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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。
Objective To investigate the feasibility and efficacy of suture combined with radiofrequency ablation (RFA) in the treatment of giant hepatic cavernous hemangiomas (HCH). Methods From June 2004 to June 2005, 15 patients with 18 HCH lesions were treated with RFA after suturing (suture group) under general anesthesia, and another 15 patients with 17 lesions were treated with RFA Not suture group). Patients showed symptoms of upper abdominal discomfort, pain or bloating. Preoperative ultrasound, spiral CT and MRI examination confirmed the average diameter of the largest tumor 8.8cm ± 1.4cm. Lesions are located on the surface of the liver, caudate lobe or near the hollow cavity of the gallbladder and other organs. 7 cases of chronic atrophic cholecystitis, common bile duct stones in 6 cases, thrombocytopenia in 5 cases, 1 case of posthepatitic cirrhosis. There are 13 cases of middle and upper abdominal surgery history. Results All 30 patients underwent ultrasound-guided open-loop RFA. At the same time due to chronic atrophic cholecystitis cholecystectomy in 7 cases, because of the tumor involving the cystic bed and affect the operation of RFA cholecystectomy in 2 cases, common bile duct exploration of T-tube drainage in 6 cases. The mean intraoperative blood loss in the suture group and the non-suture group was 88.0 ml ± 22.4 ml and 255.0 ml ± 71.7 ml, respectively (P <0.001), and the average RFA treatment time for single lesion was 23 .0 min ± 7.5 min and 53.3 min ± 16.0 min respectively (P <0.001). The maximal diameters of the lesion in six months after operation were reduced by 61.8% and 44.8% (P <0.001) . No serious complications associated with RFA treatment occurred in either group. The patients were followed up for 6-17 months (median 12 months). The complete necrosis rates of both groups were all 100%. Fifteen patients in the suture group had disappeared after surgery. Among the 15 patients without suture group, 12 patients disappeared after operation, and 3 patients relieved their symptoms. Conclusions RFA treatment of huge HCH after suture is safe and feasible, which can reduce the amount of bleeding, shorten the time of RFA treatment and improve the efficacy of RFA. The application of intraoperative ultrasound to improve the therapeutic effect and reduce complications has a certain effect.