婴幼儿肝血管瘤的临床特点、影像学表现及疗效观察

Clinical and imaging features,and curative effect observation of 54 infants with hepatic hemangioma

目的分析54例婴幼儿肝血管瘤(IHH)的临床特点及影像学表现,同时评价IHH患者治疗疗效。方法2005年1月至2018年3月山东第一医科大学附属医院收治IHH患者54例。选取同期年龄<14岁其他肝脏局灶性病变患者58例。比较两组患者的临床特征和影像学表现。结果IHH组、非IHH组年龄为(17.2±7.5)个月、(42.3±16.5)个月,差异有统计学意义(P<0.05);IHH组AFP<20μg/L为41例(75.9%),>20μg/L为13例(24.1%),非IHH组AFP<20μg/L为8例(13.8%),>20μg/L为50例(86.2%),差异有统计学意义(P<0.05);IHH组、非IHH组肿瘤直径为(5.6±1.8)cm、(8.4±2.6)cm,差异有统计学意义(P<0.05);IHH组阻力指数(RI)<0.7为43例(79.6%),>0.7为11例(20.4%),非IHH组RI<0.7为16例(27.6%),>0.7为42例(72.4%),差异有统计学意义(P<0.05)。54例IHH患者局灶型43例(79.6%),多灶型7例(13.0%),弥漫型4例(7.4%);病变边界清楚52例(96.3%),边界欠清2例(3.7%);病灶存在钙化26例(60.5%),且均为局灶型患者。CT平扫IHH均呈低密度影,增强CT动脉期病灶周边明显强化,门静脉期呈向心性填充增强。IHH病灶MRI T1加权序列表现为低信号,T2加权序列为高信号,增强MRI表现同增强CT。54例IHH患者随访观察26例(48.1%);17例因肝肿大、呼吸困难等予以药物干预,其中激素治疗8例(14.8%),普萘洛尔治疗7例(13.0%),激素联合普纳洛尔治疗2例(3.7%);9例因药物治疗效果不理想予以手术干预,其中外科手术切除7例(13.0%),经肝动脉介入栓塞治疗2例(3.7%)。病灶消退或治愈45例(83.3%),病灶显著缩小5例(9.2%)。存活51例(94.4%),3例(5.6%)因心力衰竭死亡。结论相较于其他肝脏局灶性病变,IHH患者年龄小、AFP水平低、肿瘤直径小。超声、增强CT及增强MRI是诊断IHH有效方式。多数IHH患者自然病程良好,激素、普纳洛尔及肝血管瘤外科切除均是缓解症状的治疗方式。

Objective To analyze the clinical and imaging features of ultrasound,contrasted enhanced CT(CECT)and contrasted enhanced MRI(CEMRI)in 54 infants with hepatic hemangioma(IHHs),and to evaluate the therapeutic effect of IHH.Methods From January 2005 to March 2018,there were 54 IHHs(19 males and 35 females)with an age of(17.2±8.5)months.Fifty-eight patients with other focal liver lesions under 14 years old were selected in the same period.Results Univariate analysis of clinical data of IHHs(IHH group)and other patients with focal liver lesions(non-IHH group)showed that the ages of IHH group and non-IHH group were(17.2±7.5)months and(42.3±16.5)months,with statistical significance(P<0.05).41 cases(75.9%)with AFP<20 ng/mL in IHH group,13 cases(24.1%)with AFP>20ng/ml in non-IHH group,8 cases(13.8%)with AFP<20 ng/mL and 50 cases(86.2%)with AFP>20 ng/mL had statistical significance(P<0.05).The tumor diameters of IHH group and non-IHH group were(5.6±1.8)cm and(8.4±2.6)cm,with statistical significance(P<0.05).In IHH group,resistance index(RI)was<0.7 in 43 cases(79.6%),>0.7 in 11 cases(20.4%),and in non-IHH group,RI was<0.7 in 16 cases(27.6%),and>0.7 in 42 cases(72.4%),the difference was statistically significant(P<0.05).Among the 54 IHHs,43 were focal type(79.6%),7 were multifocal type(13.0%),and 4 were diffuse type(7.4%).The lesion boundary was clear in 52 cases(96.3%)and unclear in 2 cases(3.7%).There was calcification in 26 cases(60.5%),and all cases were from patients with focal type.On plain CT scan of IHHs,it was showed low-density shadow,and CECT showed obvious enhancement around the lesion in arterial phase and centripetal filling enhancement in portal vein phase.On MRI of IHH lesions,T1-weighted sequence showed lower signal intensity than normal liver parenchyma,and T2-weighted sequence showed higher signal intensity.CEMRI showed the same performance as CECT.26 cases(48.1%)of 54 IHHs were followed up.17 cases were treated with drugs because of hepatomegaly and dyspnea,including 8 cases(14.8%)treated with hormone,7 cases(13.0%)treated with propranolol and 2 cases(3.7%)treated with hormone combined with propranolol.9 cases were treated with surgical intervention because of unsatisfactory drug treatment effect,including 7 cases(13.0%)with surgical resection and 2 cases(3.7%)with transcatheter arterial embolization.The lesions subsided or cured in 45 cases(83.3%)and significantly reduced in 5 cases(9.2%).All patients were followed up effectively for at least 3 months,51 cases(94.4%)survived and 3 cases(5.6%)died of heart failure.Conclusion Compared with other focal liver lesions,IHH is younger in diagnosis,lower in AFP level and smaller in tumor diameter.Ultrasound,CECT and CEMRI are effective ways to diagnose IHH.Most IHH patients have a good natural course of disease,and hormone,propranolol and surgical resection of hepatic hemangioma are the effective treatment methods to relieve symptoms.