| Background: Hepatic hemangioma is the most common benign hepatic tumor, with aprevalence of0.4%to7.3%in autopsy series.The carvenous hemangioma is the mostcommon type of hepatic hemangioma in clinical, mainly in female.The exact pathologicmechanism of hemangioma is not well known. Most hemangiomas are asymptomatic, and thelesions are always found by ultrasonography or computerized tomography. But some of themhave a tendency of enlarging, and the giant hepatic hemangioma is defined as the diameter ofhemangioma over5cm. Hepatic hemangiomas act as a benign course, the main symptoms ofhemangiomas include abdominal pain or discomfort and vomiting. Its complications includehemorrhage, jaundice and thrombocytopenia. No treatment but observation is needed forasymptotic hemangiomas. But active management is needed for symptomatic hemangiomasor enlarging hemangiomas. Classic therapies of hepatic hemangiomas include surgicalresection, hepatic arterial ligation, transarterial emobolization, radiation therapy and steroidtreatment. Even liver transplantation is used on patients of special hepatic hemangiomas. Withthe development of medical technologies, minimal invasive technologies are used in thetreatment of hepatic hemangiomas. Percutaneous radiofrequency (PRFA) and laparoscopicresection (LR) are the two most commonly used, minimal invasive methods for treating gianthepatic hemangiomas (GHHs5-15cm in diameter). To date, however, no study hascompared the safety and efficacy of these two treatment modalities. We used a prospective,controlled analysis to compare PRFA and LR for GHH during the same time period in thesame hospital setting.Methods: Between February2010and August2012,85patients with GHH receivedeither PRFA or LR in our hospital. Of these,55GHH (mean diameter7.2+1.9cm, range5.0–12.8cm) in54patients(male19,female35,age43.3±8.5years old, range24-61years old) received PRFA and32GHHs (mean diameter7.2+2.1cm, range5.0–15.0cm) in31patients(male9,female22, age44.2±9.2years old, range29-61years old) received LR.Patients who received one PRFA with the lesion not being completely ablated underwent asecond PRFA during the same hospitalization to achieve complete ablation of the lesion.Followup was performed using contrast-enhanced ultrasonography (CEUS) orcontrast-enhanced computed tomography (CECT) on all patients. We statistically analyzedseveral indicates of both groups, including therapy time，blood loss, complete ablation rate,symptom relief, complications, size of ablation zone and hospital stay.Results:85patients with87GHHs,55of which belong to PRFA group(50lesions≤10cm,5lesions＞10cm),32of which belong to LR group(30lesions≤10cm,2lesions＞10cm).For GHH with diameters5-10cm, treatment time and blood loss (44.9+21.3minutes,6.4+1.7ml, respectively) in the PRFA group were both much less compared to the LR group(196.7+80.6min,356.9+544.7ml; p <0.01each), while the duration of hospitalization(12.53±1.77d,12.55±2.53d, P=0.295) did not differ. In all patients in the LR group, the GHHswere removed completely during LR. In contrast, in the PRFA group, complete ablation wasachieved with a single treatment in80%(40/50) and with two treatments in90%(9/10); onepatient had a small area of residual hemangioma.For the five GHH lesions with diameters>10cm in the PRFA group, all five patientsrequired a second ablation which was successful in fully ablating the GHH in only twopatients; small areas of persistent hemangioma persisted; one patient did not undergo thesecond PRFA due to hemolytic jaundice complicating the first PRFA. In the LR group, onlytwo patients with GHH with diameters>10cm, one of whom developed massive hemorrhageduring LR requiring conversion to an open laparotomy for resection.In the PRFA group, after a mean followup of8.4months, the mean lesion diameterdecreased from7.2+1.9cm preoperatively to5.7+1.4cm (p<0.01). Moreover, the residuallesions after PRFA did not increase in size. In both groups, all clinical symptoms related toGHH were relieved after treatment. In the PRFA group, two patients developed severecomplications (hemolytic jaundice, rupture of the GHH requiring blood transfusion). In the LR group, two patients required conversion to open laparotomy for resection.Conclusions: For GHHs with a diameter of5-10cm, both PRFA and LR are safe andeffective. For GHHs with diameters greater than10cm, two or more PRFA treatments wereneeded to achieve complete ablation, while with LR, there was a high chance of severebleeding. LR is not recommended for GHHs greater than10cm. |
