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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2015, Vol. 03 ›› Issue (04) : 201 -206. doi: 10.3877/cma.j.issn.2095-5782.2015.04.008

所属专题： 专题评论； 文献；

非血管介入

射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价
宋晶晶1, 赵中伟1, 涂建飞1, 纪建松1,†(), 高君2,†()   
  1. 1. 323000　温州医科大学附属第五医院，丽水市中心医院介入科
    2. 100043　北京，首都医科大学附属北京朝阳医院西区肝胆外科
  • 收稿日期:2015-10-12 出版日期:2015-11-01
  • 通信作者: 纪建松, 高君
  • 基金资助:
    浙江省丽水市科技计划项目(2012JYZB89)

Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas

Jingjing Song1, Zhongwei Zhao1, Jianfei Tu1, Jiansong Ji1,†(), Jun Gao2,†()   

  1. 1. Department of Interventional Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang 323000, China
  • Received:2015-10-12 Published:2015-11-01
  • Corresponding author: Jiansong Ji, Jun Gao
  • About author:
    Corresponding author: Ji Jiansong, Email:
    Gao Jun, Email:
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宋晶晶, 赵中伟, 涂建飞, 纪建松, 高君. 射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价[J]. 中华介入放射学电子杂志, 2015, 03(04): 201-206.

Jingjing Song, Zhongwei Zhao, Jianfei Tu, Jiansong Ji, Jun Gao. Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2015, 03(04): 201-206.

目的

探讨射频消融（RFA）联合肝动脉栓塞（TAE）治疗巨大肝血管瘤（直径≥10 cm）的可行性、安全性及有效性。

方法

收集我院2007年10月—2015年5月期间，经TAE序贯RFA治疗15例患者15个巨大肝血管瘤的临床资料。回顾性分析其一般资料、RFA治疗策略、消融相关并发症、完全消融率、消融灶直径变化及复发情况等。

结果

所有患者均成功完成RFA联合TAE治疗。TAE后血管瘤的平均直径从（13.0±2.2）cm缩小至（7.1±2.0）cm。RFA治疗后，14个血管瘤（93.3%）获得完全消融。RFA治疗后1个月，消融灶平均直径缩小至（6.1±2.0）cm；6个月后缩小至（4.9±1.6）cm。15例患者中，4例患者发生了6个消融相关并发症；根据Dindo–Clavien分级，均属轻微并发症（I级）。

结论

RFA联合TAE治疗巨大肝血管瘤是安全、有效的；TAE可有效阻断血管瘤血供，使瘤体缩小，降低后续RFA治疗的难度，减少消融相关并发症。

关键词: 血管瘤, 肝脏, 巨大, 射频消融, 栓塞
Objective

The purpose of this study was to evaluate the feasibility, safety, and efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation combined with transcatheter arterial embolization (TAE) to treat large (≥ 10 cm) hepatic hemangiomas.

Methods

We retrospectively reviewed our sequential experience with 15 large hepatic hemangiomas in 15 patients.

Results

The mean diameter of the 15 hemangiomas was (13.0±2.2) cm (10.0–16.0 cm). RF ablation combined with TAE treatment was performed successfully in all patients. The mean diameter of the hemangiomas decreased from (13.0±2.2) to (7.1±2.0) cm fter TAE treatment. Out of 15 hepatic hemangiomas, 14 (93.3%) showed no enhancement on CT or MRI indicating complete ablation after RF treatment. The mean diameter of the ablation zone decreased to (6.1±2.0) cm one month after ablation and further decreased to (4.9±1.6) cm six months after ablation. There were six complications related to the ablation in four patients. According to the Dindo–Clavien classification, all the complications were minor (Grade I).

Conclusions

RF ablation combined with TAE is a safe and effective treatment for large hepatic hemangiomas. TAE can improve the disruption of lesion blood supply and reduce lesion size to facilitate subsequent RF ablation and reduce the risk of ablation-related complications.

Key words: Hemangioma, Liver, Large, Radiofrequency Ablation, Embolization
表1 15例患者的一般情况
特征 例（%）
合并症 ?
? 慢性乙型肝炎 2(13.3)
? 糖尿病 1(6.7)
? 肝囊肿 3(20.0)
射频消融的原因 ?
? 腹痛或不适 3(20.0)
? 血管瘤增大 4(26.7)
? 腹痛伴血管瘤增大 8(53.3)
血管瘤的位置 ?
? 肝右叶 8(53.4)
? 肝左叶 2(13.3)
? 肝左、右叶 5(33.3)
图1 患者女性，54岁，CT增强扫描发现肝右叶一直径13.0 cm的血管瘤（A-B图）；DSA引导下将碘油与平阳霉素混合物注入供血动脉（C图）；肝动脉栓塞治疗1个月后，CT显示瘤体明显缩小（D图）；CT引导下行RFA治疗（E图）；RFA治疗1个月后，增强CT显示血管瘤获得完全消融，消融灶明显缩小（F图）；RFA治疗后6个月，消融灶进一步缩小（G图）。
表2 RFA联合TAE治疗15个巨大肝血管瘤的手术参数
参数 数值
碘油用量(ml) 14.3±3.1(10.0～20.0)
TAE治疗后住院时间(d) 2.2±0.9(1～3)
TAE治疗1月后的平均直径(cm) 7.1±2.0(5～10)
消融穿刺次数 5.5±1.1(4～7)
消融时间(min) 59.2±12.0(45～80)
RFA术后住院时间(d) 3.0±1.0(3～5)
RFA术后1月消融灶直径(cm) 6.1±2.0(4～9)
RFA术后6月消融灶直径(cm) 4.9±1.6(3～7)
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