介入栓塞联合普萘洛尔治疗婴幼儿弥漫型肝血管瘤7例

Interventional embolization combined with propranolol for the treatment of diffuse infantile hepatic hemangioma:preliminary results in 7 cases

目的探讨介入栓塞联合普萘洛尔治疗弥漫型婴幼儿肝血管瘤(IHH)的安全性和有效性。方法回顾性分析7例弥漫型IHH患儿临床资料。采用介入栓塞联合口服普萘洛尔治疗方案。微导管超选择瘤体供血动脉,选用平阳霉素碘化油乳剂和聚乙烯醇(PVA)颗粒栓塞病灶,根据有无动静脉分流选择不同注射顺序,40%~50%病灶栓塞后停止栓塞,经肝固有动脉灌注平阳霉素稀释液。随访观察疗效、不良反应及并发症。结果7例弥漫型IHH患儿超选择性肝动脉栓塞术均获成功。术后口服普萘洛尔,逐渐增加剂量至2 mg/kg(2次/d)。术后随访5~14个月,4例完全缓解,2例部分缓解,总有效率为85.7%(6/7),1例死亡。未发生与介入栓塞及普萘洛尔相关并发症。结论介入栓塞联合口服普萘洛尔治疗弥漫型IHH安全有效。弥漫型IHH病情进展较快,建议在出现严重临床症状前尽早治疗。

Objective To explore the safety and efficacy of interventional embolization combined with propranolol in the treatment of diffuse infantile hepatic hemangioma(IHH).Methods The clinical data of 7 pediatric patients with diffuse IHH who received interventional embolization combined with oral propranolol were retrospectively analyzed.Superselective catheterization of the feeding artery of the hemangioma with a microcatheter was performed,which was followed by embolization of the hemangioma using pingyangmycin iodized oil emulsion and polyvinyl alcohol(PVA)granules.Based on the presence or absence of an arteriovenous shunt,the different injection orders were adopted.When 40%-50%volume of the lesion was embolized,the embolization was stopped,and the perfusion of pingyangmycin dilution via the proper hepatic artery was carried out.The pediatric patients were followed up to observe the clinical efficacy,adverse reactions and complications.Results Successful superselective hepatic artery embolization was accomplished in all the 7 pediatric patients with diffuse IHH.After surgery,propranolol was administered orally and the dose was gradually increased to 2 mg/kg(twice a day).After treatment,the patients were followed up for 5-14 months,the complete remission was obtained in 4 pediatric patients and partial remission in 2 pediatric patients,with a total response rate of 85.7%(6/7),and one pediatric patient died.No interventional embolization-related or propranolol-related complications occurred.Conclusion For the treatment of diffuse IHH,interventional embolization combined with propranolol is clinically safe and effective.As the progression of diffuse IHH disease is usually rapid,the pediatric patients should be treated as early as possible before the severe clinical symptoms occur.