缝扎术联合射频消融术治疗巨大肝脏海绵状血管瘤的临床观察

目的探讨缝扎术联合射频消融术(RFA)治疗巨大肝脏海绵状血管瘤(HCH)的可行性及疗效。方法2004年6月至2005年6月,15例共18个HCH病灶在全麻下行瘤体缝扎术后RFA治疗(缝扎组),另15例共17个病灶未缝扎行RFA治疗(未缝扎组)。患者均表现为上腹部不适、疼痛或腹胀等症状。术前经超声、螺旋CT及MRI检查获得确诊,平均瘤体最大直径8.8cm±1．4cm。病灶均位于肝脏表面、尾状叶或临近胆囊等空腔脏器。合并慢性萎缩性胆囊炎7例,胆总管结石6例,血小板减少5例,肝炎后肝硬化1例。有中上腹部手术史13例。结果30例均在超声引导下成功实施开腹RFA治疗。同时因慢性萎缩性胆囊炎行胆囊切除术7例,因瘤体累及胆囊床并影响RFA操作行胆囊切除术2例,胆总管探查T管引流术6例。缝扎组及未缝扎组平均术中出血量分别为88．0ml±22．4 ml及255．0 ml±71．7 ml(P<0．001),单个病灶平均RFA治疗时间分别为23．0 min±7．5 min及53．3 min±16．0 min(P<0．001),术后半年病灶最大直径分别缩小61．8％及44．8％(P<0．001)。两组均未出现与RFA治疗相关的严重并发症。术后随访6-17个月(中位12个月),两组病灶完全坏死率均达100％。缝扎组15例术后症状均消失;未缝扎组15例中,12例术后症状消失,3例症状明显缓解。结论缝扎术后RFA治疗巨大HCH安全可行,可减少出血量,缩短RFA治疗时间,提高RFA疗效。术中超声的应用对提高治疗效果及减少并发症具有一定的作用。

Radiofrequency ablation therapy combined with suture and ligation surgery for patients with giant cavernous hemangiomas of the liver

OBJECTIVE: To evaluate the feasibility and efficacy of radiofrequency ablation (RFA) therapy combined with suture and ligation surgery for patients with giant hepatic cavernous hemangioma (HCH). METHODS: Between June 2004 and June 2005, a total of 30 patients were treated by RFA therapy after suture and ligation surgery (SL group, n = 15, with 18 liver lesions) or RFA therapy without suture and ligation surgery (non-SL group, n = 15, with 17 liver lesions) under general anesthesia. All patients had obvious symptoms such as abdominal discomfort, pain and swelling. Preoperative diagnosis of HCH was established by means of ultrasonography, helical computed tomography (CT) scans, and magnetic resonance imaging (MRI). The mean maximum diameter of the lesions was 8.8 cm +/- 1.4 cm. All of the 35 lesions were located on the liver surface, in the caudate lobe of the liver, or adjacent to the gallbladder. Seven patients had chronic calculous cholecystitis, 6 common duct stones, 5 thrombocytopenias, and one posthepatitic cirrhosis. Thirteen of the 30 patients had previous laparotomy. Therapeutic efficacy and clinical data of RFA therapy were compared between these two groups. RESULTS: RFA therapy under ultrasound guidance was performed successfully in all the patients. Cholecystectomy was performed simultaneously for gallstones in 7 patients and for abutting of gallbladder from hemangioma in 2 patients. Choledochotomy with T-tube drainage was performed in 6 patients. The mean blood loss, the mean RFA time per lesion and reduction rate of maximum diameter of the lesions 6 months after RFA in the SL group and non-SL group were 88.0 ml +/- 22.4 ml vs. 255.0 ml +/- 71.7 ml (P < 0.001), 23.0 min +/- 7.5 min vs. 53.3 min +/- 16.0 min (P < 0.001), and 61.8% vs. 44.8% (P < 0.001) respectively. No severe complication related to RFA was observed in all patients. At a median follow-up of 12 months (6 approximately 17 months), a complete lesion necrosis was achieved on the contrast-enhanced helical CT scans in both groups. During the follow-up, all of the 15 patients were free of upper abdominal pain in the SL group, and 12 patients were symptom-free and 3 obtained significant amelioration of symptoms in the non-SL group. CONCLUSION: RFA therapy combined with suture and ligation surgery is a feasible, safe, and effective treatment modality for patients with giant HCHs. It can reduce blood loss, shorten RFA therapy time, and increase therapeutic efficacy of RFA. Intraoperative ultrasonography is a useful adjunct for increasing the therapeutic efficacy of RFA and reducing the complications related to RFA.