肝海绵状血管瘤供血方式的临床研究

CLINICAL STUDY ON BLOOD SUPPLY OF THE CAVERNOUS HEMANGIOMA OF THE LIVER

目的研究肝海绵状血管瘤（CHL）的血供，探讨经肝动脉、门静脉治疗CHL。方法综合使用术中美兰染色，离体标本造影，剔除与肿瘤相邻的正常肝脏组织检查血管与肿瘤的关系，组织病理学连续切片等方法研究CHL供血血管的特点。结果美兰染色及造影显示肝动脉、门静脉参与供血，经肝静脉流出；与肿瘤相邻的血管大多数为小静脉样结构；连续切片未发现血管直接出入肿瘤，肿瘤边缘包膜中断处血管较多，动静脉结构共存，扩张血窦与肝组织混杂存在。2例不能手术切除的CHL施行肝动脉、门静脉分支结扎插管，并行硬化治疗取得近期疗效。结论CHL由肝动脉、门静脉双重供血，肝静脉为其流出道；对不能手术切除的CHL同时经肝动脉、门静脉介入治疗可取得较好的治疗效果。

To illustrate the blood supply of the cavernous hemangioma of the liver(CHL) and conduct the clinicalpractice through the hepatic artery and portal vein. Methods The characteristics of the vessels and the relationship between vessels and the tumor were observed by methylene blue dying the tumor during the operation,angiography in the resected tumors,trimming the normal tissue around the tumor to observe the vessels,tumor histopathology by continuous shices. Results Methylene blue and angiography showed the tumor blood was supplied by both hepatic artries and portal veins and flowed out of hepaticveins;most of the tumor vessels regardless of affluence of effluence were slim venous-like tissue;histological examinations in thecontinuous slices of the tumors showed that there were no vessles going directly into the tumor region. There was discontinuous fibroconnective tissue between the tumor and liver parenchyma,moreover,both dilated hepatic sinus and normal-looking liver tissueexisted alternatively;abundant vessels were around the fibroconnective tissue. Two patients who received the sclerotherapy on bothartery and portal vein branches got a better result. Conclusions CHL is nourished by both arteries and portal veins. Hepatic vein isthe outflow vessel. Combined hepatic arterial and portal venous obstruction to treat HCH may achieve better results.