肝动脉栓塞介入术治疗不同血供类型肝血管瘤的临床观察

Effect of Transcatheter Arterial Chemoembolization in Hepatic Hemangioma Cavemosum Patients with Variant Blood Supply

目的分析富血供型、中等血供型、乏血供型对肝血管瘤经肝动脉栓塞介入术后瘤体缩小率、动脉期强化比率缩小率及肝功能的影响。方法选择不同血供类型HHC患者,富血供型30例、中等血供型30例、乏血供型30例,分别纳入富血供组、中等血供组、乏血供组。3组患者接受肝动脉栓塞介入术治疗。术后统计3组患者术后瘤体缩小、动脉期强化比率缩小率及博来霉素碘化油用量。评定临床疗效、肝功能和微循环及并发症。结果富血供组、中等血供组、乏血供组术后瘤体缩小、动脉期强化比率缩小率差异比较无统计学意义(P>0.05)。富血供组患者博来霉素碘化油用量均高于中等血供组、乏血供组(P<0.05)。3组患者临床总有效率(28/30、25/30、26/30)差异比较均无统计学意义(P>0.05)。术前3组患者丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平差异比较均无统计学意义(P>0.05);术后富血供组患者ALT、TBIL水平均低于中等血供组、乏血供组(P<0.05)。术前3组患者D-D和PT水平差异比较均无统计学意义(P>0.05);术后富血供组患者D-二聚体(D-D)和凝血酶原时间(PT)水平均低于中等血供组、乏血供组(P<0.05)。3组患者并发症总发生率(4/30、6/30、5/30)差异比较无统计学意义(P>0.05)。结论肝动脉栓塞介入术治疗不同血供类型肝血管瘤能在保证安全性和临床疗效基础上改善患者机体微循环状态,并对富血供型患者肝功能改善最明显,建议使用。

Objective To investigate the effect of transcatheter arterial chemoembolization on tumor volume reduction rate,reduction rate of arterial phase enhancement,and liver function in hepatic hemangioma cavemosum(HCC)patients with rich,medium and deficient blood supply.Methods HHC patients with different blood supply were enrolled,and classified into rich blood supply group(n=30),medium blood supply group(n=30)and deficient blood supply group(n=30).All patients received transcatheter arterial chemoembolization.After operation,the tumor volume reduction rate,reduction rate of arterial phase enhancement and the dosage of bleomycin-lipiodol were recorded in the 3 groups.The clinical efficacy,liver function,microcirculation and complications were evaluated.Results The tumor volume reduction rate and reduction rate of arterial phase enhancement demonstrated no significant difference among the 3 groups(P>0.05).The dosage of bleomycin-lipiodol of rich blood supply group was significantly higher than that of medium blood supply group and deficient blood supply group(P<0.05).The clinical efficacy rate was 28/30,25/30 and 26/30 in the 3 groups,which manifested no significant difference(P>0.05).Serum alanine transaminase(ALT)and total bilirubin(TBIL)yielded no significant difference among the 3 groups at the baseline(P>0.05).After treatment,serum levels of ALT and TBIL were significantly lower in rich blood supply group than in medium blood supply group and deficient blood supply group(P<0.05).D-dimer(D-D)and prothrombin time(PT)before surgery presented no significant difference among three groups(P>0.05),while the D-D and PT were significantly lower in rich blood supply group than in medium blood supply group and deficient blood supply group after surgery(P<0.05).The complication rate was 4/30,6/30 and 5/30 in three groups,which denoted no significant difference among three groups(P>0.05).Conclusion Application of transcatheter arterial chemoembolization in HHC patients with variant blood supply can effectively and safely ameliorate the microcirculation state and improve the liver function,and obtains prominent improvement in liver function of patients with rich blood supply,which is worthy of recommendation.