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目的利用螺旋CT评价经腹腔镜射频消融(RFA)治疗肝脏海绵状血管瘤(HCH)的效果。方法27例共50个病灶在全麻下行腹腔镜RFA治疗。术前1周内、术后1个月及6个月,分别进行全肝螺旋CT平扫及三期增强扫描,分析其CT表现。结果50个病灶均位于肝脏表面或邻近胆囊等空腔脏器,瘤体直径2.5~11.0cm,平均5.5cm。腹腔镜RFA治疗后1个月,86%(43/50)病灶直径增大,14%(7/50)病灶直径无明显变化。治疗后6个月,所有病灶均缩小,病灶区直径为原病灶直径的60%,病灶周围环状增强均消失。7例较大病灶RFA治疗后出现膈下及右侧胸腔少量积液。未发现肝内胆管扩张、肝段局部萎缩、门静脉血栓形成及肝动脉-门静脉瘘等并发症。结论HCH经腹腔镜RFA治疗后具有特定的CT表现,螺旋CT三期增强扫描可以准确评价腹腔镜RFA治疗后的疗效。
Objective To evaluate the efficacy of laparoscopic radiofrequency ablation (RFA) in the treatment of hepatic cavernous hemangiomas (HCH) using spiral CT. Methods Twenty-seven patients with 50 lesions were treated with laparoscopic RFA under general anesthesia. One week before surgery, 1 month and 6 months after operation, hepatic helical CT scan and three-phase enhanced scan were performed respectively, and their CT findings were analyzed. Results The 50 lesions were located on the surface of the liver or adjacent hollow organs such as the gallbladder. The diameter of the tumor was 2.5-11.0 cm with an average of 5.5 cm. One month after laparoscopic RFA treatment, 86% (43/50) lesion diameters increased, and 14% (7/50) lesion diameters did not change significantly. After 6 months of treatment, all lesions were reduced. The diameter of the lesion area was 60% of the diameter of the original lesion. The ring enhancement around the lesion disappeared. In 7 patients with major lesions, there was a small amount of effusion in the armpit and right thoracic cavity after RFA treatment. No complications such as intrahepatic bile duct dilation, local atrophy of the liver segment, portal vein thrombosis, and hepatic artery-portal fistula were found. Conclusions HCH has specific CT findings after laparoscopic RFA. Three-phase spiral CT scan can accurately evaluate the efficacy of laparoscopic RFA.