对成人肝血管瘤自然发展进程及生长方式的新认识：队列研究

New perspectives on the natural history and growth pattern of hepatic hemangioma in adults： a cohort study

目的探索成人肝血管瘤的自然发展进程和生长方式。方法从2010年4月至2013年3月，236例未接受过治疗的肝血管瘤成人患者纳入本研究。随访观察肝血管瘤的自然发展进程及出现的并发症。结果236例肝血管瘤直径0．6—19．2cm不等，中位大小4．5cm。在3—266个月的随访期间（中位时间为48个月），61％的患者肝血管瘤增大，23．7％的血管瘤大小无变化，8．5％的肝血管瘤缩小。30岁前为肝血管瘤患者肿瘤生长高峰（0．46±0．41cm／年），50岁以后肿瘤生长速度明显降低（0．21±0．40cm／年）。小于2．0cm的肝血管瘤生长速度最慢（0．16±0．42cm／年），8．0～10．0cm的肝血管瘤生长最快（0．80±0．62cm／年），大于10．0cm的肝血管瘤生长速度则明显变缓（0．47±0．91cm／年）。随访显示9例患者出现明显的与肿瘤相关的症状，没有发现肿瘤相关并发症。结论绝大多数肝血管瘤均有增大发展趋势，但极少引起并发症。所有肝血管瘤患者均可安全地进行随访。对于症状明显的肝血管瘤患者，手术是最佳治疗方案。

Objective To investigate the natural history and growth pattern of hepatic hemangioma in adults. Methods From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled. A routine follow-up was performed to observe the natural history and complications of these lesions. Results 236 patients were enrolled in the study. The median size of the hemangio- mas was 4. 5 cm （range 0. 6 - 19. 2 cm）. During a median follow-up of 48 months （range 3 -266 months）, the hemangiomas increased in size in 61.0% of patients, remained stable in size in 23.7% , decreased in size in 8.5%. The peak growth period was in patients 〈 30 years age （0.46 ± 0.41 cm/year） and the growth rate decreased significantly after 50 years of age （0. 21 ± 0. 40 cm/year）. Hemangiomas with a size 〈2. 0 cm had the lowest growth rate （0. 16 ±0. 42 cm/year）. The peak growth rate was in hemangiomas 8.0 - 10. 0 cm （ 0. 80 ± 0. 62 cm/year ） , but for hemangiomas 〉 10. 0 cm, the growth rate was only （0. 47 ± 0. 91 ）cm per year. Only 9 patients had severe symptoms caused by the hemangioma. No patients presented with hemangioma-related complications. Conclusions The majority of hepatic hemangiomas have the tendency to increase in size but they rarely caused complications. All the hemangiomas could be safely managed by observation, and surgery should only be considered in patients with complications.