肝海绵状血管瘤血管造影分型与超选择栓塞治疗

Angiographic classification and selective hepatic artery embolization of hepatic cavernous hemangioma

目的：探讨不同类型肝海绵状血管瘤造影表现和超选择肝动脉栓塞治疗的临床疗效。方法选择2001年9月至2012年9月泰州市人民医院收治的CHL患者48例，其中男15例，女33例，年龄25～72岁，中位年龄42岁。所有患者行腹腔动脉、肠系膜动脉造影检查，根据血管造影表现将所有病灶分为3种类型：高流量、中等流量、低流量。超选择插入肝血管瘤供血动脉，将平阳霉素与碘化油混合栓塞。参照WHO实体瘤疗效评价通用标准，根据肝血管瘤的缩小率评价疗效，同时观察患者临床症状改善及并发症发生情况。结果48例患者共92个病灶，其中高流量30个病灶，中等流量35个病灶，低流量27个病灶。31例术前有不同程度临床症状患者中，24例症状完全消失，7例症状明显缓解。随访6个月至3年，复查病灶不同程度缩小。高流量病灶与中等流量病灶治疗效果相似，但均与低流量病灶疗效存在明显差异。结论超选择性肝动脉栓塞治疗肝海绵状血管瘤，安全有效，并发症少，高流量病灶与中等流量病灶疗效佳，低流量病灶疗效欠满意，可考虑多次栓塞或外科手术。

ObjectiveTo evaluate the classification of cavernous hemangioma of liver （CHL） based on angiographic appearance and to investigate the clinical effect of selective hepatic artery embolization.Methods From September 2001 to September 2012,48 patients, included 15 male and 33 female （mean age 42 yrs）, were involved in the present retrospective study in Taizhou People＇s Hospital. Angiography was performed with the catheters placed on proper hepatic artery and superior mesenteric artery in all patients. According to the angiographic appearance, all lesions were classified as high flow type, intermediate flow type and lower flow type. Hepatic artery embolization with pingyangmycin-lipiodol emulsion was performed with via selective catheterization into the artery supplying blood to the tumors. According to WHO solid tumors reference standard, evaluate clinical efficacy by the reduction rate of tumor; the changes of the clinical symptoms and complications were all recorded in the follow-up data. Results 92 lesions of 48 cases were treated successfully.Results Of all 92 lesions, high flow type was seen in 30, intermediate flow type in 35 and lower flow type in 27. The clinical symptoms of 31 cases disappeared in 24 cases, relieved in 7 cases. Follow-up 6 months to 3 years, the size of the lesions reduced in different degrees. The clinical effect of high flow type and intermediate flow type were similar between them, but lower flow type was significant different.Conclusion Selective hepatic artery embolization for CHL proves to be effective, safe and little side-effects. The clinical effect of high flow type and intermediate flow type are excellent. Lower flow type is less satisfactory effective, and may be repeated embolized or operated.