514例肝血管瘤的治疗与临床评分
Treatment and clinical grading system of liver hemangioma among 514 patients
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摘要:
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%〖KG-*4〗~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%〖KG-*4〗~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，TAE 29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。Abstract: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 followup 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 followup observation was selected for the inoperable patients. The followup 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 followup 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 〖HJ*4〗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. Fiftyeight 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%〖KG-*4〗-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%-〖KG-*5〗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 followup 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 followup observation. Of 338 patients with score<4, 221 patients received surgical resection, 29 received TAE, 16 received RFA and 72 received followup observation. (3)All the patients were followed up for 6-150 months 〖JP3〗(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 followup 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. -
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