Gao Jun, Kong Jian, Ding Xue-Mei, Ke Shan, Niu Hai-Gang, Xin Zong-Hai, Ning Chun-Min, Guo Shi-Gang, Li Xiao-Long, Zhang Long, Dong Yong-Hong, Sun Wen-Bing
Jun Gao, Jian Kong, Xue-Mei Ding, Shan Ke, Wen-Bing Sun, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China.
World J Gastroenterol. 2015 May 21;21(19):5941-9. doi: 10.3748/wjg.v21.i19.5941.
To compare safety and therapeutic efficacy of laparoscopic radiofrequency (RF) ablation vs computed tomography (CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.
We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma. Altogether, 24 hemangiomas were ablated via a CT-guided percutaneous approach (CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach (laparoscopic ablation group).
The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm (range, 6.0-12.0 cm). There was no difference in the diameter of hemangiomas between the two groups (P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups (P > 0.05). There were 23 thoracic complications in 17 patients: 15 (62.5%, 15/24) in the CT-guided ablation group and 2 (7.4%, 2/27) in the laparoscopic ablation group (P < 0.05). According to the Dindo-Clavien classification, two complications (pleural effusion and diaphragmatic rupture grade III) were major in two patients. All others were minor (grade I). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7% (22/24) and 96.3% (26/27) in the CT-guided and the laparoscopic ablation groups, respectively (P > 0.05).
Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm. It avoids thermal injury to the diaphragm and reduces thoracic complications.
比较腹腔镜射频消融术与计算机断层扫描（CT）引导下射频消融术治疗贴近膈肌的大型肝血管瘤的安全性和治疗效果。
我们回顾性分析了51例因出现症状和/或血管瘤增大而接受CT引导或腹腔镜射频消融术治疗的贴近膈肌的大型肝血管瘤患者的连续治疗经验。其中，24例血管瘤通过CT引导下经皮穿刺方法进行消融（CT引导消融组），27例血管瘤通过腹腔镜方法进行治疗（腹腔镜消融组）。
51例血管瘤的平均直径为9.6±1.8cm（范围6.0 - 12.0cm）。两组血管瘤直径无差异（P>0.05）。所有患者均成功进行了射频消融。两组间消融时间无差异（P>0.05）。17例患者出现23例胸部并发症：CT引导消融组15例（62.5%，15/24），腹腔镜消融组2例（7.4%，2/27）（P<0.05）。根据Dindo-Clavien分类，2例患者出现2例严重并发症（胸腔积液和III级膈肌破裂）。其他均为轻微并发症（I级）。2例严重并发症均发生在CT引导消融组。轻微并发症通过保守措施成功治疗，2例严重并发症分别接受胸腔闭式引流和胸腔镜手术治疗。CT引导消融组和腹腔镜消融组的完全消融率分别为91.7%（22/24）和96.3%（26/27）（P>0.05）。
腹腔镜射频消融治疗应作为贴近膈肌的大型肝血管瘤的一线治疗选择。它可避免对膈肌的热损伤并减少胸部并发症。
