Gao Jun, Ding Xuemei, Ke Shan, Xin Zonghai, Ning Chunmin, Sha Qi, Sun Wenbing
*Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing †Department of General Surgery, Zhanhua People's Hospital §Department of Gastroenterology, Dezhou People's Hospital, Shandong ‡Department of General Surgery, Chaoyang Central Hospital, Liaoning, China.
J Clin Gastroenterol. 2014 Jul;48(6):540-7. doi: 10.1097/MCG.0b013e31829ef037.
Radiofrequency (RF) ablation is an accepted nonsurgical treatment of hepatic hemangiomas, but with an appreciable complication rate. Our study aimed to assess the safety and efficacy of RF ablation, administered with either multitined expandable electrodes or with internally cooled cluster electrodes, in the treatment of large (≥10 cm diameter) hepatic hemangiomas.
We retrospectively reviewed our sequential experience of treating 43 large hepatic hemangiomas in 42 patients with RF ablation/multitined expandable electrodes or with RF ablation/internally cooled electrodes. Twenty-two hemangiomas in 21 patients were treated with expandable electrode (multitined electrode group), and 21 hemangiomas in 21 patients were treated with internally cooled cluster electrode (internally cooled electrode group).
Among the 43 large hepatic hemangiomas, 27 subcapsular lesions were treated by a laparoscopic approach, and 16 lesions located in liver parenchyma were treated by a computed tomography-guided percutaneous approach. In the multitined electrode group, RF ablation treatment was performed in all 21 patients in 1 session. In the internally cooled electrode group, 18 patients were treated by RF ablation in 1 session, and 3 patients, with ≥14.0-cm single hemangioma, were treated with RF ablation in 2 sessions. Complete ablation was achieved in 81.8% (18/22) and 90.5% (19/21) in the multitined electrode group and the internally cooled electrode group, respectively (P>0.05). Ablation time for single hemangioma was shorter with the internally cooled electrode than with the multitined electrode (P<0.05). There were 79 complications related to ablation (2 major and 77 minor) in 31 patients. All 21 patients in the multitined electrode group experienced complications, compared with 10 of 21 patients (47.6%) in the internally cooled electrode group (P<0.05). Both of the 2 major complications occurred in the multitined electrode group. All the complications were treated successfully with conservative measures.
RF ablation is a safe and effective treatment for large hepatic hemangiomas. Use of the internally cooled cluster electrodes and a more defensive treatment algorithm can reduce the complications.
射频（RF）消融是一种公认的肝血管瘤非手术治疗方法，但并发症发生率较高。我们的研究旨在评估使用多针可扩张电极或内部冷却集束电极进行射频消融治疗直径≥10 cm的大型肝血管瘤的安全性和有效性。
我们回顾性分析了42例患者中43个大型肝血管瘤的连续治疗经验，这些患者分别接受了射频消融/多针可扩张电极或射频消融/内部冷却电极治疗。21例患者中的22个血管瘤接受了可扩张电极治疗（多针电极组），21例患者中的21个血管瘤接受了内部冷却集束电极治疗（内部冷却电极组）。
在43个大型肝血管瘤中，27个包膜下病变采用腹腔镜方法治疗，16个位于肝实质内的病变采用计算机断层扫描引导下的经皮方法治疗。在多针电极组中，所有21例患者均进行了1次射频消融治疗。在内部冷却电极组中，18例患者进行了1次射频消融治疗，3例直径≥14.0 cm的单个血管瘤患者进行了2次射频消融治疗。多针电极组和内部冷却电极组的完全消融率分别为81.8%（18/22）和90.5%（19/21）（P>0.05）。单个血管瘤的消融时间内部冷却电极组比多针电极组短（P<0.05）。31例患者发生了79例与消融相关的并发症（2例严重，77例轻微）。多针电极组的所有21例患者均出现并发症，而内部冷却电极组的21例患者中有10例（47.6%）出现并发症（P<0.05）。2例严重并发症均发生在多针电极组。所有并发症均通过保守措施成功治疗。
射频消融是治疗大型肝血管瘤的一种安全有效的方法。使用内部冷却集束电极和更具防御性的治疗方案可减少并发症。
