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目的探讨腹腔镜下射频消融(laparoscopic radiofrequency ablation therapy,LRFA)治疗特殊部位肝海绵状血管瘤(hepatic cavernous hemangioma,HCH)的可行性及其治疗效果。方法2010年1月~2013年1月,我院普通外科采用腹腔镜下射频消融术治疗特殊部位肝血管瘤11例共18个瘤体,其中3个瘤体1例,2个瘤体5例,1个瘤体5例;瘤体直径2~9cm;位于肝右叶12个(Ⅶ-Ⅷ段3个、Ⅴ-Ⅵ段9个),肝左叶6个;完全裸露于肝膈面5例,肝脏面4例分别邻近胆囊、结肠、胃等空腔脏器。射频消融治疗仪为美国AngiDynamics公司生产的RITA射频消融治疗系统1500X型射频发生器,针芯具有实时测温和注水灌注功能。结果 11例均在腹腔镜引导下顺利完成射频消融治疗,手术时间50~130min,单次射频消融时间5~12min,术中出血约50~100ml,无术后出血、胆漏、腹膜炎、膈肌损伤等并发症发生。11例术后病理组织学证实为HCH。结论对于特殊部位的肝海绵状血管瘤,腹腔镜下射频消融术治疗安全可行、疗效肯定,弥补了经皮肝穿刺射频治疗技术的不足,可有效提高射频消融治疗效果,拓展了其适应证范围,避免和减少了并发症的发生。
Objective To investigate the feasibility and efficacy of laparoscopic radiofrequency ablation therapy (LRFA) for the treatment of hepatic cavernous hemangioma (HCH). Methods From January 2010 to January 2013, 18 patients with hepatic hemangiomas at special sites were treated with laparoscopic radiofrequency ablation in our department of general surgery from January 2010 to January 2013. One of three tumors and five of two tumors , A tumor in 5 cases; tumor diameter of 2 ~ 9cm; located in the right lobe of 12 (Ⅶ-Ⅷ section 3, Ⅴ-Ⅵ section 9), left liver lobe 6; completely exposed in the liver diaphragm surface 5 For example, 4 cases of liver surface were adjacent to the gallbladder, colon, stomach and other hollow organs. Radiofrequency ablation therapy instrument for the United States AngiDynamics RITA radiofrequency ablation treatment system 1500X RF generator, needle core with real-time temperature and water injection perfusion. Results All the 11 cases underwent laparoscopic radiofrequency catheter ablation. The operation time was 50-130 minutes, the time of radiofrequency ablation was 5-12 minutes, and the intraoperative bleeding was about 50-100 ml. There was no postoperative bleeding, bile leakage, peritonitis, diaphragmatic injury Other complications occur. Histopathology was confirmed by histopathology in 11 cases. Conclusions Laparoscopic radiofrequency catheter ablation is a safe and feasible method for the treatment of hepatic cavernous hemangioma at a specific site, which has made up for the lack of percutaneous transhepatic radiofrequency ablation, which can effectively improve the radiofrequency ablation treatment and expand the range of indications , To avoid and reduce the incidence of complications.