平阳霉素碘油栓塞术治疗肝海绵状血管瘤的远期疗效分析

Evaluation of long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion in patients with hepatic cavernous hemangiomas

目的评价平阳霉素碘化油乳剂（PLE）肝动脉栓塞硬化治疗肝海绵状血管瘤（CHL）的远期疗效及其影响因素。方法回顾性分析行PLE肝动脉栓塞和（或）硬化治疗、并有完整随访资料的CHL患者105例共156个瘤灶。按照瘤灶最大径，分为A组（≤3cm）25个、B组（〉3em且〈5cm）32个、C组（≥5cm且〈10cm）58个、D组（≥10cm）41个；异常血窦丰富型90个、较丰富型57个、稀少型9个。105例共行135次治疗，其中治疗1次者75例、2次者30例。术后全部患者均经超声和CT或MRI或DSA检查随访3～8年（平均4年）。以显效、有效、好转和无效作为疗效评价标准，计算总有效率。A、B组和C、D组治疗1次者总有效率之问的比较以及D组治疗1次和2次者总有效率之间的比较皆采用χ2检验，并对瘤灶大小、异常血窦富乏和治疗次数对疗效的影响进行了分析。结果156个瘤灶的治疗总有效率为92．95％（145／156）。接受1次治疗后的A、B两组总有效率为100％（57／57），C、D两组为85．86％（85／99），差异有统计学意义（0=8．8553，P〈0．01）；D组中接受2次治疗者总有效率为100．00％（30／30），而1次治疗者则为72．73％（8／11），差异有统计学意义（χ2=5．2642，P〈0．05）。随访期间105例无复发，未见肝功能损害及严重并发症发生。结论经肝动脉PLE栓塞和（或）硬化治疗异常血窦丰富的CHL小瘤灶，可获得治愈的远期疗效；对于巨大、多发弥漫的CHL，特别是异常血窦丰富或较丰富者，通过重复治疗也可获得满意和肯定的远期疗效。

Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion（PLE） in patients with cavernous hemangiomas of the liver （CHL）and its influence factors. Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper. All hemangiomas were divided into 4 groups according to their size （ the largest size of hemangioma）by the authors as follows： A group（≤3 cm, n =25） ; B group（ 〉3 cm and 〈5 cm, n=32）;C group（≥5 cm and 〈10 cm, n=58）; and D group（ i〉10 cm, n=41）. According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types ： abundant type （ n = 90 ） ; sparse type （ n = 9 ） and the middle type （n = 57 ） . Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures （including single procedure in 75 patients, twice procedures in 30 patients）. All of the 105 patients were followed up 3 to 8 years（mean 4 years） using US, CT or MRI or DSA. The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate. Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by χ2 test respectively. And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively. Results The total effective rate of the 156 hemangiomas in 105 patients was 92. 95% （145/156）. After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% （57/57）, that of C and D groups were 85.86% （85/99）, and the difference reach significant （χ2=8. 8553, P 〈 0.01 ）. In the D group, the total effective rate in group with twice procedures （100.00%, 30/30） was significant higher （ χ2 = 5. 2642, P 〈 0.05 ） than those of group with single procedure （72, 73 %, 8/11 ）. Of this series, during the period of following-up, no recurrent or severe complications were observed. Conclusions A best longterm curative effect （complete cure） is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE.