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大型肝囊腫－以細針純酒精硬化治療之經驗
Large Hepatic Cysts-Treatment with Fine Needle Aspiration and Absolute Ethanol Injection
摘要
文獻上提及以各種硬化劑治療腎及肝囊腫之方法中，尚無人應用少量純酒精作先天性肝囊腫之治療。本文收集自1986年1月至1987年6月間共以超音波導引經皮細針抽吸及純酒精注入治療之10例13個具症狀的大型先天性肝囊腫（直徑5.7至18 cm，平均10.6cm）。酒精注入量通常為10-20 ml，注入後10-20分鐘再回抽半量，使半量存留於囊腫內；在6個月至2年的追蹤，當中發現囊腫之體積減少程度為47-100%（平均79%），症狀明顯改善之比例為50 %，完全消失者40%。治療中無嚴重併發症，僅有少數有一過性之疼痛，但在女性常見一過性醉酒症狀；有三例在追蹤後體積再變至原來的13-34%，而再行單純抽吸即得到良好的效果。由此結果可知此種細針少量純酒精注入療法為外科治療以外的有效變通方法，可作為年長患者的優先考慮。
並列摘要
Absolute ethanol has never been reported as a sclerosing agent in treatment of hepatic cysts. From January 1986 to June 1987, we tried to aspirate 13 large hepatic cysts with fine needles and injected absolute ethanol under ultrasound guidance for sclerosing therapy. These hepatic cysts measured 5.7 to 18 cm (average 10.6 cm) in diameter. The amount of ethanol injected was 10-20 ml. After 10 to 20 minutes, half of the injected ethanol was aspirated, while the other half remained in the cavity for further ablation of the cyst wall. In a follow-up period of 6 months to 2 years, the volume of the cysts were noted to have a remarkable reduction (47-100%, average 79%). Significant improvement of clinical symptoms was noted in 50% and complete disappearance in 40% of patients. No major complication except transient local pain and symptoms of drunkenness were encountered. Three patients with recurrent fluid accumulation in the cysts (13-34% of initial volume) were treated by simple aspiration with fine needle and no evidence of recurrence was found after then. The results suggested that percutaneous injection of absolute ethanol may be an effective alternative to surgical procedures for symptomatic large hepatic cysts, and may be a procedure of choice in aged patients.