肝动脉栓塞序贯化学消融治疗巨大肝海绵状血管瘤

Hepatic arterial embolization sequenced with percutaneous ethanol injection for the treatment of giant cavernous hepatic hemangioma

目的:评价肝动脉栓塞序贯化学消融治疗巨大肝海绵状血管瘤的有效性。方法:回顾性分析2013年3月-2016年6月收治的直径大于10cm的肝血管瘤患者,分别采用序贯治疗及单独栓塞治疗。序贯治疗组采用博来霉素+碘化油乳剂栓塞,术后1周CT复查,对碘油沉积缺失区采用CT引导下无水乙醇消融治疗;单独栓塞组仅应用博来霉素+碘化油乳剂栓塞。记录术前血管瘤最大径、碘化油及博来霉素用量、围手术期症状变化,栓塞术后1周、乙醇消融术后3d复查肝功能,术后3月、6月CT扫描明确病变大小,记录有无并发症。结果:单独栓塞组18例,序贯组21例。单独栓塞组与序贯组比较,术前、术后3月及术后6月血管瘤最大径分别为(13.1±3.7)cm及(12.9±2.4)cm(P>0.05)、(11.6±3.5)cm及(8.5±2.5)cm(P<0.05)、(7.9±3.9)cm及(5.9±3.8)cm(P<0.05);碘化油用量分别为(10.6±3.8)mL及(11.5±5.3)mL(P>0.05);博来霉素用量分别为(15.8±3.9)mg及(16.2±4.9)mg(P>0.05)。栓塞反应分别发生7例和6例。序贯组乙醇用量5~33mL,平均(16.3±7.7)mL。术后复查肝功能无明显变化。随访期间,腹部症状分别消失分别为6(6/7)例及10(10/12)例,2组均无胆管损伤发生。结论:博来霉素碘化油乳剂栓塞巨大肝海绵状血管瘤疗效确切,栓塞后序贯乙醇化学消融更有利于血管瘤体积的缩小。

Objective: To evaluate the efficacy of transcatheter arterial embolisation(TAE) sequenced with percutaneous ethanol injection(PEI) for the treatment of giant cavernous hepatic hemangioma. Meth.ods: Clinical data of 39 patients with giant cavernous hepatic hemangioma(the max diameter more than 10 cm)were retrospectively analyzed. Patients in the sequential therapy group were treated with TAE with the emulsion of bleomycin and lipiodol, 1 week later, PEI was sequencially performed under the CT-guidance to inject the ethanol to the iodine deficient areas. Transcatheter arterial embolization was solely performed in the TAE alone group. The max diameter of the hemangioma, dosage of iodized oil and bleomycin, as well as the symptom changes were recorded and compared. Liver func-tion were reviewed one week postoperation and three days post PEI. The max diameter of the hemangioma on CT images 3 and 6 months postoperation and the complications during the follow-up were also recorded and compared. Results: Sequential therapy was performed in 21 cases and TAE alone was performed in 18 patients. The max diameter of the hemangioma before operation, 3 months after operation,and 6 months after operation were(13.1±3.7) cm vs(12.9±2.4) cm(P>0.05),(11.6±3.5) cm vs(8.5± 2.5) cm(P<0.05),(7.9± 3.9) cm vs(5.9± 3.8) cm(P<0.05), in the TAE alone group vs the sequential group, respectively; as well as dosage of iodinated oil and bleomycin were(10.6± 3.8)mL vs(11.5±5.3) mL(P>0.05) and(15.8±3.9) mg vs(16.2±4.9) mg(P>0.05), respectively. Postoperative embolization syndromes occured in 7 cases in TAE alone group and 6 cases in sequential group. Dosage of ethanol was 5-33 mL(16.3 ± 7.7 mL). There were no significant changes of liver function before and after the procedure(TAE and PEI), also, there was no billiary damage during the follow-up. In addition, abdominal symptoms disappeared in 6 cases of group of TAE alone and 10 cases of the sequential group. Conclusion: TAE with the emulsion of bleomycin and lipiodol is an effective therapy for the treatment of giant cavernous hepatic hemangioma, while TAE sequenced with percutaneous ethanol injection(PEI) has much better efficacy for the reduction of the hemangioma.