉栓塞,先用碘油或超液态碘油栓塞肿瘤区小血管,再用明胶海绵细条栓塞供血动脉主干。结果:血管造影复查显示碘油聚积于肿瘤内,肿瘤血管消失,供血动脉闭塞,1～2 个月后复查肿瘤不同程度缩小,其中缩小50% 以上者9例,不足50% 者3 例,2 例栓塞后获手术切除,瘤体大部分纤维化,血管闭塞。结论:巨大肝血管瘤经动脉栓塞治疗是一种安全、简单、有效的治疗方法,认为对需手术切除的巨大肝血管瘤应先栓塞治疗     

肝动脉栓塞治疗巨大肝海绵状血管瘤疗效分析

肝海绵状血管瘤是肝脏最常见的良性肿瘤，尸解发现率可达4％-7％。女性多见，传统治疗方法以外科手术为主，但手术创伤及风险大，随着介入放射学迅速发展，介入治疗肝海绵状血管瘤是一种有效可行方法，尤其是巨大肝海绵状血管瘤。我院自2003年8月-2005年7月期间对16例巨大肝海绵状血管瘤进行了肝动脉栓塞治疗，现报告如下。     

肝血管瘤的超声诊断

肝血管瘤是肝脏最常见的良性肿瘤,超声检查作为其首选的影像学方法已被临床广泛应用,现就肝血管瘤在灰阶超声上的形态与回声类型、彩色多普勒显像、三维超声、超声造影检查的特点及其进展作一综述。     

脂肪肝合并巨大肝血管瘤1例

1病例介绍 患者男性,42岁。无明显诱因出现腹胀、食欲不振1月余,加重3 d。体检：肝脏肋下10 cm,余无明显阳性体征。患者既往无病毒性肝炎、自身免疫性疾病史。实验室检查无明显异常。CT表现：平扫示肝脏体积增大,肝叶比例失调,左叶增大明显,局部包膜隆起,肝内见大片状混杂密度减低区,最大截面25 cm×15 cm,病灶主要位于肝左叶,大部分密度均匀,左叶外侧段内见“五角星”状密度更低影,境界清楚,胃、脾脏及肠管受压向外后方移位;肝右叶后段内见多发片状密度减低影散在分布（图1、2）。     

超选择性动脉栓塞治疗巨大肝血管瘤

目的 评价超选择性动脉插管栓塞治疗肝血和瘤的应用价值。方法 本组２０例,男８例,女１２例。肝血管瘤体最大直径５ｃｍ～２３ｃｍ,将导管超选择插入血管瘤供体血动脉,一次或分次输注平阳霉不和超液化碘油乳剂。最后用明胶海绵颗粒栓塞供血动脉。术后定期复查。结果 介入手术成功率９０．５％总胶有效率９０％（１８／２０）,并发症少,术后复发率低。结论 超选择动脉插管栓塞是治疗肝血管瘤的很有价值的方法,可作为首选。     

射频消融新技术治疗巨大肝血管瘤效益的分析

目的：探索加强型射频消融新技术与传统手术切除治疗巨大肝血管瘤的社会、经济效益。方法将应用加强型射频消融新技术治疗的30例巨大肝血管瘤患者（观察组）与匹配的传统手术切除治疗的30例肝巨大血管瘤（对照组）进行术后生活质量、平均住院日及住院费用的比较。结果两组患者在随访期内血管瘤均无复发,疗效肯定。与对照组相比,观察组患者术后生活质量提高,平均住院日缩短（P<0.001）。住院费用减少（P=0.004）。结论用加强型射频消融新技术治疗巨大肝血管瘤,能够缩短住院时间、减少住院费用,提高患者术后生活质量,具有明显的经济效益和社会效益。     

腹腔镜射频消融治疗肝脏海绵状血管瘤39例临床观察

目的：探讨腹腔镜射频消融治疗肝脏海绵状血管瘤的可行性及实用性。方法：39例共64个瘤体全麻气管插管后，腹腔镜下行射频消融治疗，其中10例同时行胆囊切除术。结果：全部病例治疗效果满意，术后无残留病灶，无明显并发症。结论：腹腔镜射频消融治疗肝脏海绵状血管瘤安全可行，治疗彻底，是一项微创治疗新技术。     

Percutaneous radiofrequency ablation of symptomatic giant hepatic cavernous hemangiomas: report of two cases and review of literature

The presented cases detail percutaneous radiofrequency (RF) ablation of multiple giant hepatic hemangiomas in two patients who presented with right upper-quadrant pain and fullness and chose not to undergo surgical resection. Treatment of two hemangiomas per patient, 7 cm and 6 cm in one and 9 cm and 2 cm in the other, was accomplished in single ablation sessions with 12 and nine cycles, respectively. Patients had durable resolution of symptoms with reduction of lesion size by 68%-82% at a mean follow-up of 13 months. These cases, along with promising results in the current literature, support RF ablation as a safe and effective surgical alternative.     

肝癌射频消融后的影像学评价

射频消融术(RFA)是肝癌综合治疗中的一项重要手段,尤其是对小肝癌的治疗,临床疗效较好。由于RFA治疗范围的局限,术后常有肿瘤病灶的残存或出现复发。因此,准确地评价RFA术后疗效非常重要。本文综述了不同影像手段对RFA治疗肝癌的疗效评价,同时讨论不同评价方法的优劣,以冀为采取合理的影像手段,做出正确的临床处理提供参考。     

Transcatheter arterial embolization of two symptomatic giant cavernous hemangiomas of the liver

Cavernous hemangiomas are usually asymptomatic; however, a small percetage may cause symptoms. This case report discusses palliation by transcatheter arterial embolization with polyvinyl alcohol particles.     

腹腔镜下肝脏海绵状血管瘤的治疗

目的总结腹腔镜下肝脏海绵状血管瘤的治疗经验,探讨其安全性及可行性。方法回顾性分析我院67例腹腔镜下治疗肝脏海绵状血管瘤的临床资料,其中58例行腹腔镜下肝脏海绵状血管瘤的射频消融治疗,9例行腹腔镜下肝血管瘤的切除治疗。结果本组病例均在腹腔镜下完成手术治疗,平均手术时间约100 min,平均出血量约300 ml,术后第2天均能下地活动,并进流质饮食,术后平均住院时间5 d,1例术后出现右肝管狭窄,术后无胆漏出血,随访远期效果良好。结论腹腔镜下肝海绵状血管瘤的治疗是安全可行的,疗效确切,治疗病例应严格选择。     

Thoracic paravertebral block for analgesia following liver mass radiofrequency ablation

A 66-year-old man presented for a second attempt of radiofrequency ablation of a metastatic carcinoid liver lesion. The first attempt using intravenous sedation was unsuccessful because of inadequate pain control and subsequent patient combativeness. Despite fentanyl being given during general anaesthesia, the patient complained of severe right flank pain after emergence. A thoracic paravertebral block was performed without complication and the patient's pain decreased to "3 out of 10" on a standard 10-point scale after 10 min, and "0 out of 10" after 30 min. The patient's pain score remained 0 throughout the following day, and no further analgesics were required. Thoracic paravertebral block can provide complete and lasting analgesia following hepatic radiofrequency ablation, and warrants further study for patients undergoing hepatic radiological interventions.     

射频消融治疗肺部恶性肿瘤的临床护理

目的 探讨CT引导下射频消融(RFA)治疗肺恶性肿瘤的护理策略.方法 对21例肺恶性肿瘤患者的31个瘤体进行CT引导下射频治疗.结果 所有患者均顺利完成了RFA治疗.手术并发症有少量气胸、液气胸、血痰、疼痛和轻度发热,进行对症处理及护理后缓解,无一例死亡,全部患者没有出现其他严重并发症.结论 对RFA治疗肺部恶性肿瘤患者进行术后精心护理,及时观察并发症并对症处理,有助于促进患者康复.     

Impact of thrombocytopenia on radiofrequency ablation therapy of hepatocellular carcinoma in patients with liver cirrhosis

Objective

The objective of our study was to assess the impact of thrombocytopenia on percutaneous radiofrequency ablation (RFA) therapy of Hepatocellular carcinoma (HCC) in patients with liver cirrhosis.

Material and methods

We analyzed retrospectively 64 patients with liver cirrhosis and thrombocytopenia, defined as a platelet count of less than 100 × 10³/mm³ that had undergone percutaneous RFA to treat 86 HCCs. The Kaplan–Meier and Cox regression methods were used to predict hemorrhage, and time to the first decompensation event, defined as the development of ascites, hepatic encephalopathy, variceal hemorrhage, and deterioration of liver function to Child-Pugh class B/C.

Results

There were no significant risk factors of hemorrhage. Univariate and multivariate analyses revealed that liver decompensation was clearly linked to prothrombin activity (p = 0.010 and p = 0.006, respectively) and a ? 63% of prothrombin activity was found as significant threshold for the occurrence of liver decompensation (p = 0.003) confirmed by the Cox model (p = 0.05).

Conclusion

Percutaneous RFA for HCC can be performed safely without the need for support, in patients with liver cirrhosis and thrombocytopenia up to 37 × 10³/mm³.     

射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价

目的探讨射频消融（RFA）联合肝动脉栓塞（TAE）治疗巨大肝血管瘤（直径≥10 cm）的可行性、安全性及有效性。 方法收集我院2007年10月—2015年5月期间,经TAE序贯RFA治疗15例患者15个巨大肝血管瘤的临床资料。回顾性分析其一般资料、RFA治疗策略、消融相关并发症、完全消融率、消融灶直径变化及复发情况等。 结果所有患者均成功完成RFA联合TAE治疗。TAE后血管瘤的平均直径从（13.0±2.2）cm缩小至（7.1±2.0）cm。RFA治疗后,14个血管瘤（93.3%）获得完全消融。RFA治疗后1个月,消融灶平均直径缩小至（6.1±2.0）cm;6个月后缩小至（4.9±1.6）cm。15例患者中,4例患者发生了6个消融相关并发症;根据Dindo–Clavien分级,均属轻微并发症（I级）。 结论RFA联合TAE治疗巨大肝血管瘤是安全、有效的;TAE可有效阻断血管瘤血供,使瘤体缩小,降低后续RFA治疗的难度,减少消融相关并发症。