平阳霉素碘油乳剂联合无水乙醇治疗巨大肝海绵状血管瘤

Pingyangmycin-lipiodol combined with ethanol in treatment of giant cavernous hemangiomas of liver

目的探讨经导管肝动脉灌注平阳霉素碘油乳剂和无水乙醇治疗巨大肝血管瘤的临床疗效、安全性及并发症。方法对13例巨大肝海绵状血管瘤（最大径8～18．5cm）进行经导管肝动脉灌注平阳霉素碘油乳剂（16mg＋碘油10～15ml），然后再将SP管超选择进入肝血管瘤瘤内动脉分别注射无水乙醇碘油乳剂（无水乙醇：碘油1：1）8～17ml，对比观察治疗前后患者的临床表现及肝海绵状血管瘤的大小。结果13例患者进行肝动脉栓塞术均获得成功，8例腹胀患者术后第2天症状消失，1周复查肝肾功能仅3例患者出现谷丙转氨酶（GPT）和碱性磷酸酶（ALP）升高，1个月后复查恢复正常。1个月后复查CT，肝血管瘤缩小51．04％～77．51％。未出现胆道损伤、肝脓肿等并发症。结论经导管肝动脉灌注平阳霉素碘油乳剂及无水乙醇治疗巨大肝海绵状血管瘤具有损伤小、并发症少、疗效好的特点，是肝海绵状血管瘤理想的治疗方法。

Objective To evaluate the therapeutic efficiency, safety and complication of pingyangmycin lipiodol combined with ethanol intra-arterial emholization in treatment of giant cavernous hemangiomas of liver （CHL）. Methods CHLs （maximum diameter 8--18.5 cm） were embolized with Pingyangmycin-lipiodo （Pingyangmycin 16 mg-blipiodo 10--15 ml） via the hepatic artery firstly in 13 patients, and then 8--17 ml ethanol-lipiodol （ethanol ：lipiodol 1：1） were infused into the internal arteries of CHI, with SP microcatheter. The differences of clinic symptoms and tumor volumes pre-procedures and post-procedures were compared. Results The transcatheter arterial embolization （TAE） of 13 patients was all successful. Abdominal distension disappeared for all 8 patients two days after the procedure. GPT and ALP of 3 patients were significantly increased after TAE on the 7 th day and recovered after one month later. CT scan showed significant reduction in tumor size from 51.04% to 77.51% one month after the treatment. There were no significant complications related to the procedures after 9 to 43 months. Conclusion Transeatheter arterial emobilization with pingyangmycin-lipiodol combined with ethanol is an effective method for the treatment of CHL.