腹腔镜加强型射频消融治疗直径》5cm肝血管瘤的临床疗效分析

目的 探讨腹腔镜加强型射频消融术治疗直径〉5 cm肝血管瘤的疗效和技术要点.方法 22例肝血管瘤（直径〉5 cm）应用最新的加强型射频消融电极[StarBurst（R） Xli-enhanced RFA]进行腹腔镜射频治疗,采用腹腔镜超声定位穿刺血管瘤主要供血区域,逐步法张开电极,改变射频电极位置,治疗范围以覆盖整个瘤体及周边0.5～1 cm正常肝组织为标准.结果 22例均安全地完成腹腔镜射频消融术,单个病灶射频消融时间为（81.9±18.5） min,手术时间为（96.5±15.4） min,出血量为（74.7±32.8） ml.术后2例出现明显血红蛋白尿,未发生腹腔出血、胃肠道损伤、膈肌损伤及肝衰竭等并发症.术后1个月螺旋CT增强扫描证实,瘤体完全消融率达95.5%.术后无症状再发,复查B超见病灶明显缩小,血供完全消失,定期复查B超未见血管瘤复发.结论 腹腔镜加强型射频消融术治疗直径〉5 cm肝血管瘤是安全有效的治疗方法,可进一步扩大射频消融术的手术指征.

Clinical application of laparoscopic radiofrequency enhanced ablation therapy in hepatic giant hemangioma with the diameter more than 5 cm

Objective To investigate technical features and efficacy of laparoscopic radiofre- quency enhanced ablation （LREA） therapy for patients with hepatic giant hemangioma with the diame- ter more than 5 erm Methods The operation data of 22 cases of hepatic hemangioma with diameter 5 cm subject to LRFA by using the ultramodern starburst （R） Xli-enhanced RFA were analyzed. The main blood supply area of hepatic hemangioma was located under the guide of intro-operative laparo- scope ultrasound. The radiofrequency ablation treatment zone covered the tumor and normal liver tis- sues 0. 5-1.0 cm away from the margin. RF electrodes were stretched step-by-step and RF electrodes position changed during LREA. Results LREA therapy was performed succegsfully in all patients. The mean RFA time per lesion was （81.9 ＋ 18. 5） rain, the mean total operation time was （96. 5 ＋- 15.4） rain, and the mean total blood loss was （74. 7 ＋ 32. 8） mL. Hemoglobinuria occurred in 2 ca- ses. There were no severe complications such as bleeding, gastrointestinal tract damage, diaphragmat- ic injury and liver function failure after operations. All patients were examined by the contrast-en- hanced helical CT scans one month after the procedures. Tumor ablation complete rate was 95.5 %. B- mode ultrasound re-examination revealed no recurrence. Conclusion LREA therapy is a safe and ef- fective treatment for hepatic giant hemangioma with the diameter more than 5 cm, which extended the indication of the radiofrequency ablation for hepatic hemangioma.