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目的比较分析腹腔镜射频消融(RFA)与外科切除治疗巨大肝脏海绵状血管瘤(HCH)的疗效、并发症及各临床参数。方法2001年3月至2005年2月,31例病人共39个HCH病灶在全麻下进行了腹腔镜RFA治疗或外科切除术。男7例,女24例,平均年龄(47．7±8．6)岁。病人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,平均最大肿瘤直径(9．6±1．4)cm。结果17例HCH成功实施了腹腔镜RFA治疗,14例进行了外科切除术。腹腔镜RFA组及外科切除组的平均出血量分别为(192．4±85．0)ml及(714．3±276．3)ml(P< 0．01),平均手术时间为(107．5±34．4)min及(115．4±23．7)min(P>0．05),平均术后住院日为(4．9±1．2)d及(11．6±3．0)d(P<0．01)。腹腔镜RFA组均未输血,外科切除组中10例输血。腹腔镜治疗组中,2例出现一过性血红蛋白尿;外科切除组中,1例出现术后腹腔渗血,另1例肺部感染。所有病例术后均出现血清转氨酶(ALT及AST)一过性升高。随访6～35个月(中位21个月),腹腔镜RFA治疗组病灶完全坏死率达100％,外科切除组均未见残留病灶。腹腔镜RFA治疗组中,15例症状完全消失,2例症状明显改善;外科切除组中,13例无症状,1例右上腹轻度不适。结论外科切除仍然是巨大HCH最有效的治疗方法。腹腔镜RFA治疗巨大HCH具有微创、避免输血、缩短住院日等优点,治疗效果肯定,适用于病灶位于肝脏表面或临近胆囊等空腔脏器的病人,术中超声的应用可有效避免相关并发症的发生。
Objective To compare and analyze the efficacy, complications and clinical parameters of laparoscopic radiofrequency ablation (RFA) and surgical excision for the treatment of giant hepatic cavernous hemangiomas (HCH). Methods From March 2001 to February 2005, a total of 39 HCH lesions of 31 patients underwent laparoscopic RFA or surgical resection under general anesthesia. There were 7 males and 24 females with an average age of 47.7 ± 8.6 years. Patients were manifested as upper abdominal discomfort, pain or bloating and other symptoms. Preoperative diagnosis by ultrasound, spiral CT and MRI examination, the average maximum tumor diameter (9.6 ± 1.4) cm. Results 17 cases of HCH successfully implemented laparoscopic RFA treatment, 14 cases of surgical resection. The average amount of bleeding in laparoscopic RFA group and surgical resection group was (192.4 ± 85.0) ml and (714.3 ± 276.3) ml respectively (P <0.01), and the average operation time was (107 ±). 5 ± 34.4) min and (115.4 ± 23.7) min respectively (P> 0.05). The average postoperative hospital stay was (4.9 ± 1.2) d and (11.6 ± 3) days, respectively. 0) d (P <0.01). No transfusion was performed in the laparoscopic RFA group, and 10 transfusions were performed in the surgical resection group. Laparoscopic treatment group, 2 cases of transient hemoglobinuria; surgical resection group, 1 case of postoperative peritoneal bleeding, another case of pulmonary infection. Serum transaminases (ALT and AST) were transiently elevated in all cases. All cases were followed up for 6 to 35 months (median 21 months). The complete necrosis rate of the lesions in the laparoscopic RFA group was 100%. No residual lesions were seen in the surgical resection group. Laparoscopic RFA treatment group, 15 cases of symptoms disappeared completely, 2 cases of symptoms improved significantly; surgical resection group, 13 cases were asymptomatic, 1 case of right upper quadrant mild discomfort. Conclusions Surgical resection remains the most effective treatment for large HCHs. Laparoscopic RFA treatment of huge HCH has the advantages of minimally invasive, to avoid transfusions, shorten the hospital stay, etc., the treatment effect is affirmative, apply to the lesions located in the liver or near the gallbladder and other hollow organs of the patient, the application of intraoperative ultrasound can effectively avoid the related complications Occurrence of the disease.