Giant cavernous liver hemangiomas： is it the time to change the size categories？

BACKGROUND： Four different sizes （4, 5, 8 and 10 cm in diameter） can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category ＂giant＂ for liver heman- gioma. DATA SOURCES： We reviewed the reports on the categoriza- tion of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symp- tomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups： 〈5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and 〉15.0 cm in diameter. Inclu- sion criteria were noted in 34 articles involving 1972 （43.0%） hemangiomas （〉4.0 cm）. RESULTS： The patients were divided into the following groups： 154 patients （30.0%） with hemangiomas less than 5.0 cm in diameter （small）, 182 （35.5%） between 5.0 cm and 9.9 cm （large）, 75 （14.6%） between 10.0 and 14.9 cm （giant）, and 102 （19.9%） more than 15.0 cm （enormous）. There were 786 （39.9%） asymptomatic patients and 791 （40.1%） symptomatic patients. Indications for surgery related to symptoms were reported in only 75 （3.8%） patients. Operations including 137 non-anatomical resection （12.9%） and 469 enudeation （44.1%） were undearly related to size and symptoms.CONCLUSIONS： The term ＂giant＂ seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as ＂giant＂ are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.

The origin of blood supply for cavernous hemangioma of the liver

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL). METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by in jection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage. RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor. CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

Source of blood supply of liver cavernous hemangioma and sclerosis and embolization treatment

AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25～57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%～30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.

Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma

BACKGROUND: This paper was to review the effects of intraoperative autologous transfusion during modified, normal-temperature, total hepatic vascular exclusion (THVE) for extracapsular resection of giant hepatic cavernous hemangioma. METHODS: The clinical data from 28 patients, who underwent hepatic resection requiring intraoperative autologous transfusion with the cell-saver apparatus, were analyzed retrospectively. The tumors in the 28 patients involved the proximal hepatic veins and inferior vena cava. The diameters of these hemangiomas ranged from 12x15 cm to 18-40 cm. All patients had varying degrees of THVE. ' RESULTS: The 28 patients with hemangioma received integrated resection and recovered. One patient had rupture of tumors resulting in massive hemorrhage of 6000 ml during liver resection; 4 patients had blood transfusions of 400-800 ml; the other 23 patients had no blood transfusion. Only 6 patients underwent the Pringle maneuver with resection. The other 22 patients underwent THVE during the liver resection. The interval of THVE was 5-30 minutes (mean 16 minutes). CONCLUSIONS: Intraoperative autologous transfusion during modified, normal-temperature THVE for extracapsular resection of huge hepatic cavernous hemangioma is feasible.

Resection of Giant Hepatic Cavernous Hemangiomas after Dissection of the Third Porta Hepatis

Objective To establish a novel and safe operation technique for the resection of giant hepatic cavernous hemangiomas involving the retro-hepatic vena cava.Methods After ligating the hepatic artery of affected lobe, the short hepatic veins at the third porta hepatis were dissected and ligated individually to separate the tumor from the retrohepatic vena cava, followed by the resection of the tumor under intermittent interruption of the porta hepatis.Results A total of 62 giant hepatic cavernous hemangiomas were successfully resected without hepatic vascular exclusion. Right and caudate lobectomies were done in 27 cases, right hemihepatectomies in 5 cases, right upper segmentectomies in 7 cases, right posterior lobec-tomies in 7 cases, extended left and caudate lobectomies in 10 cases, and caudate lobectomies in 6 cases. The blood transfusion requirement during operation was 1 400 ml on average. All did well postoperatively during a follow up of 4 - 84 months.Conclusion It is safe and feasible to resect giant hepatic cavernous hemangioma following dissection of the third porta hepatis. During operation the key step is dissection of the short hepatic veins.

Manifestations of hepatic cavernous hemangioma in carbon dioxidedigi-tal subtraction angiography

Objective: To describe the characteristic appearance of cavernous hemangioma of the liver (CHL) presented in carbon dioxide digital subtraction angiography (CO2-DSA) and to evaluate the significance of CO2-DSA in the diagnosis of CHL. Methods: Both CO2-DSA and iodinated contrast DSA (IC-DSA) were performed in all 16 patients with CHL, and the angiographic manifestations in the same patients were compared. The image quality was rated by three experienced angiographers, and the complications were also assessed. Results: There was good correlation between angiographers on image quality (R = 0. 73). Diagnostic images were obtained with both CO2-DSA and IC-DSA in all CHL patients. No difference was noted between IC-DSA and CO2-DSA in visualizing the proper hepatic arteries and its branches (P>0. 05). CO2-DSA produced better images that clearly described the tumor size, shape and margination than those by IC-DSA (P< 0. 05), but both demonstrated characteristic appearances of early opacification and persistent contrast enhancement of the tumors. The portal vein branches near the tumors were constantly demonstrated by CO2-DSA in 15 cases (15/16) but only in 2 cases (2/16) by IC-DSA. Conclusion: CO2-DSA is sensitive in CHL diagnosis, and in patients with contraindications to IC or with unsatisfactory imaging results by IC-DSA, CO2-DSA is a good alternative. As show in most cases by CO2-DSA, the portal veins might act as the main drainage vein of CHLs.

Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma

Sclerosing cholangitis(SC)is a rarely reported morbidity secondary to transcatheter arterial chemoembolization(TACE)with bleomycin-iodinated oil(BIO)for liver cavernous hemangioma(LCH).This report retrospectively evaluated the diagnostic and therapeutic course of a patient with LDH who presented obstructive jaundice 6 years after TACE with BIO.Preoperative imaging identified a suspected malignant biliary stricture located at the convergence of the left and right hepatic ducts.Operative exploration demonstrated a full-thickness sclerosis of the hilar bile duct with right hepatic duct stricture and right lobe atrophy.Radical hepatic hilar resection with right-side hemihepatectomy and Roux-en-Y hepaticojejunostomy was performed because hilar cancer could not be excluded on frozen biopsy.Pathological results showed chronic pyogenic inflammation of the common and right hepatic ducts with SC in the portal area.Secondary SC is a long-term complication that may occur in LCH patients after TACE with BIO and must be differentiated from hilar malignancy.Hepatic duct plasty is a definitive but technically challenging treatment modality for secondary SC.

Interventional treatment of huge hepatic cavernous hemangioma

Obejctive To study the methods of interventional treatment of huge hepatic cavernous hemangioma (HCH) Method A total of 14 patients with HCH were treated with lipiodol ultrafluid (10-15?ml), bleomycin A (PYM 16-32?mg), and gelatin sponge particles Results DSA hepatic arteriography showed multiple vascular lakes in the early arterial phase, so called “to hang the fruits on the branches', which persisted for a long time CT scan showed a significant reduction in tumor size in 8 of the 14 patients after the treatment Conclusion Embolization with lipiodol ultrafluid, PYM and gelatin sponge particles is one of the best methods for the treatment of HCH

平阳霉素碘油乳剂联合无水乙醇治疗巨大肝海绵状血管瘤

目的探讨经导管肝动脉灌注平阳霉素碘油乳剂和无水乙醇治疗巨大肝血管瘤的临床疗效、安全性及并发症。方法对13例巨大肝海绵状血管瘤（最大径8～18．5cm）进行经导管肝动脉灌注平阳霉素碘油乳剂（16mg＋碘油10～15ml），然后再将SP管超选择进入肝血管瘤瘤内动脉分别注射无水乙醇碘油乳剂（无水乙醇：碘油1：1）8～17ml，对比观察治疗前后患者的临床表现及肝海绵状血管瘤的大小。结果13例患者进行肝动脉栓塞术均获得成功，8例腹胀患者术后第2天症状消失，1周复查肝肾功能仅3例患者出现谷丙转氨酶（GPT）和碱性磷酸酶（ALP）升高，1个月后复查恢复正常。1个月后复查CT，肝血管瘤缩小51．04％～77．51％。未出现胆道损伤、肝脓肿等并发症。结论经导管肝动脉灌注平阳霉素碘油乳剂及无水乙醇治疗巨大肝海绵状血管瘤具有损伤小、并发症少、疗效好的特点，是肝海绵状血管瘤理想的治疗方法。

平阳霉素碘油乳剂治疗肝血管瘤的临床应用价值

目的 评价和探讨平阳霉素碘油乳剂 (PLE)治疗肝血管瘤的临床应用和疗效。方法 治疗肝血管瘤 12例 ,瘤体最小 3 .3cm× 3 .0cm ,最大 12 .0cm× 13 .0cm ,采用Seldinger技术股动脉插管 ,将导管超选择至肿瘤供血动脉插管后 ,注入平阳霉素碘油乳剂 ,并用明胶海绵颗粒栓塞供血动脉。术后定期复查。结果 介入治疗栓塞后碘油沉积良好 ,所有瘤体均有不同程度缩小 ,术后无严重并发症发生。结论 平阳霉素碘油乳剂治疗肝血管瘤安全、有效 ,并发症少 ,可成为治疗肝血管瘤的重要手段。

平阳霉素碘油乳剂治疗肝血管瘤

目的 探讨平阳霉素碘油乳剂 (PLE)在肝海绵状血管瘤 (CHL)介入治疗中的临床价值。方法 2 8例肝CHL ,经肝动脉的PLE治疗 ,观察治疗前后肿瘤大小 ,碘油沉积情况 ,临床症状及并发症。结果 PLE治疗后 ,肿瘤直径明显缩小 ,碘油沉积良好 ,临床症状缓解 ,无严重并发症。结论 PLE经肝动脉介入治疗CHL是安全有效的方法。

肝脏海绵状血管瘤的双重供血及外科处理

１３年来，住院治疗的６８例成人肝脏海绵状血管瘤病人，男３１例，女３７例，年龄３６－６７，平均４３岁。肿瘤直径３．５－２９ｃｍ。手术包括单纯肿瘤切除，肝脏楔脉造影显示：肝脏海绵状血管瘤系肝动脉和门静脉双重供血。肝动脉栓塞，硬化疗法和结扎的适应证：有症状的大海绵状血管，手术切除困难或有较大的手术危险性者。

肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

目的探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的疗效和安全性。方法前瞻性研究9例少血供性肝海绵状血管瘤患者经肝动脉栓塞结合经皮经肝瘤体内药物注射治疗情况。对于CT/MRI明确诊断的肝海绵状血管瘤(直径>5cm),且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此表现的9例患者,先行肝动脉插管栓塞术,栓塞剂为超液化碘油(10ml)与博莱霉素(8mg)混悬剂,实际用量为5～10ml。栓塞后4d开始行经皮经肝瘤体内穿刺多点注射博莱霉素8～16mg,间隔3～4d再次注射,连续2～3次,1个月后复查CT,以后3、6个月及1年不定期复查CT。结果9例患者DSA上所见血管瘤染色与CT增强扫描表现一致,碘油沉积呈散在点状分布,治疗后1个月瘤体均明显缩小,以后继续缩小,1年后复查基本稳定不再缩小。2例患者出现急性胆囊炎,对症处理后痊愈。1例出现栓塞后胆汁瘤,随访观察未进一步进展,未作特殊处理。结论经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法。

PLE+GF栓塞治疗肝血管瘤

目的探讨平阳霉素碘油乳剂(PLE)+明胶海绵(GF)颗粒栓塞治疗肝血管瘤的疗效和价值。方法采用Seldinger技术经股动脉穿剌插管,超选择至血管瘤供血动脉,对15例肝海绵状血管瘤(CHL)注入PLE至血管瘤体完全充填,并用GF颗粒栓塞供血动脉。定期观察瘤腔碘油充填情况、疗效和并发症。结果PLE+GF栓塞治疗后,碘油存积好,血管瘤体积明显缩小,无严重并发症。结论PLE+GF栓塞治疗肝血管瘤具有疗效好、创伤小、并发症少等优点。

肝海绵状血管瘤经动脉栓塞治疗

目的 探讨经动脉栓塞治疗肝海绵状血管瘤的机理、临床疗效及并发症的防治。方法 １２ 例经Ｂ超、ＣＴ 或ＭＲＩ及血管造影证实的肝海绵状血管瘤，作超选择性肝动脉插管栓塞。栓塞剂为超液态碘油、明胶海绵及弹簧圈。结果 栓塞术后病人症状改善，所有病灶均有不同程度的缩小，其中９ 例缩小５０ ％ 以上，１ 例４ 年后Ｂ超检查瘤体消失。结论 经动脉栓塞治疗肝海绵状血管瘤是一种有效方法，在碘油和明胶海绵栓塞基础上再用弹簧圈栓塞。

肝海绵状血管瘤的外科综合治疗

目的 探讨多种外科方式治疗肝海绵状血管瘤(LHG)的适应证与手术经验。方法 对我院近10年来经手术切除、瘤体捆扎、肝动脉结扎或栓塞、微波固化术等不同方法治疗的LHG580例进行总结、分析,对手术指征,手术方式选择,术中防止大出血的方法及应急措施,术后辅助治疗等进行讨论。结果 全组术后1个月内死亡2例,占034%;其余均恢复顺利,近5年来已无手术死亡。结论 为提高手术安全性,获得满意疗效,治疗LHG应根据病变大小、部位、全身情况,选择不同的手术方法或联合方式进行综合治疗。

肝海绵状血管瘤CO_2-DSA与常规DSA的比较研究

目的：评价二氧化碳数字减影血管造影（CO2－DSA）在肝海绵状血管瘤（CHL）中的诊断价值。材料和方法：对7例CHL患者行CO2－DSA，其影像表现与常规DSA相比较。结果：7例CHL患者均获得有明显诊断价值的CO2－DSA图像，与常规DSA相比仅1个近右隔顶的小病灶未被显示。CO2－DSA显示瘤体大小、形态及边缘情况较碘剂DSA好，同样可显示出“早出晚归”这一特征性表现。7例CHL－CO2－DSA均在瘤体附近出现门脉分支的显影（7／7），而常规DSA仅有1例显示（1／7）。结论：CO2－DSA可对CHL作出准确诊断，CHL患者CO2－DSA中显示门脉，提示门脉为CHL的主要引流静脉。

甲状腺腺瘤与肝海绵状血管瘤同期联合微波消融治疗的初步尝试

超声引导下经皮穿刺微波消融术具有创伤小、恢复快、患者依从性高等优势，是不愿或无法接受外科手术患者的较好选择，目前常用于肝、肺、肾、甲状腺、下颌下腺等部位肿瘤的微创治疗，显示了初步疗效[1]。微波消融术常针对单个脏器单独施治，也可多个脏器联合消融[5]，且由于具有微创、损伤局限等特点，其对患者生命体征影响小，多个脏器联合消融可能更有应用前景，但目前相关临床实践较少。

肝动脉栓塞联合经皮瘤体内注药术治疗肝海绵状血管瘤

目的探讨经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤的疗效和价值。方法采用Seldinger技术行肝动脉插管至血管瘤供血动脉,对32例肝海绵状血管瘤注入PLE至血管瘤体大部分充填,用明胶海绵颗粒栓塞供血动脉;对碘油空虚区域再行经皮瘤体内直接注射PLE。定期观察瘤体碘油充填情况,瘤体大小和并发症。结果经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤后,碘油存积好,血管瘤体积明显缩小,无严重并发症。结论经肝动脉栓塞结合经皮瘤体内直接注射治疗肝血管瘤具有疗效好,并发症少等优点。

动脉栓塞术与微波消融术治疗肝海绵状血管瘤患者临床疗效对比研究

目的对比研究动脉栓塞术(TAE)与微波消融治疗肝海绵状血管瘤(CHL)患者的临床疗效。方法2014年1月~2018年4月我院综合介入科就诊的74例CHL患者,其中37例接受微波消融治疗,另37例接受TAE治疗,随访6个月。结果两组疗效比较,无统计学差异(86.5%对75.7%,P>0.05);治疗后,微波消融组血清丙氨酸氨基转移酶和天门冬氨酸氨基转移酶水平分别为(47.9±5.7)U/L和(35.5±4.3)U/L,显著低于TAE组[分别为(93.5±11.2)U/L和(61.3±5.8)U/L,P<0.05];术后12 h、24 h和48 h时,微波消融组视觉模拟评分分别为(2.8±0.5)分、(1.7±0.2)分和(1.1±0.1)分,显著低于TAE组[分别为(4.7±0.9)分、(2.6±0.8)分和(1.8±0.3)分,P<0.05];治疗后,两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论TAE和微波消融治疗CHL患者疗效类似,术后不良反应发生率低,临床可根据技术条件选择应用。