超声引导下热消融术与腹腔镜手术治疗肝脏局灶性结节性增生的回顾性对照研究

Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study.

作者信息

Zhang Dan-Ling, Chen Sheng, Lin Yu-Cheng, Ye Wenxin, Li Kai, Wu Song-Song

机构信息

Department of Ultrasonography, Fuzhou No.7 Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China.

Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China.

出版信息

Front Oncol. 2022 Aug 4;12:932889. doi: 10.3389/fonc.2022.932889. eCollection 2022.

Abstract

PURPOSE

This study aims to evaluate the value of the clinical application of ultrasound-guided percutaneous thermal ablation in focal nodular hyperplasia (FNH) by comparing its safety, effectiveness, and patient experience to surgery in the treatment of hepatic FNH ≤5 cm.

METHOD

This retrospective study enrolled 82 patients with hepatic FNH having a maximum diameter of ≤5 cm, confirmed by postoperative pathologic diagnosis or needle biopsy, who underwent thermal ablation or surgery between January 2019 and September 2021. Postoperative efficacy, surgical trauma (operation time, intraoperative bleeding volume, liver function, and lost volume of normal liver tissue), postoperative complications (postoperative infection, pleural effusion, and liver dysfunction), patient experience (degree and time of postoperative pain, postoperative fasting time, indwelling thoracic chest drain, and scar size), and economic indices (postoperative hospitalization and total charges) were compared between both groups.

RESULT

No significant difference existed in postoperative efficacy between both groups ( > 0.05). No recurrent or new lesions were observed during the 6-month follow-up in both groups. However, significant differences were observed in operation time, intraoperative bleeding volume, and lost volume of normal liver tissue ( < 0.05), with significantly less trauma in the thermal ablation group. No statistically significant differences in ALT, AST, and Hb existed between both groups ( > 0.05); however, albumin was higher in the ablation group compared to the surgery group (38.21 ± 3.32 vs. 34.84 ± 3.71 g/L, < 0.05), and WBC were lower in the ablation group (11.91 ± 3.37 vs. 13.94 ± 3.65/L, < 0.05). The incidence of postoperative complications in the ablation group was significantly lower than that in the surgery group ( < 0.05). Patient experiences were significantly better than in the surgical group ( < 0.05), with economic indicators being significantly less in the ablation group ( < 0.05).

CONCLUSION

Ultrasound-guided percutaneous thermal ablation can treat hepatic FNH ≤5 cm with similar clinical efficacy as surgery and is an economical, safe, and minimally invasive treatment method worthy of recommendation.

摘要

目的

本研究旨在通过比较超声引导下经皮热消融术与手术治疗直径≤5 cm的肝脏局灶性结节性增生(FNH)的安全性、有效性及患者体验,评估其临床应用价值。

方法

本回顾性研究纳入了82例最大直径≤5 cm的肝脏FNH患者,经术后病理诊断或穿刺活检确诊,于2019年1月至2021年9月期间接受热消融或手术治疗。比较两组患者的术后疗效、手术创伤(手术时间、术中出血量、肝功能及正常肝组织损失量)、术后并发症(术后感染、胸腔积液及肝功能障碍)、患者体验(术后疼痛程度及时间、术后禁食时间、胸腔闭式引流、瘢痕大小)及经济指标(术后住院时间及总费用)。

结果

两组术后疗效无显著差异(>0.05)。两组在6个月随访期间均未观察到复发或新发病变。然而,手术时间、术中出血量及正常肝组织损失量存在显著差异(<0.05),热消融组创伤明显更小。两组间谷丙转氨酶(ALT)、谷草转氨酶(AST)及血红蛋白(Hb)无统计学显著差异(>0.05);然而,消融组白蛋白水平高于手术组(38.21±3.32 vs. 34.84±3.71 g/L,<0.05),消融组白细胞计数更低(11.91±3.37 vs. 13.94±3.65/L,<0.05)。消融组术后并发症发生率显著低于手术组(<0.05)。患者体验明显优于手术组(<0.05),消融组经济指标显著更低(<0.05)。

结论

超声引导下经皮热消融术治疗直径≤5 cm的肝脏FNH具有与手术相似的临床疗效,是一种经济、安全且微创的治疗方法,值得推荐。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af22/9386309/d2c4d904d3d0/fonc-12-932889-g001.jpg

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