肝切除与TAE治疗肝血管瘤患者术后生存质量评价

doi:10.3969/j.issn.1672-5069.2020.05.035

摘要/Abstract

摘要： 目的探讨肝切除和肝动脉栓塞术(TAE)治疗肝血管瘤患者生存质量的差异。方法 2015年12月～2017年12月我院收治的179例肝血管瘤患者,其中131例行肝切除治疗(A组),48例行TAE治疗(B组)。采用问卷调查方法评价消化病生存质量指数(GLQI)。将患者一般资料和随访内容录入 Epidata 数据库,应用SPSS 25.0软件进行统计学分析。结果在术后1周,A组血清ALT、AST和肌酐水平显著高于B组(P＜0.05); A组手术时间、术中出血量、术后住院日和住院费用均显著高于或多于B组(P＜0.05);术前,两组总GLQI评分差异无统计学意义(P>0.05),但术后两组GLQI评分总体变化趋势有显著差异(F=5.331,P<0.05),在术后12个月,A组GLQI评分显著高于BA组(P<0.05)。结论 TAE治疗肝血管瘤患者具有微创的特点,但肝切除治疗具有确切的疗效,还有助于改善患者远期生存质量。

关键词: 肝血管瘤, 肝切除, 肝动脉介入栓塞术, 生存质量 , ,

Abstract: Objective To investigate the impact of hepatectomy or percutaneous transcatheter arterial chemoembolization (TAE) in treatment of patients with hepatic hemangioma on quality of life thereafter. Methods A total of 179 patients with hepatic hemangioma were admitted to our hospital between December 2015 and December 2017, and among them, 131 patients underwent hepatectomy (group A) and 48 patients received TAE (group B). The differences with respect to liver function index, renal function, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization stay and costs were compared. The patients' quality of life was assessed with the gastrointestinal quality of life index (GLQI).The materials were recorded in Epidata database. The statistical process was finished with SPSS 25.0 software. Results Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine levels in group A were significantly higher than those in group B (P <0.05) one week after operation; the operation time, intraoperative blood loss, postoperative hospital stay, and medical fees in group A were significantly higher or greater than those in group B (P<0.05); there was no statistical difference in total GLQI score between the two groups (P>0.05) at presentation, but the overall changing trend of the total GLQI scores after operation was significantly different between the two groups, which showed a continuous increase after operation in group A, and 12 months after operation, the total GLQI score was significantly higher than that in group B (P<0.05). Conclusion Hepatectomy has an exact curative effect on patients with hepatic hemangiomas, with a less incidence of adverse reactions, and might help improve patients’long-term quality of life.

Key words: Hepatic hemangioma, Hepatectomy, Transcatheter hepatic artery embolization, Quality of life

费贤明, 荚卫东. 肝切除与TAE治疗肝血管瘤患者术后生存质量评价[J]. 实用肝脏病杂志, 2020, 23(5): 743-746.

Fei Xianming, Jia Weidong.. Evaluation of quality of life after hepatectomyor transcatheter arterial chemoembolization in treatment of patients with hepatic hemangioma[J]. Journal of Practical Hepatology, 2020, 23(5): 743-746.

参考文献

[1] Jiansong Ji,Jun Gao,Lizhen Zhao,et al.Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas.Medicine,2016,95(15):e3402.
[2] Talamonti M,Ginsburg H,Ferral M,et al.Percutaneous transhepatic placement of a stent-graft to treat a delayed mesoportal hemorrhage after pancreaticoduodenectomy.World J Surg Oncol,2014,12(3):315.
[3] Toro A, Mahfouz AE, Ardiri A,et al. What is changing in indications and treatment of hepatic hemangiomas,A Review. Ann Hepatol,2014,13(4):327-39.
[4] Bajenaru N, Balaban V, Svulescu F,et al. Hepatic hemangioma -review-.J Med Lif,2015,8:4-11.
[5] Ho HY, Wu TH, Yu MC,et al. Surgical management of giant hepatic hemangiomas:complications and review of the literature. Chang Gung Med J, 2012,35(1):70-78.
[6] 吴珍宝,王苏丹,汪长青,等.腹腔镜下微波消融治疗肝血管瘤的临床研究.中国普通外科杂志,2015,24(7):996-1000.
[7] Tang XY, Ding M, Lu BW,et al. Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas.Int J Hyperthermia,2019,36(1):632-639.
[8] Duxbury MS, Garden OJ. Giant haemangioma of the liver:observation or resection? Dig Surg, 2010, 27(1):7-11.
[9] 金亮,蔡飞,李琪,等.肝血管瘤患者瘤体剥除与介入栓塞术后生存质量对比评价.中国普通外科杂志,2016,25(1):103-108.
[10] Tang DL,Wang SB. Assessment of quality of life and its application in clinical trial. Nat Med J Chin,1993,74:175-179.
[11] Eypasch E,Williams JI, Wood-Dauphinee S, et al. Gastrointestinal quality of life index:development,validation and application of a new instrument.Br J Surg, 1995,82:216-222.
[12] Goh CR,Lee KS,Tan TC,et al.Measuring quality of life in different cultures:translation of the functional living index for cancer into Chinese and Malay in Singapore. Ann Acad Med Singapore,1996,25(3):323-324.
[13] Gao J, Fan RF, Yang JY,et al. Radiofrequency ablation for hepatic hemangiomas:a consensus from a Chinese panel of experts. World J Gastroenterol,2017,23(39):7077-7086.
[14] 国际肝胆胰协会中国分会肝血管瘤专业委员会.肝血管瘤诊断和治疗多学科专家共识(2019年版).中华消化外科杂志,2019,18(8):705-710.
[15] Bai DS, Chen P, Qian JJ,et al. Modified laparoscopic hepatectomy for hepatic hemangioma.Surg Endosc,2015,29(11):3414-3421.
[16] 李秋生,邢中强,冯峰,等.腹腔镜Pringle法肝门阻断下肝血管瘤剥除术221例临床分析. 中华肝胆外科杂志,2018,24(9):633-635.
[17] Gao J, Kong J, Ding XM,et al. Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm. World J Gastroenterol,2015,21(19):5941-5949.
[18] Zeng GL, Li YH, Chen Y,et al. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study. Cardiovasc Intervent Radiol,2004,27(5):481-485.
[19] Ketchum WA, Lin-Hurtubise KM, Ochmanek E,et al. Management of symptomatic hepatic "mega" hemangioma. Hawaii J Med Public Health,2019,78(4):128-131.
[20] 刘勇峰,梅乐园,袁泉,等.微波消融与肝动脉栓塞治疗肝血管瘤的对照研究.中国普通外科杂志,2013,22(7):871-875.
[21] Lupinacci RM, Szejnfeld D D, Farah JF,et al. Spontaneous rupture of a giant hepatic hemangioma. Sequential treatment with preoperative transcatheter arterial embolization and conservative hepatectomy. G Chir,2011,32(11/12):469-472.
[22] Liu QQ, Liu F, Ding JJ,et al. Surgical outcomes and quality of life between laparoscopic and open approach for hepatic hemangioma:a propensity score matching analysis.Medicine,2019,98(6):e14485.