新生儿肝血管瘤13例报道

Diagnosis And Management of Neonatal Hepatic Hemangioma

目的总结新生儿肝血管瘤的诊治经验。方法回顾性分析我院近10年来收治的13例新生儿肝血管瘤病例,分析其首发症状、合并症、诊治方法以及临床疗效。结果13例首发症状包括腹部包块、肝脏肿大、黄疸、肺炎。合并症包括全身多发皮肤血管瘤、心功能不全。2例为产前B超发现。全部病例B超和CT检查均有典型的血管瘤表现,单个病灶的直径在53～91mm。接受手术切除4例,活检2例,7例仅接受激素治疗。病理报告为海绵状血管瘤2例,毛细血管瘤11例。有心功能不全和肺炎者接受内科强心、利尿及抗炎治疗。结果1例因顽固性心衰伴肺炎和多脏器感染于术后死亡,1例肝脏多发病例于活检后放弃治疗,其余病例均获5个月～1.5年的随访。3例手术切除患儿无复发。所有保守治疗病例均见血管瘤在1年内自行消退,无死亡病例。结论肝血管瘤可通过临床症状、超声和CT检查明确诊断。激素治疗是有效的治疗方法。积极治疗充血性心力衰竭对肝血管瘤的治疗有帮助。手术有增加并发症的危险,不宜作为新生儿肝血管瘤的治疗选项。

Objective To summarize the experience for the diagnosis and treatment of neonatal hepatic hemangioma in our hospital.Methods Thirteen cases of neonatal hepatic hemangioma were managed in our hospital,the initial symptom,combination symptom,diagnosis and treatment were analysised.Results The initial symptom of neonatal hepatic hemangioma were abdominal mass,hepatomegaly,jaundice and pneumonia.The combination symptoms were multiple skin hemangioma and cardiac insufficiency.Ultrasound and CT scan showed the typical characteristics of the liver hemangioma,the diameter of single focus of this group is around 53～91mm.3 cases of them received surgical resection and 2 got biopsy.Other 7 cases only received steroid treatment.Those who has cardiac insufficiency and pneumonia received digitalis,diuresis and antibiotic treatment.One neonate who has cardiac insufficiency and pneumonia had MODS after operation,last dead.One has multi-focus in the liver abandoned treatment after biopsy.Others got 5～17 months follow up.Two cases who got total resection have no recurrence.In those who received conservative therapy,all the hemangiomas disappear by oneself within one year.Conclusion The diagnosis of hepatic hemangioma can be made from symptom,ultrasound and CT scan.The pathologic sample is not necessary.Steroid therapy is the most effective.Therapy postively for congestive heart failure is helpful for cure of the liver hemangioma.Invasive therapy such as surgical operation etc can increase the risk of complications,so it is not fit for the neonatal hepatic hemangioma treatment.