经皮B超引导下微波消融术治疗肝脏巨大血管瘤的可行性、安全性及疗效分析

摘要/Abstract

摘要： 目的评估微波消融治疗肝脏巨大血管瘤(直径≥10 cm)的可行性、安全性和有效性。方法 2013年12月到2016年6月间,12例肝脏巨大血管瘤(≥10 cm)患者共13个肿瘤接受超声引导下经皮穿刺微波消融治疗。观察治疗相关并发症。所有患者均在术后1个月通过磁共振或增强计算机成像(CT)随访,评估消融治疗效果。结果 12例患者中男性4例,女性8例,平均年龄(41±10)岁。除1例同时存在2枚直径≥10 cm的肝血管瘤,其他患者均只有1枚直径≥10 cm。肿瘤最大直径平均(11.7±1.6) cm。13枚巨大血管瘤初始共接受17次微波消融治疗(4例采取有计划2次消融),单枚血管瘤的消融平均时间(39.0±14.4) min。术后2例患者出现急性非少尿型肾功能不全,无腹腔内出血、肝功能衰竭等并发症发生。平均随访时间20.7个月,9例患者10个巨大血管瘤完全坏死,体积显著缩小,一次性完全消融10/13枚。1例术后残留者因生长速度较快,于术后第5个月实施二次微波消融,复查完全坏死,故总体完全消融11/13枚。另外2例因残留体积较小而定期复查,未予任何有创治疗。结论影像引导下微波消融肝脏巨大血管瘤安全、可行,且操作简单、快捷、恢复迅速、损伤轻微,无远期并发症,因而有潜力成为肝脏巨大血管瘤的一线治疗方式。

关键词: 肝血管瘤, 微波消融, 超声, 并发症, 完全消融率

Abstract: Objective To investigate the feasibility, safety and efficacy of microwave ablation (MWA) guided with ultrasound in the treatment of giant hepatic hemangioma (≥ 10 cm in diameter).Methods A total of 13 tumors (≥ 10 cm in diameter) in 12 patients with giant hepatic hemangioma received ultrasound-guided percutaneous MWA in our hospital from December 2013 to June 2016. MWA-related complications were observed. The effcacy of MWA for all patients was assessed using magnetic resonance imaging or enhanced computed tomography within one month after treatment.Results Four male and 8 female patients were enrolled with average age of 41 ± 10 years old (31-65 years old). Besides 1 patient had two hepatic hemangiomas (≥ 10 cm in diameter), the other 11 patients had one hepatic hemangioma (≥ 10 cm in diameter). The average diameter of hemangiomas was 11.7 ± 1.6 cm, ranging from 10 to 14.5 cm. The 13 giant hemangiomas underwent 17 MWA treatments, including 4 received treatment twice. The mean time of single hemangioma ablation was 39.0 ± 14.4 minutes (20-62 minutes). After treatment, 2 patients experienced acute non-oliguric renal dysfunction without other complications, such as intra-abdominal hemorrhage and liver failure. With average follow-up of 20.7 months (5-36 months), 10 giant hemangiomas in 9 patients achieved complete ablation with significant reduction in volume. The primary complete ablation rate was 76.9% (10/13). One patient who failed to the primary treatment received a second MWA treatment 5 months later, and then achieved complete ablation. So the overall complete ablation rate was 84.6% (11/13). Two patients were reviewed regularly without further therapies for small residual tumors.Conclusion Ultrasound-guided percutaneous MWA is a safe, feasible and effective treatment for giant hepatic hemangiomas.

Key words: Hepatic hemangioma, Microwave ablation, Ultrasound, Complication, Complete ablation

戚星星,汤晓寅,王智,王涛,崔丹,翟博. 经皮B超引导下微波消融术治疗肝脏巨大血管瘤的可行性、安全性及疗效分析[J]. 肝脏, 2017, 22(8): 680-684.

QI Xing-xing, TANG Xiao-yin, WANG Zhi, WANG Tao, CUI Dan, ZHAI Bo. Feasibility, safety and efficacy of ultrasound-guided percutaneous microwave ablation for giant hepatic hemangioma[J]. Chinese Hepatolgy, 2017, 22(8): 680-684.

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