Typical case Ms. Li is a patient with hepatic hemangioma, one in her left and one in her right liver. Although she had no obvious discomfort, three ultrasound examinations in the past two years revealed that the two hepatic hemangiomas had a tendency to increase in size, growing to 6.6 cm and 8.3 cm in diameter respectively. Just when she was anxious about undergoing a major surgery to remove the left and right hepatic hemangiomas, advances in medical technology brought her a blessing – both hepatic hemangiomas could be cured simultaneously through laparoscopic radiofrequency ablation. Gao Jun, Department of Hepatobiliary, Pancreatic and Splenic Surgery, West Hospital, Beijing Chaoyang Hospital, Capital Medical University Hepatic hemangioma is a common benign tumor of the liver, which can be observed clinically if the tumor is small and has no obvious symptoms. Traditional treatment still has shortage At present, physicians in surgery, interventional medicine and other specialties are trying different treatments, and there is still a lack of unified understanding in terms of treatment timing and means. Surgical resection is the most effective treatment for hepatic hemangioma, but surgical treatment is very traumatic and is only considered to be applied when the tumor grows to a certain extent. Radiation therapy can reduce the size of the tumor and relieve symptoms, but it can cause complications such as radioactive hepatitis and veno-occlusive disease. Transhepatic artery embolization can also be used to treat huge and symptomatic hepatic hemangiomas, but the high recurrence rate after surgery and the possibility of serious complications such as intrahepatic bile duct injury and ectopic embolism make it difficult to be widely accepted and applied. Radiofrequency ablation is a common minimally invasive treatment modality for hepatic malignancies. The main principle is to generate enough heat by radiofrequency current to cause coagulative necrosis of the tissue. In recent years, radiofrequency ablation has been applied experimentally in the treatment of hepatic hemangioma, which has initially shown the advantages of definite efficacy, high safety, small trauma and low recurrence rate, and has good application prospects and is worthy of further promotion and application. Radiofrequency treatment Safe and effective The safety of radiofrequency ablation treatment of hepatic hemangioma originates from the following aspects. Firstly, the target of ablation is clearer when RF ablation treats hepatic hemangioma, and only the part of the tumor visible to the naked eye or on the image needs to be ablated. Second, the goal of radiofrequency ablation for hepatic hemangioma is to destroy the tumor blood vessels, reduce the size of the tumor, and stop its further growth. During the treatment process, some of the hemangioma tissue can be left behind without regret for safety reasons. Third, the vast majority of hepatic hemangiomas can be treated by percutaneous puncture or laparoscopic route to obtain treatment and avoid complications associated with open surgery. For hepatic hemangiomas within the liver parenchyma, percutaneous puncture radiofrequency ablation can be preferred; while exophytic or partially exophytic hepatic hemangiomas, which are usually more closely related to cavernous organs such as the stomach, intestine, and gallbladder, especially those distributed in the left and right hepatic lobes, are more suitable for the laparoscopic route. Of course, for hepatic hemangiomas of huge size, it is not easy to observe or control bleeding under the percutaneous puncture route and laparoscopic route, so the open route is preferred. Finally, the most common complication of radiofrequency ablation for hepatic hemangioma is hemoglobinuria. It is more likely to occur when the tumor is large and the ablation time is long. The mechanism of occurrence is that the heat generated during ablation causes some damage to the red blood cells in the blood. It usually disappears within 3 days after the procedure with no after-effects. Treatment philosophy More aggressive The safety and minimally invasive nature of radiofrequency ablation for hepatic hemangioma will influence the treatment philosophy of hepatic hemangioma to some extent. It used to be that treating a benign tumor like hepatic hemangioma by surgical resection with certain risks can cause a lot of psychological stress to doctors and patients. As a result, there was a clinical tendency to conservatively postpone treatment of hepatic hemangioma, and preventive treatment was rarely aggressively pursued. The result is usually that the disease gets later and later, and the treatment becomes more difficult and risky the longer we wait. The minimally invasive and safe nature of radiofrequency ablation treatment has lowered the psychological “threshold” for aggressive treatment of hepatic hemangioma for both doctors and patients, making aggressive preventive treatment possible. At present, if the diameter of hepatic hemangioma is larger than 5 cm and the growth trend is obvious, it seems reasonable to apply radiofrequency ablation treatment in a timely manner.