Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery.
Department of General Surgery, the Second Hospital affiliated to Harbin Medical University, Harbin 150000, China.
Ann Hepatol. 2018 Mar 1;17(2):268-273. doi: 10.5604/01.3001.0010.8653.
Radiofrequency ablation (RFA) is an effective and minimally invasive technique for the management of hepatic hemangiomas (HHs). This study aims to assess the safety and efficacy of laparoscopic RFA for HHs.
Forty-four patients with 50 hepatic hemangiomas (5-10 cm in diameter) undergoing laparoscopic RFA from January 2012 to May 2015 at three tertiary hospitals in China were retrospectively analyzed.
Thirty-three patients with subcapsular hemangiomas were treated with a laparoscopic approach, and 11 patients with lesions in the liver parenchyma were treated with a combined laparoscopy and an ultrasound-guided percutaneous approach. No conversion to open surgery or two-step surgery occurred during the study period. Patients with small hemangiomas (< 7 cm) required a significantly shorter operating time (71.1 ± 20.18 min vs. 106 ± 23.55 min, p = 0.000) and fewer punctures compared with patients with large hemangiomas (> 7 cm) (4.61 ± 1.09 vs. 6.73 ±1.01, P < 0.05). According to the Dindo-Clavien classification, 15 patients experienced 34 Grade 1 complications, and two had complications of Grade 3a. All complications were resolved by conservative treatment. Forty-three (86.0%) HHs in 38 patients were completely ablated after RFA, and 7 (14.0%) HHs in 6 patients were incompletely ablated. All patients were followed up for 6-24 months (mean 15 ± 6 months).
The data showed that laparoscopic RFA is an effective treatment for small (< 10 cm) HHs. While the incidence of postoperative complications remains high, the majority of complications are minor. Patients undergoing laparoscopic RFA for HHs, even for the small ones, should be carefully selected.
射频消融（RFA）是一种治疗肝血管瘤（HHs）的有效微创技术。本研究旨在评估腹腔镜 RFA 治疗 HHs 的安全性和有效性。
回顾性分析 2012 年 1 月至 2015 年 5 月期间在中国三家三级医院接受腹腔镜 RFA 治疗的 44 例 50 个肝血管瘤（直径 5-10cm）患者的临床资料。
33 例包膜下血管瘤患者采用腹腔镜治疗，11 例肝实质内病变患者采用腹腔镜联合超声引导经皮治疗。研究期间无中转开腹或两阶段手术。小血管瘤（<7cm）患者的手术时间明显缩短（71.1±20.18min 比 106±23.55min，p=0.000），且穿刺次数也较少（4.61±1.09 比 6.73±1.01，P<0.05）。根据 Dindo-Clavien 分级，15 例患者发生 34 例 1 级并发症，2 例患者发生 3a 级并发症。所有并发症均经保守治疗治愈。38 例患者中的 43 个（86.0%）HHs 在 RFA 后完全消融，6 例患者中的 7 个（14.0%）HHs不完全消融。所有患者均随访 6-24 个月（平均 15±6 个月）。
数据显示，腹腔镜 RFA 是治疗小（<10cm）HHs 的有效方法。虽然术后并发症发生率仍然较高，但大多数并发症为轻度。对于接受腹腔镜 RFA 治疗的 HHs 患者，即使是小 HHs，也应仔细选择。
