切换至 "中华医学电子期刊资源库"

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:
引用本文:

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/OL]. 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/OL]. 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。

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.

表1 15例患者的一般情况
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
1
Schnelldorfer T, Ware AL, Smoot R, et al. Management of giant hemangioma of the liver: resection versus observation[J]. J Am Coll Surg, 2010,211(6):724-730.
2
Beatty JS, Mitchell JW, Holsten SB, et al. Traumatic rupture of a previously undiagnosed giant hepatic hemangioma[J]. Am Surg,2013,79(9):e314-e315.
3
Hasan HY, Hinshaw JL, Borman EJ, et al. Assessing normal growth of hepatic hemangiomas during long-term follow-up[J]. JAMA Surg,2014,149(12):1266-1271.
4
Miura JT, Amini A, Schmocker R, et al. Surgical management of hepatic hemangiomas: a multi-institutional experience[J]. HPB (Oxford),2014,16(10):924-928.
5
Zhang W, Huang ZY, Ke CS, et al. Surgical treatment of giant liver hemangioma larger than 10 cm: a single center's experience with 86 patients[J]. Medicine (Baltimore),2015,94(34):e1420.
6
Fan RF, Chai FL, He GX, et al. Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients[J]. Surg Endosc,2006,20(2):281-285.
7
Zhang X, Yan L, Li B, et al. Comparison of laparoscopic radiofrequency ablation versus open resection in the treatment of symptomatic-enlarging hepatic hemangiomas: a prospective study[J]. Surg Endosc,2016,30(2):756-763.
8
Gao J, Ke S, Ding XM, et al. Radiofrequency ablation for large hepatic hemangiomas: initial experience and lessons[J]. Surgery,2013,153:78-85.
9
Park SY, Tak WY, Jung MK, et al. Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation[J]. J Hepatol,2011,54(3):559-565.
10
Gao J, Ding X, Ke S, et al. Radiofrequency ablation in the treatment of large hepatic hemangiomas: a comparison of multitined and internally cooled electrodes[J]. J Clin Gastroenterol,2014,48(6):540-547.
11
Firouznia K, Ghanaati H, Alavian SM, et al. Management of liver hemangioma using trans-catheter arterial embolization[J]. Hepat Mon,2014,14(12):e25788.
12
Sun JH, Nie CH, Zhang YL, et al. Transcatheter arterial embolization alone for giant hepatic hemangioma[J]. PloS One,2015,10(8):e0135158.
13
Akamatsu N, Sugawara Y, Komagome M, et al. Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report[J]. J Med Case Rep,2010,4:283.
14
Lupinacci RM, Szejnfeld D, Farah JF. Spontaneous rupture of a giant hepatic hemangioma. Sequential treatment with preoperative transcatheter arterial embolization and conservative hepatectomy[J]. G Chir,2011,32(11-12):469-472.
15
Gao J, Zhang Q, Zhang J, et al. Radiofrequency ablation of the main lesion of hepatocellular carcinoma and bile duct tumor thrombus as a radical therapeutic alternative: two case reports[J]. Medicine (Baltimore),2015,94(27):e1122.
16
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg,2004,240(2):205-213.
17
Tacher V, Lin M, Duran R, et al. Comparison of existing response criteria in patients with hepatocellular carcinoma treated with transarterial chemoembolization using a 3D quantitative approach[J]. Radiology,2015,278(1):275-284.
18
Gao J, Wang SH, Ding XM, et al. Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment[J]. World J Gastroenterol,2015,21(17):5287-5294.
19
Zhu AX, Abou-Alfa GK. Expanding the treatment options for hepatocellular carcinoma: combining transarterial chemoembolization with radiofrequency ablation[J]. JAMA,2008,299(14):1716-1718.
20
Tanaka M, Ando E, Simose S, et al. Radiofrequency ablation combined with transarterial chemoembolization for intermediate hepatocellular carcinoma[J]. Hepatol Res,2014,44(2):194-200.
21
Zhang L, Yin X, Gan YH, et al. Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria[J]. BMC Gastroenterol,2014,14:11.
[1] 叶美妮, 刘思嘉, 臧玉玮, 刘云建. 肝硬化门静脉血栓形成的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 379-384.
[2] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[3] 杨建波, 马欢, 黄小梅, 刘华柱. 结肠镜辅助下EMR、CSP和RFA术治疗直径<1cm结直肠息肉的疗效和安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 76-79.
[4] 林巧, 周丽. RFA联合LAH术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 521-524.
[5] 皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[6] 臧宇, 姚胜, 朱新勇, 戎世捧, 田智超. 低温等离子射频消融治疗腹壁疝术后补片感染的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 687-692.
[7] 张春玉, 陈海云, 肖忠萍, 罗琴, 潘运昌. 血清NT-proBNP 预测肺栓塞心脏功能障碍的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 805-808.
[8] 罗迎吉星, 隗瑞丽, 王天晓, 黄笳, 徐力, 孙永亮, 杨志英. 开放、腔镜、机器人辅助肝血管瘤剥除术治疗巨大肝血管瘤对比[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 277-283.
[9] 任江波, 李丽, 王萍. 阻断PI3K/Akt信号通路促进低表达FoxA2肝脏前体细胞对分化诱导剂应答并朝肝细胞方向分化[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 336-343.
[10] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[11] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[12] 雷永琪, 刘新阳, 杨黎渝, 铁学宏, 俞星新, 耿志达, 刘雨, 陈政良, 惠鹏, 梁英健. 肝脏血管周上皮样细胞肿瘤合并贫血一例并文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 710-718.
[13] 刘华亭, 张媛, 张登文, 王杰, 袁阳. 介入栓塞联合手术切除治疗头皮动静脉畸形的疗效观察[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 273-278.
[14] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
[15] 于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?