摘要
目的探讨肝脏海绵状血管瘤（hepatic cavernous hemangioma，HCH）合并肝硬化病人行腹腔镜射频消融（radiofrequency ablation，RFA）治疗的可行性、安全性及疗效。方法2001年3月～2005年8月，15例HCH合并肝硬化病人在全麻下进行腹腔镜RFA治疗。男6例，女9例，年龄（46．2±7．0）岁。均有上腹部不适、疼痛或腹胀。乙型肝炎13例，丙型肝炎2例。肝功能Child A级10例，Child B级5例。术前经超声、螺旋CT或MRI等检查共发现病灶20个，肿瘤直径（7．2±1．4）cm。病灶均位于肝脏表面或临近胆囊等空腔脏器。血小板计数（31．2±10．4）×10^9／L。合并慢性结石性胆囊炎3例，糖尿病2例。术中行腹腔镜超声检查及病理活检。结果15例均顺利完成腹腔镜RFA治疗，同时行胆囊切除术3例。单个病灶射频治疗时间（68．8±34．0）min，总手术时间（120．0±28．0）min。未出现腹腔出血、胃肠道损伤、膈肌损伤、胆漏及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实，肿瘤完全坏死率达100％（20／20）。随访5～31个月，中位15个月，13例症状完全消失，2例症状明显改善。结论HCH合并肝硬化病人行腹腔镜RFA治疗安全可行，治疗效果肯定，并有效避免了并发症的发生。
Objective To evaluate the feasibility, safety, and efficacy of laparoscopic radiofrequency ablation （RFA） for the treatment of hepatic cavernous hemangioma （HCH） in patients with liver cirrhosis. Methods A total of 15 patients with HCH and liver cirrhosis received laparoscopic RFA under general anesthesia between March 2001 and August 2005. There were 6 men and 9 women, with a mean age of 46.2 ± 7.0 years. All the patients had complained of obvious symptoms of abdominal discomfort, pain, or fullness. The etiologic factor of liver cirrhosis was hepatitis B in 13 patients and hepatitis C in 2 patients. The Child classification revealed grade A in 10 patients and grade B in 5 patients. A total of 20 liver lesions located on the surface of the liver or adjacent to the gallbladder, with a mean diameter of 7.2 ± 1.4 cm, were identified preoperatively in the 15 patients by uhrasonography, helical CT scans, or MRI. The platelet count was （31.2 ± 10.4） ×10^9/L. Co-morbidities included chronic calculous cholecystitis in 3 patients and diabetes mellitus in 2 patients. Laparoscopic ultrasonography and liver biopsy were routinely performed during the operation. Results Laparoscopic RFA was successfully performed in all the 15 patients and laparoscopic cholecystectomy was conducted simultaneously in 3 patients. The ablation time per lesion was 68.8 ± 34.0 min, and the total operative time was 120.0 ± 28.0 min. No severe complications, such as intraperitoneal hemorrhage, gastrointestinal injury, diaphragmatic injury, bile leakage, and liver function failure, developed during and after the operation. Complete tumor necrosis was achieved in all the 20 lesions （ 100% , 20/20） on contrast-enhanced helical CT scans 1 month after the treatment. During a follow-up period of 5 -31 months, symptoms completely disappeared in 13 patients and significantly subsided in 2 patients. Conclusions Laparoscopic radiofrequency ablation is a feasible, safe, and effective treatment for hepatic cavernous hemangioma complicating liver cirrhosis.
出处
《中国微创外科杂志》
CSCD
2006年第8期575-577,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
肝脏
海绵状血管瘤
肝硬化
射频消融
腹腔镜技术
Liver
Cavernous hemangioma
Liver cirrhosis
Radiofrequency ablation
Laparoscopic technique
