肝脏尾状叶血管瘤介入治疗致左半肝坏死一例

患者女 ,6 6岁 ,于 1998年 2月 2 1日因肝脏尾状叶血管瘤在外院行介入治疗 ,造影见肝左动脉由肝固有动脉发出 ,肝右动脉由肠系膜上动脉发出 ,分别自肝左动脉分支灌注碘油 8ｍｌ加平阳霉素 2 0ｍｇ ,肝右动脉分支灌注碘油 2ｍｌ加平阳霉素 4ｍｇ。治疗后自觉右上腹部间歇痛伴呕吐 ,先后于 3月 4日、3月 2 5日入我院治疗。查体 :Ｔ 37 8℃。皮肤、巩膜无黄染 ,右上腹部触痛 ( ) ,莫菲征 ( ) ,肝区叩击痛 ( )。腹部Ｂ超提示 :慢性结石性胆囊炎。初步诊断 :(1)慢性结石性胆囊炎急性作者单位 :0 10 0 5 1　呼和浩特 ,解放军第 2 5 3医院普外科 (…     

介入治疗肝血管瘤28例分析

目的评价超选择性动脉插管栓塞治疗肝血管瘤的临床价值。方法本组28例,男18例,女10例。将导管超选择性插入肝血管瘤供血动脉,一次或分次注入平阳霉素和超液化碘油乳剂。最后用明胶海绵颗粒栓塞供血动脉。结果本组28例栓塞治疗术后1~6个月复查肿瘤不同程度缩小,16例缩小50%以上,不足50%者9例,大小无变化者3例,有效率89.3%(25/28),所有患者术后反应轻、并发症少。结论超选择性动脉插管栓塞是治疗肝血管瘤较理想的治疗方法。     

甲状腺血管瘤一例

患者男性,66岁,发现甲状腺结节2周入院.患者体检扪及右侧甲状腺多发结节,行甲状腺B超提示:甲状腺右叶内多个低回声,内有形态不规则无回声,最大者2.6 cm×1.9 cm,彩色超声提示周边条状血流信号.     

肝海绵状血管瘤致上消化道大出血一例

患者男,32岁。因呕血及排柏油样便三天,以上消化道出血原因待查收入我院。检查除剑突下轻压痛外余正常。经输液止血等治疗无效。剖腹探查,见肝左外叶脏面有一半球形直径6cm的红色包块,质软,表面光滑,与周围肝组织界限分明。腹腔无出血,胃及十二指肠球部均未见溃疡和肿物,胆囊及胆总管不粗大。当即行肝左外叶切除术,术后出血停止,恢复顺利,病理切片为肝海绵状血管瘤。     

肝血管瘤放射介入治疗

肝血管(Cavernous hemangioma of liver,CHL)是肝脏最常见的良性肿瘤,以单发多见。男女之比为1：3,肝血管瘤可分为小的毛细血管瘤和较大的海绵状的血管瘤。临床常无症状。肿瘤巨大可压迫周围脏器引起相应症状,并因肝脏张力升高,有肝破裂的危险。手术切除是治疗肝脏海绵状血管瘤的首选疗法,但病灶巨大,位置临近大血管的疑难病例,手术难度极大,并可给病人带来很大创伤。     

肝血管瘤栓塞致肝脏炎性假瘤一例

患者男性 ,5 5岁。因例行健康体格检查时发现肝血管瘤 4年 ,行病灶硬化剂治疗后发热、腹痛 1年余入院。患者于 1994年体格检查 ,Ｂ型超声发现右肝“血管瘤” ,直径 0 5ｃｍ ,无任何症状。 1997年初复查 ,血管瘤直径增至 2 7ｃｍ。在当地医院行病灶穿刺硬化剂栓塞治疗 (鱼肝油酸钠 )。术后 2月余 ,出现反复高热 38～ 39℃ ,伴右肝区胀痛 ,不伴有恶心、呕吐及黄疸。静脉点滴注射抗生素体温可降至正常 ,停用抗生素后体温又反复升高。Ｂ型超声及ＣＴ均提示 :右肝后叶近膈面实性占位病变 ,直径 5 0ｃｍ ,拟“肝脓肿”收入院。体格检查 :稍消瘦…     

甲状腺海绵状血管瘤一例

患者男,68岁。颈前肿物20余年,近增长加速伴右头疼,影响呼吸、睡眠。查气管偏向左后,颈静脉不怒张。颈前3个结节状肿物,左、峡部及右侧各1个。均有表面光滑、质硬的特点,右侧者最大,为15×15cm,峡部及左侧肿物随吞嚥活动。在锁骨上可扪及玉米粒大淋巴结。X线检查,见右侧块状阴影的上缘模糊,密度不均,可见多数棉团及砂粒样钙化堆集。左侧阴影唯边缘不光滑与之不同。按结节性腺瘤行手术治疗。病理检查切除的囊性腺叶,见甲状腺包膜边缘散在多量被有内皮细胞的血窦,海绵状,排列混乱,腔大小不等,内充满红细胞。诊断:甲状腺海绵状血管瘤。     

肝血管瘤介入治疗术后右肝内胆管广泛坏死一例

病人,女,51岁,于2007年6月冈肝区胀痛,体检发现肝右叶占位,直径约8 cm,后确诊为肝血管瘤,入院后使用碘油、平阳霉素等行介入栓塞(HAE)治疗.     

症状性肝血管瘤介入治疗

目的:评价平阳霉素碘油乳剂及明胶海绵经选择性肝动脉栓塞治疗症状性肝血管瘤的临床应用和疗效.方法:对40例有症状的肝血管瘤患者行肝动脉插管注入平阳霉素碘油乳剂栓塞硬化肝血管瘤体,并用明胶海绵颗粒栓塞瘤体供血动脉.结果:栓塞治疗后肿瘤明显缩小,术后第3、6、12个月复查:肿瘤平均缩小45%、75.0%、80.9%.所有患者栓塞治疗后临床症状明显减轻或消失,无严重并发症发生.结论:选择性肝动脉栓塞术治疗肝血管瘤安全、有效、并发症少,值得临床推广应用.我院自2004-5至2009-12采用平阳霉素碘油乳剂及明胶海绵颗粒或明胶海绵颗条进行时40例肝血管瘤进行了选择性肝动脉栓塞治疗,疗效满意,现报道如下.     

肝海绵状血管瘤的介入治疗

作者自１９９１年３月以来，对３９例肝海绵状血管瘤患者分别经１～３次介入治疗，２８例痊愈，８例病灶区缩小５０％、３例缩小３０％，全组自觉症状消失，取得满意的近期效果。本文对肝海绵状血管瘤的介入治疗、诊断、栓塞材料的选择进行了讨论，并认为血管造影有助于肝脏肿瘤良恶性判别，经导管栓塞肝海绵状血管瘤是一种可行的有效的治疗方法。     

Pineal apoplexy due to massive hemorrhage associated with cavernous angioma: case report

BACKGROUND

Pineal apoplexy is a rare apoplectic event in the pineal region with various possible causes. We report a case of massive hemorrhage in the pineal region associated with a cavernous angioma, and discuss the pathogenesis of pineal apoplexy.

CASE DESCRIPTION

An 11-year-old girl presented with nausea and vomiting persisting for 1 week. Neuroimaging revealed enlarged ventricles and a 4 cm round mass in the pineal region consistent with hematoma. Two weeks after cerebrospinal fluid drainage, the mass was totally removed via the occipital transtentorial approach. The postoperative course of the patient was uneventful. Magnetic resonance imaging after the operation confirmed two paraventricular lesions with surrounding hemosiderin rings, characteristic of cavernous angioma. Histologic examination showed large hematomas and numerous vascular spaces lined by a single layer of endothelium. The diagnosis was pineal apoplexy associated with cavernous angioma, based on the histologic and radiological findings.

CONCLUSIONS

Pineal cavernous angiomas are extremely rare, with only fourteen cases reported previously. We recommend total removal of the causative lesion in cases of pineal apoplexy to prevent repeated bleeding or life-threatening massive hemorrhage.     

A case of cerebellar hematoma due to venous angioma presenting trigeminal dysfunction

With regard to the natural history of venous angioma, the risk of hemorrhage is reported to be relatively higher if the lesion exists in the posterior fossa. However a recent report of 100 cases of venous angioma concluded that the risk of hemorrhage was low, being only 0.22%/year. Although the true rate of hemorrhage is uncertain, we have encountered case of cerebellar hematoma due to venous angioma in the posterior fossa where the patient presented with trigeminal dysfunction and cerebellar ataxia, without any history of hypertension. We considered that venous angioma in the posterior fossa might cause cerebellar hemorrhage. After removal of the hematoma, the patient's symptoms were resolved. In the posterior fossa, a relatively higher volume of venous blood would cause venous congestion to occur more easily, leading to damage of the fragile wall of the angioma.     

Pulmonary embolism due to hepatic tissue--a forensic vital sign? A case report

A case of pulmonary embolism due to hepatic tissue occurring after trauma is presented. This finding may be of forensic value in indicating the antemortem nature of an injury by constituting evidence of an intra vitam phenomenon.     

二次手术切除肝巨大血管瘤一例分析

病人女,68岁,因右上腹坠胀伴乏力2个月入住外院,CT显示肝轮廓明显增大,肝右叶向下至髂棘水平,肝右叶被巨大低密度影肿块占据,约21 cm×15 cm× 28 cm,内见不规则低密度影,增强见动脉期肿块内少许线样强化灶,中心低密度区无强化,门脉期肿块内强化显著,诊断为肝巨大血管瘤.     

Portal hypertension due to hepatic artery-portal vein arteriovenous fistula--a case report.

A case of portal hypertension secondary to traumatic hepatoportal arteriovenous fistula with portal fibrosis was successfully treated by ligation of the afferent hepatic arteries which decreased significantly portal pressure and corrected the abnormal blood inflow to the portal vein via A-V fistula resulting in a recovery of the disturbed liver function. Collateral blood supply from the left hepatic artery into the right hepatic lobe was found to be quite satisfactory after the ligation of the hepatic artery. Hemodynamic data and clinical findings of the present case suggest that the mechanism responsible for the portal hypertension is the inflow block resulting from the interruption of portal venous flow by the inflow of arterial blood via A-V fistula and the subsequent increased blood pressure in portal vein radicals.     

Prolonged hepatic ischaemia due to liver injury: a case report.

A case is reported in which a young male who underwent right hepatectomy necessitated by gunshot wound to the liver, survived 2 h 20 min of normothermic hepatic ischaemia. This case extends the documented duration of hepatic ischaemia compatible with survival and documents the histopathology of the post-ischaemic liver.     

Huge HCC embolized by gelatin sponge particles and iodized oil compared with by iodized oil alone

目的 比较明胶海绵颗粒+碘化油联合化疗栓塞与单独使用碘化油化疗栓塞治疗巨块型肝细胞癌的近期疗效.方法 将行介入治疗的巨块型肝癌患者随机分为两组:明胶海绵颗粒+碘油联合化疗栓塞组及碘油单独栓塞组.明胶海绵颗粒+碘油组33例,年龄为(50.55±10.25)(31～74)岁.单纯碘油组23例,年龄为(56.30±11.53)(34～75)岁.分别对两组患者治疗前与治疗后3天及治疗后1月的肝功能变化、血清甲胎蛋白(AFP)水平、肿瘤大小的改变情况以及栓塞术后并发症发生率进行比较.结果 术前两组各项比较差异无统计学意义,接受治疗1月后两组肝功能指标差别无统计学意义;明胶海绵颗粒+碘油组患者肿瘤缩小程度及AFP阳性患者AFP值下降较单纯碘油组明显(P=0.03,P=0.03);两组术后并发症发生率差别无统计学意义(P=0.08).结论 明胶海绵颗粒+碘化油联合栓塞治疗巨块型肝细胞癌较单独使用碘化油栓塞更有效,是治疗巨块型肝癌的安全、有效的方法.