Abstract
Aim. To refine treatment of patients with liver hemangiomas with new minimally invasive method of surgical treatment (microwave ablation). Material and Methods. The study included 64 patients with liver hemangiomas up to 5 cm in diameter. In 23 patients (35.9%) there was 2–2,5-fold increase of hemangioma's size within 1.5–4 years. The diagnosis of liver hemagioma was installed in all patients based on multispiral computed tomography (MSCT). Surgery was performed in X-ray operation theater under intravenous anesthesia. Inter- or infracostal approach was used depending on the location of hemangioma. Percutaneous transhepatic introduction of thermal probe was performed into hemangioma under ultrasound control so that the tip of thermal probe has reached the opposite edge of the tumor. Then we applied microwave ablation for 15–20 minutes at temperature of 80–120 degrees. In the postoperative period within 2–3 days preventive antibiotic therapy as well as hepatoprotectors were administered. Effectiveness of method was evaluated at 3 (ultrasound) and 6 months (MSCT). Results. 23 patients with liver hemangiomas were treated using percutaneous microwave ablation. Complications were not marked. In 21 (91.3%) patients one procedure was conducted, 2 patients (8.7%) required repeated ablation because of recurrence of tumor according to control MSCT. In patient with multiple hemangiomas simultaneous ablation of two the largest hemangiomas was performed. Patients were discharged at 3–5 days after surgery. The follow-up was 7–35 months (average period 24 months). Dynamic ultrasonic examination showed that within 2–3 months the patients were able to form small liquid pockets in the site of ablation (7 patients), which independently regressed by the end of the 6th month followed by fibrosis. Presence of fibrous foci was confirmed by computed tomography at 6 months. Conclusion. Percutaneous microwave ablation may be recommended for some patients with liver hemangiomas due to minimal invasiveness, efficiency, simplicity, safety and easy repeatability
Highlights
Percutaneous transhepatic introduction of thermal probe was performed into hemangioma under ultrasound control so that the tip of thermal probe has reached the opposite edge of the tumor
In 21 (91.3%) patients one procedure was conducted, 2 patients (8.7%) required repeated ablation because of recurrence of tumor according to control multispiral computed tomography (MSCT)
Что в силу минимальной инвазивности, эффективности, простоты, безопасности и легкой повторяемости чрескожной микроволновой абляции (ЧМВА) может быть выбрана методом лечения гемангиом печени для отдельных пациентов, у которых гемангиома имеет тенденцию к росту и размер ее не превышает 5 см, имеются клинические проявления заболевания
Summary
Уточнить тактику ведения больных гемангиомами печени с учетом нового миниинвазивного метода хирургического лечения – микроволновой абляции. Всего под наблюдением находилось 64 больных гемангиомами печени до 5 см. Термозонд проводили чрескожно чреспеченочно по длиннику гемангиомы под контролем ультразвукового исследования (УЗИ) так, чтобы кончик термозонда достиг противоположного края опухоли. Проводили микроволновую абляцию в течение 15–20 мин при температуре 80–120 °С. Всего с использованием чрескожной микроволновой абляции гемангиом печени излечены 23 пациента. При УЗИ установлено, что в течение 2–3 мес у больных могли сформироваться небольшие жидкостные очаги в зоне абляции (7 пациентов), которые самостоятельно к концу 6-го месяца регрессировали с формированием фиброза. В силу минимальной инвазивности, эффективности, простоты, безопасности и легкой повторяемости микроволновая абляция может быть выбрана методом лечения гемангиом печени для отдельных пациентов. Ключевые слова: печень, гемангиома, микроволновая абляция, миниинвазивные методы лечения, доброкачественные образования печени
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