目的 探讨肝血管瘤不同治疗方式的临床疗效,提出肝血管瘤临床评分并评价其应用价值.方法 回顾性分析2002年1月至2013年12月新疆医科大学第一附属医院收治的514例肝血管瘤患者的临床资料.患者分别施行手术切除、肝动脉栓塞术(TAE)、RFA治疗或随访观察,观察其治疗情况,手术时间,术后1周ALT水平,术后住院时间,术后并发症等,评价其临床疗效.根据患者临床症状、肿瘤直径、位置、肿瘤直径增长速度4项相关因素,提出肝血管瘤临床评分:分值≥4分者可考虑行手术治疗,对不宜或不愿行手术切除者,可考虑TAE或随访观察;分值＜4分且未合并危险因素者可随访观察,合并者视患者个体情况选择个性化随访、再评估后手术切除、TAE或RFA.采用门诊及电话随访.随访时间截至2014年6月.结果 (1)治疗情况:①手术疗效,380例患者肿瘤完整切除.195例患者症状缓解,17例患者症状缓解不明显,手术时间为(175±15) min,术后1周ALT为(139±14) U/L,术后住院时间为(11.5±1.4)d,术后发生并发症58例.②TAE疗效,37例患者行TAE,术后CT检查示1例患者瘤体未见强化;36例瘤体部分强化,体积缩小25％ ～ 90％.13例患者症状缓解,10例患者症状缓解不明显,手术时间为(67 ± 13) min,术后1周ALT为(64±13) U/L,术后住院时间为(6.8±0.7)d,术后发生并发症2例.③RFA疗效,16例患者行RFA,术后CT检查示2例患者瘤体未见强化;14例瘤体部分强化,体积缩小29％～72％.3例患者症状缓解,1例患者未缓解,手术时间为(75±26) min,术后1周ALT为(41±18) U/L,术后住院时间为(5.3±2.7)d.④随访观察情况,81例仅随访观察患者中24例症状消失,8例未缓解,49例仍无症状.20例肿瘤缓慢增大,3例因肿瘤增大迅速行手术切除,无并发症发生.(2)临床评分:分值≥4分患者176例,手术切除159例,TAE 8例,随访观察9例;分值＜4分患者338例,手术切除221例,TAE29例,RFA 16例,随访观察72例.(3)随访情况:所有患者获得随访,随访时间为6～ 150个月,平均随访时间为89个月,患者恢复良好.结论 手术切除是治疗肝血管瘤的有效方法,TAE及RFA具有创伤小的优点,但疗效欠佳,随访观察可作为暂无手术指征患者的选择.肝血管瘤临床评分可作为选择治疗方式的参考依据,但应结合患者具体情况决定治疗方式.
目的 探討肝血管瘤不同治療方式的臨床療效,提齣肝血管瘤臨床評分併評價其應用價值.方法 迴顧性分析2002年1月至2013年12月新疆醫科大學第一附屬醫院收治的514例肝血管瘤患者的臨床資料.患者分彆施行手術切除、肝動脈栓塞術(TAE)、RFA治療或隨訪觀察,觀察其治療情況,手術時間,術後1週ALT水平,術後住院時間,術後併髮癥等,評價其臨床療效.根據患者臨床癥狀、腫瘤直徑、位置、腫瘤直徑增長速度4項相關因素,提齣肝血管瘤臨床評分:分值≥4分者可攷慮行手術治療,對不宜或不願行手術切除者,可攷慮TAE或隨訪觀察;分值＜4分且未閤併危險因素者可隨訪觀察,閤併者視患者箇體情況選擇箇性化隨訪、再評估後手術切除、TAE或RFA.採用門診及電話隨訪.隨訪時間截至2014年6月.結果 (1)治療情況:①手術療效,380例患者腫瘤完整切除.195例患者癥狀緩解,17例患者癥狀緩解不明顯,手術時間為(175±15) min,術後1週ALT為(139±14) U/L,術後住院時間為(11.5±1.4)d,術後髮生併髮癥58例.②TAE療效,37例患者行TAE,術後CT檢查示1例患者瘤體未見彊化;36例瘤體部分彊化,體積縮小25％ ～ 90％.13例患者癥狀緩解,10例患者癥狀緩解不明顯,手術時間為(67 ± 13) min,術後1週ALT為(64±13) U/L,術後住院時間為(6.8±0.7)d,術後髮生併髮癥2例.③RFA療效,16例患者行RFA,術後CT檢查示2例患者瘤體未見彊化;14例瘤體部分彊化,體積縮小29％～72％.3例患者癥狀緩解,1例患者未緩解,手術時間為(75±26) min,術後1週ALT為(41±18) U/L,術後住院時間為(5.3±2.7)d.④隨訪觀察情況,81例僅隨訪觀察患者中24例癥狀消失,8例未緩解,49例仍無癥狀.20例腫瘤緩慢增大,3例因腫瘤增大迅速行手術切除,無併髮癥髮生.(2)臨床評分:分值≥4分患者176例,手術切除159例,TAE 8例,隨訪觀察9例;分值＜4分患者338例,手術切除221例,TAE29例,RFA 16例,隨訪觀察72例.(3)隨訪情況:所有患者穫得隨訪,隨訪時間為6～ 150箇月,平均隨訪時間為89箇月,患者恢複良好.結論 手術切除是治療肝血管瘤的有效方法,TAE及RFA具有創傷小的優點,但療效欠佳,隨訪觀察可作為暫無手術指徵患者的選擇.肝血管瘤臨床評分可作為選擇治療方式的參攷依據,但應結閤患者具體情況決定治療方式.
목적 탐토간혈관류불동치료방식적림상료효,제출간혈관류림상평분병평개기응용개치.방법 회고성분석2002년1월지2013년12월신강의과대학제일부속의원수치적514례간혈관류환자적림상자료.환자분별시행수술절제、간동맥전새술(TAE)、RFA치료혹수방관찰,관찰기치료정황,수술시간,술후1주ALT수평,술후주원시간,술후병발증등,평개기림상료효.근거환자림상증상、종류직경、위치、종류직경증장속도4항상관인소,제출간혈관류림상평분:분치≥4분자가고필행수술치료,대불의혹불원행수술절제자,가고필TAE혹수방관찰;분치＜4분차미합병위험인소자가수방관찰,합병자시환자개체정황선택개성화수방、재평고후수술절제、TAE혹RFA.채용문진급전화수방.수방시간절지2014년6월.결과 (1)치료정황:①수술료효,380례환자종류완정절제.195례환자증상완해,17례환자증상완해불명현,수술시간위(175±15) min,술후1주ALT위(139±14) U/L,술후주원시간위(11.5±1.4)d,술후발생병발증58례.②TAE료효,37례환자행TAE,술후CT검사시1례환자류체미견강화;36례류체부분강화,체적축소25％ ～ 90％.13례환자증상완해,10례환자증상완해불명현,수술시간위(67 ± 13) min,술후1주ALT위(64±13) U/L,술후주원시간위(6.8±0.7)d,술후발생병발증2례.③RFA료효,16례환자행RFA,술후CT검사시2례환자류체미견강화;14례류체부분강화,체적축소29％～72％.3례환자증상완해,1례환자미완해,수술시간위(75±26) min,술후1주ALT위(41±18) U/L,술후주원시간위(5.3±2.7)d.④수방관찰정황,81례부수방관찰환자중24례증상소실,8례미완해,49례잉무증상.20례종류완만증대,3례인종류증대신속행수술절제,무병발증발생.(2)림상평분:분치≥4분환자176례,수술절제159례,TAE 8례,수방관찰9례;분치＜4분환자338례,수술절제221례,TAE29례,RFA 16례,수방관찰72례.(3)수방정황:소유환자획득수방,수방시간위6～ 150개월,평균수방시간위89개월,환자회복량호.결론 수술절제시치료간혈관류적유효방법,TAE급RFA구유창상소적우점,단료효흠가,수방관찰가작위잠무수술지정환자적선택.간혈관류림상평분가작위선택치료방식적삼고의거,단응결합환자구체정황결정치료방식.
Objective To investigate the clinical efficacies of different treatment methods and evaluate the application value of clinical grading system for liver hemangioma.Methods The clinical data of 514 patients with liver hemangioma who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to December 2013 were retrospectively analyzed.The surgical resection,transcatheter arterial embolization (TAE),radiofrequency ablation (RFA) and follow-up observation were selectively applied to patients.The treatment,operation time,level of ALT at postoperative week 1,duration of postoperative hospital stay and incidence of complications in all patients were observed.The clinical grading system for liver hemangioma was proposed based on the clinical effects and symptoms of patients,diameter,location,diametral growth rate of tumor and related factors.The surgical treatment method was selected for the patients with score≥4,and TAE or follow-up observation was selected for the inoperable patients.The follow-up observation was selected for the patients with score ＜ 4 and without other risk factors.The patients with score ＜ 4 and other risk factors received the individual follow-up based on conditions of patients,and then underwent surgical resection or TAE or RFA after reevaluation.All the patients were followed up via outpatient examination and telephone interview up to June 2014.Results (1) The results of treatment showed as follows:① Of 380 patients undergoing complete resection,195 had symptoms remission and 17 had no obvious symptoms remission.The operation time,level of ALT at postoperative week 1 and duration of postoperative hospital stay were (175 ± 15) minutes,(139 ± 14) U/L and (11.5 ± 1.4) days,respectively.Fifty-eight patients had complications.② Of 37 patients undergoing TAE,the results of postoperative CT showed that no enhancement was detected in 1 patient and partial enhancement in 36 patients,with the loss of volume of 25％-90％.Thirteen patients had symptoms remission and 10 had no obvious symptoms remission.The operation time,level of ALT at postoperative week 1 and duration of postoperative hospital stay were (67 ± 13) minutes,(64 ± 13) U/L and (6.8 ± 0.7) days,respectively.Two patients had complications.③ Of 16 patients undergoing RFA,the results of postoperative CT showed that no enhancement was detected in 2 patients and partial enhancement in 14 patients,with the loss of volume of 29％-72％.Three patients had symptoms remission and 1 had no symptoms remission.The operation time,level of ALT at postoperative week 1 and duration of postoperative hospital stay were (75 ± 26) minutes,(41 ± 18) U/L and (5.3 ± 2.7) days,respectively.④ Of 81 patients undergoing follow-up observation,24 had symptoms remission,8 had no symptoms remission and 49 had no symptoms.Twenty had slow enlarging tumor and 3 received surgical resection of rapid enlarging tumor without complications.(2) The results of clinical grading system showed as follows:of 176 patients with score ≥4,159 patients received surgical resection,8 received TAE and 9 received follow-up observation.Of 338 patients with score ＜ 4,221 patients received surgical resection,29 received TAE,16 received RFA and 72 received follow-up observation.(3)All the patients were followed up for 6-150 months (mean,89 months) with full recovery.Conclusions Surgical resection is an effective method for the treatment of liver hemangioma.TAE and RFA have an advantage of minimal surgery wounds with poor efficacy,and follow-up observation could be applied to patients without surgical indications.The selection of treatment may depend on the clinical grading system for liver hemangioma,and combining with the individual conditions.
