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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 333 -338. doi: 10.3877/cma.j.issn.2095-3232.2020.04.009

所属专题： 文献；

临床研究

腹腔镜下超声引导微波消融治疗巨大肝血管瘤疗效分析
陈亚峰1, 杜锡林1,†(), 董瑞1, 鲁建国1, 臧莉1   
  1. 1. 710038　西安，空军军医大学第二附属医院普通外科
  • 收稿日期:2020-03-27 出版日期:2020-08-10
  • 通信作者: 杜锡林
  • 基金资助:
    国家自然科学基金(81172287)

Efficacy of laparoscopic ultrasound-guided microwave ablation for giant hepatic hemangioma

Yafeng Chen1, Xilin Du1,†(), Rui Dong1, Jianguo Lu1, Li Zang1   

  1. 1. Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
  • Received:2020-03-27 Published:2020-08-10
  • Corresponding author: Xilin Du
  • About author:
    Corresponding author: Du Xilin, Email:
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陈亚峰, 杜锡林, 董瑞, 鲁建国, 臧莉. 腹腔镜下超声引导微波消融治疗巨大肝血管瘤疗效分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(04): 333-338.

Yafeng Chen, Xilin Du, Rui Dong, Jianguo Lu, Li Zang. Efficacy of laparoscopic ultrasound-guided microwave ablation for giant hepatic hemangioma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(04): 333-338.

目的

探讨腹腔镜下超声引导微波消融治疗巨大肝血管瘤的疗效。

方法

回顾性分析2016年1月至2018年6月空军军医大学第二附属医院收治的72例巨大肝血管瘤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男32例，女40例；平均年龄（50±13）岁。根据不同手术方式将患者分为腹腔镜下超声引导微波消融组（微波组，36例）和腹腔镜肝血管瘤切除组（切除组，36例）。比较两组围手术期情况和并发症发生情况，并评价手术疗效。年龄、血管瘤最大径等计量资料比较采用t检验。并发症发生率、治疗缓解率等比较采用χ2检验或Fisher确切概率法。

结果

微波组手术时间、术后引流管拔除时间、术后住院时间分别为（76±25）min、（3.2±0.8）d、（4.7±0.9）d，明显少于切除组的（138±27）min、（4.5±1.0）d、（6.0±1.1）d、（t=-6.494，-3.045，-3.262；P<0.05）。术后3 d，微波组ALB为（36.1±1.7）g/L，明显高于切除组的（34.7±1.6）g/L（t=2.852，P<0.05）。微波组PT为（11.5±1.1）s，明显低于切除组的（12.9±1.8）s（t=-2.522，P<0.05）。微波组术后腹腔出血、胆漏、血红蛋白尿分别为0、0、5例，切除组相应为4、4、0例，差异有统计学意义（P<0.05）。术后12个月微波组总体缓解率为89%（32/36），切除组为81%（29/36），差异无统计学意义（χ2=0.966，P>0.05）。

结论

腹腔镜下超声引导微波消融治疗巨大肝血管瘤疗效显著，且具有安全、微创优势。

关键词: 腹腔镜, 超声检查，介入性, 导管消融术, 血管瘤, 肝切除术
Objective

To explore the efficacy of laparoscopic ultrasound-guided microwave ablation in the treatment of giant hepatic hemangioma.

Methods

Clinical data of 72 patients with giant hepatic hemangioma who admitted in the Second Affiliated Hospital of Air Force Medical University from January 2016 to June 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 32 patients were male and 40 female, with a mean age of (50±13) years old. Patients were assigned to laparoscopic ultrasound-guided microwave ablation group (microwave group, n=36) and laparoscopic resection of hepatic hemangioma group (resection group, n=36) according to different operations. The perioperative situation and complications between two groups were compared and the efficacy was evaluated. Measurement data such as age and maximum diameter of hemangioma were compared using t test. Incidence of complication, remission rates, etc. were compared using Chi-square test or Fisher's exact probability.

Results

The duration of operation, time to postoperative drainage tube extraction, and length of postoperative hospital stay in microwave group were (76±25) min, (3.2±0.8) d, and (4.7±0.9) d, respectively, significantly lower than (138±27) min, (4.5±1.0) d, and (6.0±1.1) d in resection group (t=-6.494, -3.045, -3.262; P<0.05). At postoperative 3 d, ALB in microwave group was (36.1±1.7) g/L, which was significantly higher than (34.7±1.6) g/L in resection group (t=2.852, P<0.05). The prothrombin time in microwave group was (11.5±1.1) s, which was significantly lower than (12.9±1.8) s in resection group (t=-2.522, P<0.05). In microwave group, no intra-abdominal hemorrhage, no bile leakage and 5 cases of hemoglobinuria were observed, and in resection group, it was accordingly 4, 4, 0 cases, where significant differences were observed (P<0.05). The overall remission rate at 12 months postoperatively was 89% (32/36) in microwave group and 81% (29/36) in resection group, which did not significantly differed between two groups (χ2=0.966, P>0.05).

Conclusions

Laparoscopic ultrasound-guided microwave ablation exert significant effect for giant hepatic hemangioma with advantages of safety and minimal invasion.

Key words: Laparoscopes, Ultrasonography, interventional, Catheter ablation, Hemangioma, Hepatectomy
表1 微波组和切除组巨大肝血管瘤患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s ） BMI （kg/m2，±s ） 血管瘤最大径（cm，±s ） 肝功能Child-Pugh分级（例） ICGR15[M （QR）]
男 女 A级 B级
微波组 36 13 23 51±15 21.8±2.7 12.5±1.6 28 8 0.06(0.01, 0.25)
切除组 36 16 20 48±12 20.9±1.8 11.7±1.2 32 4 0.05(0.01, 0.16)
统计值 ? χ2=0.520 t=0.740 t=1.711 t=1.333 χ2=0.600 Z=1.604
P值 ? 0. 471 0.475 0.109 0.209 0.206 0.109
表2 微波组和切除组巨大肝血管瘤患者围手术期指标比较
组别 手术时间（min，±s ） 术中出血量[ml，M（QR）] 术中输血量[ml，M（QR）] 术后恢复进食时间（d，±s ） 术后引流管拔除时间（d，±s ） 术后住院时间（d，±s ）
微波组 76±25 070（30，250） 000（0，0） 2.1±0.6 3.2±0.8 4.7±0.9
切除组 138±27 450（100, 1 000） 200（0, 600） 3.0±0.8 4.5±1.0 6.0±1.1
统计值 t=-6.494 Z=-3.297 Z=-2.692 t=-3.210 t=-3.045 t=-3.262
P值 0.000 0.001 0.007 0.009 0.011 0.006
表3 术后第3天微波组和切除组巨大肝血管瘤患者肝功能比较
组别 ALB（g/L，±s ） ALT[U/L，M（QR）] TB（μmol/L，±s ） PT（s，±s ）
微波组 36.1±1.7 125（52, 312） 35±10 11.5±1.1
切除组 34.7±1.6 140（78, 440） 38±12 12.9±1.8
统计值 t=2.852 Z=-1.015 t=-1.704 t=-2.522
P值 0.017 0.310 0.110 0.030
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