微波消融与肝动脉栓塞治疗肝血管瘤的对照研究

目的:比较微波消融与肝动脉栓塞治疗肝血管瘤的疗效.方法:对2009年1月-2012年4月院收治的70例肝海绵状血管瘤患者随机分为消融组(37例,在局部麻醉B超引导下穿刺定位或全麻后腹腔镜直视下穿刺肝血管瘤微波消融治疗)和栓塞组(33例,采用超选择性肝血管瘤动脉注射平阳霉素碘油乳剂栓塞治疗),对比观察两种治疗方法的效果.结果:术后6个月,消融组有9例(24.32％)血管瘤残留血供,进行第2次微波消融治疗；栓塞组有18例(54.55％)血管瘤残留血供,进行2次治疗(肝动脉栓塞治疗13例,微波消融治疗5例).术后12个月随访,消融组31例(83.78％)瘤体缩小幅度达75％以上,瘤体血供完全消失,6例(16.22％)瘤体缩小＜75％,瘤体血供大部分消失；栓塞组15例(45.45％)瘤体缩小达75％以上,瘤体血供完全消失,18例(54.55％)进行2次治疗后瘤体缩小＜75％,瘤体血供大部分消失,两组间差异有统计学意义(P＜0.01).结论:微波消融治疗肝海绵状血管瘤效果可靠,且在缩小瘤体和减少病灶血供上优于肝动脉栓塞术.

Microwave ablation versus hepatic arterial embolization for liver hemangioma

Objective: To compare the efficacy of microwave ablation and hepatic arterial embolization for hepatic hemangioma. Methods: Seventy patients with liver hemangioma admitted between January 2009 and April 2012 were randomly assigned to ablation group (37 cases undergoing microwave ablation of the liver hemangioma by ultrasonography guided percutaneous approach under local anesthesia or laparoscopic puncture under general anesthesia) and embolization group (33 cases undergoing super-selective embolization of the liver hemangioma with pingyangmycin-lipiodol emulsion). The therapeutic effects between the two treatment methods were compared. Results: Six months after treatment, 9 patients (24.32%) in ablation group had residual blood supply to the lesions, and underwent a second microwave ablation treatment, while 18 patients (54.55%) in embolization group had residual blood supply to the lesions and received a second treatment (13 cases underwent hepatic artery embolization and 5 cases underwent microwave ablation). At follow-up of 12 months after treatment, in ablation group, 31 patients (83.78%) had reduction in tumor size by more than 75%, with complete disappearance of blood supply to the tumor and 6 patients (16.22%) whose reduction of tumor size was less than 75% showed that most of the blood supply to the tumor had disappeared; in embolization group, tumor size in 15 patients was reduced by more than 75%, and blood supply to the tumor had completely disappeared, whereas the 18 patients (54.55%) who underwent the second treatment had less than 75% reduction of tumor size, and most of the blood supply to the tumor had disappeared. The difference between the two groups had statistical significance (P<0.01). Conclusion: Microwave ablation has reliable efficacy for hepatic hemangioma, which is better than hepatic arterial embolization in reducing tumor size and blood supply to the lesion.