加强型射频消融治疗肝血管瘤的疗效及预后分析
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摘要
目的评估加强型射频消融术治疗肝血管瘤的疗效及预后。方法回顾性分析1999年6月至2012年11月我院经皮射频消融术治疗病灶直径≥5.0 cm的118例肝血管瘤患者的病例资料,根据手术治疗方法分为行常规射频消融术组(A组,n=54)和行加强型射频消融术组(B组,n=64),统计分析两组手术时间、并发症发生率、病灶完全毁损率、住院时间和随访结果(瘤体缩小率及局部复发率)。结果术后A组出现并发症14例(25.93%),B组14例(21.88%),A组与B组并发症差异无统计学意义(P=0.382)。A组中病灶完全毁损41例(75.93%),B组58例(90.63%),两组间差异有统计学意义(P=0.043)。随访结果,A组平均瘤体缩小率为66.95%,B组为83.21%,两组间差异有统计学意义(P<0.001);肝血管瘤局部复发17例(14.41%),其中A组局部复发12例(22.22%),B组5例(7.81%),两组之间差异有统计学意义(P=0.035)。结论加强型射频消融术治疗肝巨大血管瘤可提高病灶毁损率并获得更好的远期疗效,是巨大肝血管瘤患者较好的选择。
Objective To evaluate the curative effect and prognosis of enhanced radiofrequency ablation(ERFA) for hepatic hemangioma(HH).Methods A retrospective study was adopted to analyze the clinical data of 118 cases of HH patients whose diameter of lesions ≥ 5.0 cm and treated with RFA initially from Jun.1999 to Nov.2012 in our hospital.According to the treatment procedure,patients were divided into group A(treated with RFA,n=54) and group B(treated with ERFA,n=64).The operation duration,postoperative complications incidence,rate of completely destroyed of lessons,postoperative hospitalization and results of follow up(including minification and local recurrence) between the two groups were statistically analyzed.Results Postoperative complications occurred in 14(25.93%) cases in the group A and 14(21.88%) cases in group B.There was no statistical difference between the two groups(P=0.382).The lesions of 41(75.93%) cases were completely destroyed in group A,and 58(90.63%) cases in group B.There was statistical difference between the two groups(P=0.043).The average minification of lesions in group A was 66.95% and 83.21% in group B.There was statistical difference between group A and B(P<0.001).Twelve(22.22%) cases were confirmed local recurrence in group A and 5(7.81%) cases in group B.There was statistical difference between group A and B(P=0.035).Conclusion ERFA treatment for giant HH can improve the rate of completely destroy of lesions and achieve better long-term effect than RFA.It is a good choice for giant HH.
Objective To evaluate the curative effect and prognosis of enhanced radiofrequency ablation(ERFA) for hepatic hemangioma(HH).Methods A retrospective study was adopted to analyze the clinical data of 118 cases of HH patients whose diameter of lesions ≥ 5.0 cm and treated with RFA initially from Jun.1999 to Nov.2012 in our hospital.According to the treatment procedure,patients were divided into group A(treated with RFA,n=54) and group B(treated with ERFA,n=64).The operation duration,postoperative complications incidence,rate of completely destroyed of lessons,postoperative hospitalization and results of follow up(including minification and local recurrence) between the two groups were statistically analyzed.Results Postoperative complications occurred in 14(25.93%) cases in the group A and 14(21.88%) cases in group B.There was no statistical difference between the two groups(P=0.382).The lesions of 41(75.93%) cases were completely destroyed in group A,and 58(90.63%) cases in group B.There was statistical difference between the two groups(P=0.043).The average minification of lesions in group A was 66.95% and 83.21% in group B.There was statistical difference between group A and B(P<0.001).Twelve(22.22%) cases were confirmed local recurrence in group A and 5(7.81%) cases in group B.There was statistical difference between group A and B(P=0.035).Conclusion ERFA treatment for giant HH can improve the rate of completely destroy of lesions and achieve better long-term effect than RFA.It is a good choice for giant HH.
引文
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[8]Nam SY,Rhim H,Kang TW,et al.Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm:clinical assessment of the heat-sink effect of artificial ascites[J].AJR Am J Roentgenol,2010,194(2):W227-W231.
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[10]邹华,闫军,吴艳霞,等.加强型射频消融新技术治疗巨大肝血管瘤[J].中华肝脏病杂志,2012,20(4):261-265.
[11]芶欣,黄建钊,孙倩,等.经皮集束射频消融治疗肝血管瘤的近期疗效观察[J].广东医学,2011,32(7):889-890.
[12]van Tilborg AA,Nielsen K,Scheffer HJ,et al.Bipolar radiofrequency ablation for symptomatic giant(>10 cm)hepatic cavernous haemangiomas:Initial clinical experience[J].Clin Radiol,2013,68(1):e9-e14.
[13]夏峰,陈媛媛,马宽生,等.肝血管瘤的多途径射频消融治疗[J].肝胆外科杂志,2009,17(4):274-276.
[14]Li GW,Chen QL,Jiang JI,et a1.The origin of blood supply for cavemous of the liver[J].Hepatobil Pancr Dis Int,2003,2(3):36 7.
[15]王江华,陈先祥,吴黎明,等.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[J].腹部外科,2013,26(5):317-319.
[16]何伏虎.经导管动脉栓塞联合CT导引经皮经肝肿瘤射频消融术治疗肝血管瘤[J].中华普通外科学文献·电子版,2010,4(6):42-44.
[2]Hinshaw JL,Laeseke PJ,Weber SM,et al.Multiple-electrode radiofrequency ablation of symptomatic hepatic cavernous hemangioma[J].AJR Am J Roentgenol 2007,189(3):W146-W1 49.
[3]Karahasanoglu T,Altinli E,Ergüney S,et a1.Laparoscopic enucleation of giant liver hemangioma[J].Surg Endosc,2001,15(12):1489.
[4]Deutsch GS,Yeh KA,Bates WB 3rd,et a1.Embolization for management of hepatic hemangiomas[J].Am Surg,2001,67(2):159-164.
[5]Cui Y,Zhou LY,Dong MK,et al.Ulstrasonography guided percutaneous radiofrequency ablation hepatic cavernous hemangioma[J].World J Gastroenterol,2003,9(9):2132-2134.
[6]Schnelldorfer T,Ware AL,Smoot R,et al.Management of giant hemangioma of the liver:resection versus observation[J].J Am Coll Surg,2010,211(6):724-730.
[7]吴伯文,吴孟超,潘泽亚,等.肝海绵状血管瘤的外科综合治疗[J].中国普通外科杂志,2000,9(1):52-54.
[8]Nam SY,Rhim H,Kang TW,et al.Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm:clinical assessment of the heat-sink effect of artificial ascites[J].AJR Am J Roentgenol,2010,194(2):W227-W231.
[9]吴德全,高峰,王勤运.巨大肝血管瘤的诊断及外科治疗[J].腹部外科,2012,25(3):131-133.
[10]邹华,闫军,吴艳霞,等.加强型射频消融新技术治疗巨大肝血管瘤[J].中华肝脏病杂志,2012,20(4):261-265.
[11]芶欣,黄建钊,孙倩,等.经皮集束射频消融治疗肝血管瘤的近期疗效观察[J].广东医学,2011,32(7):889-890.
[12]van Tilborg AA,Nielsen K,Scheffer HJ,et al.Bipolar radiofrequency ablation for symptomatic giant(>10 cm)hepatic cavernous haemangiomas:Initial clinical experience[J].Clin Radiol,2013,68(1):e9-e14.
[13]夏峰,陈媛媛,马宽生,等.肝血管瘤的多途径射频消融治疗[J].肝胆外科杂志,2009,17(4):274-276.
[14]Li GW,Chen QL,Jiang JI,et a1.The origin of blood supply for cavemous of the liver[J].Hepatobil Pancr Dis Int,2003,2(3):36 7.
[15]王江华,陈先祥,吴黎明,等.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[J].腹部外科,2013,26(5):317-319.
[16]何伏虎.经导管动脉栓塞联合CT导引经皮经肝肿瘤射频消融术治疗肝血管瘤[J].中华普通外科学文献·电子版,2010,4(6):42-44.