| Objectives To compare the efficacy of laparoscopic microwave ablation combined poly cinnamyl alcohol injection in the treatment of liver hemangioma with traditional surgical resection,and to evaluate the practicability and safety of laparoscopic microwave ablation combined poly cinnamyl alcohol injection,and provide new ideas or methods for the treatment of liver hemangioma in future.Methods Altogether 56 patients with hepatic hemangioma confirmed by general surgery department of 81 st Clinical Academy of People's Liberation Army were divided into laparoscopic microwave ablation combined poly cinnamyl alcohol injection group(n=27),traditional surgical resection group(n=29)by admission number is singular or dual.Using ELISA to test and compare the 12-hour IL-6 and TNF-? before operation and after operation.After the treatment,the time of operation,amount of bleeding during operation,hospitalization time,complications after operation,liver function after operation and satisfaction of two groups were observed.Results All two groups were successfully completed surgery,perioperative death and severe complications such as liver failure were not found in any case.1.The time of operation of microwave ablation groups were(67±15)min,and were shorter than traditional group(124±21)min,(t=11.540,P=0.000);The amount of bleeding during operation of microwave ablation groups were(41±16)ml,and were shorter than traditional group(248±167)ml,(t=6.623,P=0.000);Hospitalization time of microwave ablation groups were(6.9±1.2)d,and were shorter than traditional group(12.1±1.8)d,(t=12.843,P=0.000).One patient from microwave ablation group got ascites after operation,twe patients got hemoglobinuria,one patient got mild hepatic encephalopathy and twe patients got mild abdominal pain,and the rate of complication after operation were 22.2%(6/27).four patients from traditional group got ascites after operation,one patient got incision infection,one patient got bile leakage and twe patients got mild hepatic encephalopathy,four patients got incisional pain and the rate of complication after operation were 41.4%(12/29).There was no statistically significant difference comparing the two groups(?2=2.353,P=0.125).Satisfaction of microwave ablation groups were 88.9%(24/27),higher than traditional groups 70.0%(20/29),and there was no significant difference(?2=3.296,p=0.069).2.Two groups of ALT and AST were rise,and ALB was reduce after operation.ALT of 1day after operation of microwave ablation groups were(233.5±99.1)U/L,lower than traditional groups ALT(299.7±73.4)U/L,(t=2.822,p=0.007);AST of after operation of microwave ablation groups were(239.2±80.3)U/L,higher than traditional groups(297.6±71.1)U/L,(t=2.889,p=0.006);ALB of after operation of microwave ablation groups were(38.9±2.6)g/L,higher than traditional groups(35.6±3.0)g/L,(t=4.596,p=0.000).Two groups of patients were performed postoperative liver albumin infusion after symptomatic treatment,until liver function returned to normal levels.3.Two groups of IL-6 of 12 hours after operation and TNF-? were rise,and there are significant difference compare to before operation.IL-6 of microwave ablation groups were(19.5±3.6)pg/ml,lower than traditional groups(25.7±4.5)pg/ml,(t=5.723,p=0.000),and there was significant difference.TNF-? of microwave ablation groups were(54.4±6.9)pg/ml,lower than traditional groups(64.5±7.8)pg/ml,and there was significant difference(t=5.100,p=0.000).4.Let patients postoperative 1 month later for our review.All patients use abdominal ultrasonography,twenty patients from microwave ablation groups found no blood flow signals.seven patients' tumors had peripheral part of the blood flow signals due to large tumors.Give the second microwave ablation,we found there were no blood flow signals.Fifty six patients all disappear the symptoms such as nausea and vomiting and postprandial full.After the microwave ablation,tumors decrease volume,the rate of complete remission were 74.1%(20/27),the rate of partial remission were 18.5%(5/27),the rate of better were 18.5%(5/27),the rate of total remission were92.6%(25/27).The tumors of microwave ablation groups decrease obviously,volume of the tumors of one month?three months?six months after the microwave ablation were 46.7cm3?25.8cm3?15.7cm3,the rate of decrease were 45.9%?72.7%?78.2%.5.Compare to microwave ablation groups with traditional surgery groups,we found that microwave ablation combined poly cinnamyl alcohol injection for 5 cm to 10 cm in diameter of liver hemangioma is superior to the effect of diameter greater than 10 cm the therapeutic effect of hepatic hemangioma.The rate of first microwave ablation for 5 cm to 10 cm in diameter of liver hemangioma were 90.1%(20/22),the rate of complete remission were 86.4%(19/22),the rate of partial remission were 13.6%(3/22),the rate of total remission were100%(22/22).Large than 10 cm in diameter of liver hemangioma need second microwave ablation,and the rate of complete remission were 20%(1/5),the rate of partial remission were 40%(2/5),the rate of total remission were 60%(3/5).Conclusions 1.Laparoscopic microwave ablation combined cinnamyl alcohol injection treatment of liver hemangioma have many advantages,such as simple to operate?small trauma?less complications and so on.2.Surgical resection the tumor have bad effect to body,but curative effect.3.It was successful for smaller than 10 cm in diameter to use microwave ablation combined cinnamyl alcohol injection treatment of liver hemangioma.4.As for larger than 10 cm in diameter of liver hemangiomam,it important to choose the way to treat. |
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