探讨腹腔镜第一肝门阻断在微波消融治疗巨大肝血管瘤中应用的安全性和疗效。

回顾性分析2018年5月至2020年5月在云南省第一人民医院行腹腔镜下超声引导微波消融的20例巨大肝血管瘤患者临床资料。其中男8例，女12例；年龄20~70岁，中位年龄42岁。血管瘤单发5例，多发15例；肿瘤直径10~15 cm。患者均签署知情同意书，符合医学伦理学规定。患者术前进行肝脏三维可视化重建，制定消融方案；术中腹腔镜第一肝门阻断后，采用超声引导下经腹壁穿刺肝血管瘤微波消融；术后复查CT，采用实体瘤疗效评定标准评价消融疗效。

所有患者均顺利完成手术，无中转开腹。患者第一肝门阻断次数的中位数为2（1~3）次，阻断时间24（15~45）min，平均消融时间（26.4±2.7）min，术中出血量（16±6）ml，术后住院时间4（3~7）d。术后血红蛋白尿1例，发热12例，经对症处理后降至正常。无发生出血、胆漏、邻近脏器损伤等严重并发症。术后6个月复查微波消融完全缓解率为70%（14/20），部分缓解率为25%（5/20），总缓解率为95%（19/20）。

对于巨大肝血管瘤微波消融治疗，采用腹腔镜第一肝门阻断以减少血流"热沉降效应"，可获得良好疗效，且具有微创、并发症发生率低的优势。

To evaluate the safety and efficacy of laparoscopic occlusion of the first porta hepatis in the microwave ablation of giant hepatic hemangioma.

Clinical data of 20 patients with giant hepatic hemangioma who underwent laparoscopic ultrasound-guided microwave ablation in the First People's Hospital of Yunnan Province from May 2018 to May 2020 were retrospectively analyzed. Among them, 8 patients were male and 12 female, aged 20-70 years, with a median age of 42 years. 5 patients were diagnosed with single onset of hemangioma, and 15 cases multiple onset. The tumor diameter was measured as 10-15 cm. The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperatively, all patients received D visual reconstruction of the liver to determine the ablation plans. Intraoperatively, laparoscopic occlusion of the first porta hepatis was performed. Ultrasound-guided percutaneous microwave ablation of hepatic hemangioma was performed through abdominal wall. Postoperative CT scan was carried out. The ablation efficacy was evaluated by the Response Evaluation Criteria in Solid Tumor.

All patients successfully completed the surgery. No patient was converted to open surgery. The median number of occlusion of first porta hepatis was 2(1-3). The occlusion time was 24(15-45) min. The average ablation time was (26.4±2.7) min. Intraoperative blood loss was (16±6) ml. The length of postoperative hospital stay was 4(3-7) d. Hemoglobinuria occurred in 1 case and fever in 12 cases after surgery, and they were cured after symptomatic treatments. No severe complications, such as bleeding, bile leakage or adjacent organ injury, were reported. At postoperative 6 months, the complete remission rate of microwave ablation was 70%(14/20), 25%(5/20) for the partial remission rate and 95%(19/20) for the total remission rate.

For microwave ablation in treating giant hepatic hemangioma, laparoscopic occlusion of the first porta hepatis can reduce the heat sink effect produced by blood flow and yield favorable clinical efficacy, which has the advantages of minimal invasiveness and low incidence of complications.