肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

Treatment of hypovascular hepatic cavernous hemangiomas by percutaneous intratumoral bleomycin injection after selective hepatic arterial embolization

目的探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的疗效和安全性。方法前瞻性研究9例少血供性肝海绵状血管瘤患者经肝动脉栓塞结合经皮经肝瘤体内药物注射治疗情况。对于CT/MRI明确诊断的肝海绵状血管瘤(直径>5cm),且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此表现的9例患者,先行肝动脉插管栓塞术,栓塞剂为超液化碘油(10ml)与博莱霉素(8mg)混悬剂,实际用量为5～10ml。栓塞后4d开始行经皮经肝瘤体内穿刺多点注射博莱霉素8～16mg,间隔3～4d再次注射,连续2～3次,1个月后复查CT,以后3、6个月及1年不定期复查CT。结果9例患者DSA上所见血管瘤染色与CT增强扫描表现一致,碘油沉积呈散在点状分布,治疗后1个月瘤体均明显缩小,以后继续缩小,1年后复查基本稳定不再缩小。2例患者出现急性胆囊炎,对症处理后痊愈。1例出现栓塞后胆汁瘤,随访观察未进一步进展,未作特殊处理。结论经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法。

Objective To assess the safety and effectiveness of treatment of cavernous hemangiomas of liver （CHL）by percutaneous intratumoral bleomycin injection after transarterial embolization （TAE）. Methods 9 cases of hypovascular CHL treated by percutaneous intratumoral bleomyein injection after TAE were studied prospectively. All the cases were diagnosed as hypovascular CHL（diameter 〉 5 cm） by CT/MRI. With only spotty or few patchy enhancement in arterial phase persisting into the delayed phase were shown on enhanced CT. TAE with emulsion of ultra-fluid lipiodol（10 ml） and bleomycin（8 mg） was performed in every patient, with dosage of 5-10 ml depending on the vascular space of different lesions. Percutaneous intratumoral multi- point injection with bleomycin （8-16 mg） solution was undertaken 4 days after TAE, and repeated every 3-4 days for 2-3 times. Each case undertook upper abdominal CT scan 1 month later, and then with 3, 6 month to 1 year periodic follow-up. Results DSA features of all the 9 cases demonstrated as same as those on enhanced CT scanning with dispersion of lipiodol within the lesions. All the lesions decreased in volume markedly 1 month after the therapy, and kept on until 1 year later. 2 patients developed post-TAE acute cholecystitis and one intrahepatic biloma. Conclusion TAE combined with pereutaneous intra-tumoral bleomycin injection is a safe and effective method in treating hypovascular CHL.（J Intervent Radiol, 2007, 16： 387-389）