超声引导下聚桂醇与无水乙醇注射硬化治疗肝囊肿患者疗效比较研究*

doi:10.3969/j.issn.1672-5069.2024.03.033

摘要/Abstract

摘要： 目的比较在超声引导下聚桂醇与无水乙醇硬化治疗肝囊肿(HC)患者的疗效。方法 2019年10月～2022年10月我院收治的HC患者107例,被随机分为观察组54例和对照组53例,分别在超声引导下穿刺囊腔内注射聚桂醇或无水乙醇治疗,于治疗后6个月复查超声。采用荧光免疫分析法检测血清高尔基体蛋白73(GP73)、蛋白二硫化物异构酶A3(PDIA3)和壳多糖酶3样蛋白1(CHI3L1)水平,采用ELISA法检测血清髓过氧化物酶(MPO)和皮质醇(Cor)水平,采用化学发光法检测血清淀粉样蛋白A(SAA)水平,采用视觉模拟评分法(VAS)评价疼痛程度。结果观察组治疗总有效率为98.1%,显著高于对照组的88.7%(P<0.05),在随访时,观察组囊肿复发率为3.7%,显著低于对照组的16.9%(P<0.05);在术后1w,观察组血清GP73、PDIA3和CHI3L1水平分别为(23.1±3.8)pg/L、(69.2±5.6)ng/mL和(44.9±4.9)ng/L,显著低于对照组【分别为(37.3±4.3)pg/L、(94.8±5.4)ng/mL和(67.7±4.6)ng/L,P<0.05】;观察组血清MPO、Cor和SAA水平分别为(121.5±18.3)U/L、(259.7±24.1)ng/L和(14.5±2.5)mg/L,显著低于对照组【分别为(158.1±20.1)U/L、(298.6±26.3)ng/L和(20.2±3.1)mg/L,P<0.05】;在术后1 d和3 d,观察组VAS评分分别为(3.1±0.6)分和(2.2±0.3)分,均显著低于对照组【分别为(4.5±0.5)分和(3.2±0.4)分,P<0.05】;术后,对照组出现腹痛和醉酒貌等不良反应发生率为20.8%,显著高于观察组的3.7%(P<0.05)。结论在超声引导下穿刺向囊腔内注射聚桂醇硬化治疗HC患者可能比注射无水乙醇有更好的临床疗效,且不良反应发生率低,可能与激起机体应激反应轻有关。

关键词: 肝囊肿, 聚桂醇, 无水乙醇, 硬化治疗, 超声引导, 治疗

Abstract: Objective The aim of this study was to explore the efficacy of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts (HC). Methods 107 patients with HC were enrolled in our hospital between October 2019 and October 2022, and were divided randomly into observation (n=54) and control group (n=53), receiving lauromacrogol or absolute ethanol sclerotherapy under ultrasound (US) guidance. After 6 months of treatment, the ultrasonography was performed, and the clinical efficacy was evaluated. Serum Golgi protein 73 (GP73), protein disulfide isomerase A3 (PDIA3) and chitosanase 3-like protein 1 (CHI3L1) levels were detected by fluoroimmunoassay. Serum myeloperoxidase (MPO) and cortisol (Cor) levels were measured by ELISA, and serum amyloid A (SAA) level was detected by chemiluminescence. The visual analogue scale (VAS) score was evaluated. Results The total effectiveness rate in the observation group was 98.1%, significantly higher than 88.7% in the control group (P<0.05), and at the end of six-month of follow-up, the recurrence of HC was 3.7%, much lower than 16.9%(P<0.05) in the control; one week after operation, serum GP73, PDIA3 and CHI3L1 levels in the observation group were (23.1±3.8)pg/L, (69.2±5.6)ng/mL and (44.9±4.9)ng/L, all significantly lower than [(37.3±4.3)pg/L, (94.8±5.4)ng/mL and (67.7±4.6)ng/L, respectively, P<0.05] in the control; serum MPO, Cor and SAA levels were (121.5±18.3)U/L, (259.7±24.1)ng/L and (14.5±2.5)mg/L, all significantly lower [(158.1±20.1)U/L, (298.6±26.3)ng/L and (20.2±3.1)mg/L, respectively, P<0.05] in the control; at day one and three after sclerotherapy, the VAS score in the observation group were (3.1±0.6) and (2.2±0.3), both much less than [(4.5±0.5) and (3.2±0.4), P<0.05] in the control; the incidence of untoward effect, such as abdominal pain and drunkenness-like symptoms in the observation group was 3.7%, much lower than 20.8%(P<0.05) in the control group. Conclusion The sclerotherapy with lauromacrogol injection in the treatment of patients with HC has a relatively better clinical efficacy as compared to the ethanol injection, which might be related to a low body stress reaction and low incidence of side effects.

Key words: Hepatic cysts, Lauromacrogol, Anhydrous ethanol, Ultrasound-guidance, Sclerotherapy, Therapy

李玮健, 刘昕, 舒红艳. 超声引导下聚桂醇与无水乙醇注射硬化治疗肝囊肿患者疗效比较研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 450-453.

Li Weijian, Liu Xin, Shu Hongyan. Comparison of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts[J]. Journal of Practical Hepatology, 2024, 27(3): 450-453.

参考文献

[1] Hogan MC, Chamberlin JA, Vaughan LE, et al. Pansomatostatin agonist pasireotide long-acting release for patients with autosomal dominant polycystic kidney or liver disease with severe liver involvement: A randomized clinical trial. Clin J Am Soc Nephrol, 2020, 15(9):1267-1278.
[2] Bo R, Aji T, Jiang T, et al. Differentiation between hepatic cystic echinococcosis types 1 and simple hepatic cysts: A retrospective analysis. Medicine, 2019, 98(1):e13731.
[3] Zhang H, Xiong SH, Jiang XJ, et al. A painless and time-saving modified technique for simple renal cyst treatment with single-session ethanol sclerotherapy. Sci Rep, 2020, 10(1):5019-5019.
[4] Kumar A, Zendel A, Rodriguez PS, et al. Inconclusive rule out diagnosis and indication of surgery for hepatic cyst. J Am Coll Surg, 2021, 233(5):e111-e115.
[5] Marrero JA,Ahn J, Rajender Reddy K, et al. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol, 2014, 109(9):1328-1348.
[6] 孙兵,车晓明.视觉模拟评分法(VAS).中华神经外科杂志,2012,28(6):645-645.
[7] 李晓红,严继萍,王军,等.超声引导下经皮注射聚桂醇治疗腹、盆腔囊性病变的临床研究.中华医学超声杂志:电子版,2018,15(8):625-628.
[8] Chebib FT, Harmon A, Irazabal Mira MV, et al. Outcomes and durability of hepatic reduction after combined partial hepatectomy and cyst fenestration for massive polycystic liver disease discussion. J Am Coll Surg, 2016, 223(1):118-126.
[9] 张静,林铤,孙翔.超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿患者疗效研究.实用肝脏病杂志,2022,25(4):571-574.
[10] Watson M, Baimas-George M, Salibi P, et al. Robotic hepatic cyst marsupialization is equivalent to laparoscopy. HPB, 2020, 22(5):S182.
[11] Ma F, Li Q, Zhu H, et al. A novel miniature flexible single-site laparoscopic device for fenestration of hepatic cyst: A feasibility study. J Am Coll Surg, 2020, 231(4):e156.
[12] Shao F, Tang J, Lan X. Variable I-131 activity in multiple hepatic cysts in a patient with thyroid cancer. Clin Nucl Med, 2019, 44(4):324-326.
[13] Lee SK, Han YS, Han JR, et al. Laparoscopic excision of huge hepatic cyst under near-infrared fluorescence imaging using indocyanine green. HPB, 2019, 21(6):S520-S521.
[14] Bruijninckx CM. Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies. Phlebology, 2016, 31(7):449-455.
[15] 王琳玲,周琼,王月爱.超声引导下经皮穿刺置管引流联合聚桂醇泡沫硬化治疗单纯性HC患者疗效研究.实用肝脏病杂志,2020,23(6):909-912.
[16] Yin M, Wang Z, Xiao W. The significance of ultrasound-guided lauromacrogol injection to hepato-cellular carcinoma. Acta Medica, 2018, 34(5):1331-1335.
[17] Chai Y, Zhou Z, Song J, et al. Safety of intralesional injection of lauromacrogol combined with triamcinolone for infantile hemangiomas. J Dermatol, 2019, 46(9):770-776.
[18] Baron TH, Lappas BM. Successful EUS-guided cystoduodenostomy of a large hepatic cyst causing biliary obstruction. Gastrointest Endosc, 2021, 93(4):981-982.
[19] Xiaoqing Z, Na L, Lili M, et al. Endoscopic cyanoacrylate injection with lauromacrogol for gastric varices: long-term outcomes and predictors in a retrospective cohort study. J Laparoendosc Adv Surg Tech A, 2019, 29(9):1135-1143.
[20] Parsi K, Kang M, Trimboli A. Ultrasound-guided TriVex -powered phlebectomy for debulking of peripheral vascular anomalies - A novel treatment technique. Phlebology, 2019, 34(8):523-529.
[21] Mamidi IS, Lee E, Benito DA, et al. Ultrasound-guided ethanol sclerotherapy for non-surgical treatment of Warthin's tumor. Am J Otolaryngol, 2021, 42(1):102813.

超声引导下聚桂醇与无水乙醇注射硬化治疗肝囊肿患者疗效比较研究^*

Comparison of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈从新, 陈曦, 王莉苹, 赵秋香, 刘颖, 周海洋. 糖皮质激素在肝病治疗中的应用[J]. 实用肝脏病杂志, 2024, 27(3): 321-323.
[2]	赵玉雯, 朱传龙. 肝硬化营养不良及肌少症治疗研究进展[J]. 实用肝脏病杂志, 2024, 27(3): 324-328.
[3]	罗良德, 任成果, 王守军, 邓颖春. 恩替卡韦联合多烯磷脂酰胆碱治疗慢性乙型肝炎合并NASH患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 333-336.
[4]	周安琪, 孟舒婷, 吴应冬, 张弦. 接受核苷(酸)类似物抗病毒的慢性乙型肝炎患者发生低病毒血症危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 337-340.
[5]	程艳洁, 王鹏飞, 李峻. 水飞蓟素联合复方蛋氨酸胆碱治疗酒精性肝炎患者疗效及其对血清肝纤维化指标的影响^*[J]. 实用肝脏病杂志, 2024, 27(3): 349-352.
[6]	徐秋萍, 黄彬, 陈敏, 余静. 泼尼松与泼尼松联合硫唑嘌呤治疗自身免疫性肝炎患者外周血MDSCs百分比、肝组织白细胞介素-35和血清CD38水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(3): 374-377.
[7]	姜正伟, 周冰清, 汤洁, 蒋蓓莉. 血清抗糖蛋白210抗体阳性的原发性胆汁性胆管炎患者临床特征分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 378-381.
[8]	李菊兰, 张华堂, 郑怡娟, 余雪平, 邓勇, 苏智军. 恩替卡韦联合扶正化瘀片治疗乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 402-405.
[9]	蔡峻岭, 苏立, 郝丽, 赵敏, 裴旭东. 基于索磷布韦的直接抗病毒药物治疗丙型肝炎肝硬化患者疗效评价^*[J]. 实用肝脏病杂志, 2024, 27(3): 406-409.
[10]	闫振, 赵博文, 林国英, 殷和良. 影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 438-441.
[11]	王苓入, 苏虹, 郝晓炜, 李娜. 超声引导下PTGD联合聚桂醇硬化治疗单纯性肝囊肿患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 454-457.
[12]	徐旭, 施漪雯, 范建高. 肝豆状核变性治疗现状与展望^*[J]. 实用肝脏病杂志, 2024, 27(3): 477-480.
[13]	徐京杭, 于岩岩, 徐小元. 肝硬化临床研究进展[J]. 实用肝脏病杂志, 2024, 27(2): 161-164.
[14]	李兴泉, 杨春, 李诗源, 翁凯, 彭麟. 奥比帕利联合达塞布韦治疗基因1b型慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 177-180.
[15]	于欣欣, 付朝霞, 薛莉. 减量索磷布韦联合全量达卡他韦治疗终末期肾病合并急性丙型肝炎患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 181-184.