肝海绵状血管瘤患者肝动脉栓塞致门静脉损伤原因分析

经肝动脉内注入平阳霉素碘油乳剂栓塞治疗肝海绵状血管瘤1例。结果患者出现门静脉血栓形成、肝栓塞坏死严重并发症。认为用血管硬化剂平阳霉素碘油乳剂超选择性栓塞肝动脉，可造成病变外正常肝和门静脉的损伤，且治疗非常困难。     

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技术经股动脉穿刺插管,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.     

经导管动脉栓塞治疗肝海绵状血管瘤

目的评价经导管肝动脉栓塞术治疗肝海绵状血管瘤的疗效。方法经导管注入碘油和平阳霉素混合乳剂,再用适量明胶海绵颗粒加强栓塞治疗肝海绵状血管瘤28例(34次),术后随访12～24月,观察栓塞前、后瘤体的变化及临床症状缓解情况。结果所有患者经1～3次栓塞治疗后临床症状完全消失,瘤体均有不同程度的缩小,部分缓解者(瘤体缩小大于50%)19例(67.9%,19/28),好转者(瘤体缩小25%～50%)7例(25%,7/28),均无严重并发症发生。结论碘油和平阳霉素混合乳剂加适量明胶海绵颗粒联合栓塞是治疗肝海绵状血管瘤较为理想的方法,临床观察安全有效。     

介入栓塞治疗不同体积肝血管瘤的临床疗效及血流动力学特征

目的探讨平阳霉素碘油乳剂肝动脉栓塞治疗不同体积肝血管瘤的临床疗效。方法将30例肝血管瘤患者分为3组,分别为A组病灶5 cm者6例、B组病灶为5~8 cm者15例、C组病灶8 cm者9例。采用世界卫生组织(WHO)实体瘤疗效评价标准对经肝动脉平阳霉素碘油栓塞治疗12~24个月后的疗效进行分析。结果介入栓塞治疗后A组血管瘤平均缩小率82.7%,栓塞有效率为100%(6/6)。B组血管瘤平均缩小率70.5%,栓塞有效率为86.7%(13/15)。C组平均缩小率63.5%,栓塞有效率为77.8%(7/9)。A组血管瘤平均缩小率及总有效率显著优于B、C组,差异有统计学意义(P0.05)。B组血管瘤平均缩小率及总有效率高于C组,差异有统计学意义(P0.05)。结论介入栓塞的疗效与肝血管瘤体积呈负相关。     

复合性碘油乳剂栓塞治疗肝脏血管瘤

目的肝脏血管瘤栓塞治疗方法很多,本文重点探讨复合性碘油乳剂对栓塞治疗肝脏血管瘤的疗效评定及毒副反应.方法经股动脉穿刺插管在X线电视导向下将导管选择性插入到肝动脉的病变近端注入复合性碘油乳剂10mL～20mL行肝脏血管瘤栓塞(其配方为乙碘油10mL、鱼肝油酸钠6mL、平阳霉素16mg/5mL生理盐水).结果12例肝脏血管瘤病例均为一次栓塞成功,术后患者症状消失,肝脏功能正常,追踪1a～5a复查可见病变缩小1/3～1/2,治疗效果肯定,病变无复发.结论复合性碘油乳剂栓塞治疗肝脏血管瘤可使病变血管内膜破坏粘连狭窄和阻断,病变面积缩小,其疗效肯定,毒副作用小,应推广使用.     

碘油平阳霉素乳剂联合明胶海绵颗粒栓塞子宫动脉治疗子宫肌瘤

将64例子宫肌瘤患者随机分为两组。观察组34例,用碘油平阳霉素乳剂联合明胶海绵颗粒实施子宫动脉栓塞术（UAE）;对照组30例,用海藻酸钠微球（KMG）实施UAE。治疗6个月后,观察组子宫及肌瘤平均缩小率分别为51.13%、57.96%,对照组分别为50.44%、59.17%,两组相比,P均〉0.05;观察组月经量减少32.63%,对照组减少42.61%,两组相比,P均〉0.05。认为碘油平阳霉素乳剂联合明胶海绵颗粒栓塞子宫动脉治疗子宫肌瘤,效果与KMG相近。     

肝血管瘤动脉造影诊断与栓塞治疗

为了探讨肝血管瘤(CHL)的肝动脉造影诊断及特异性鉴别诊断征象,总结栓塞治疗效果,寻求理想栓塞方法,回顾分析了25例CHL选择性肝动脉造影的表现与鉴别诊断征象,观察平阳霉素(PYM)超液态碘化油乳剂栓塞治疗的效果,随访6-48个月。CHL典型的瘤体显影形态,造影剂染色时间的特点,可与肝癌鉴别,动-静脉瘘的出现作为鉴别依据缺乏特异性;25例栓塞治疗,其中1次栓塞18例,2次栓塞7例,瘤体均缩小达50％以上,临床有效率达100％,无严重并发症发生。选择性肝动脉造影是诊断肝血管瘤较理想的方法,介入栓塞治疗应作为首选方法推广应用。     

微波刀消融肝海绵状血管瘤的临床报告

目的探讨在B超引导下使用微波刀消融肝海绵状血管瘤的临床价值。方法63例肝海绵状血管瘤患者随机分成观察组39例，应用B超引导下冷循环微波刀局部消融治疗，对照组24例选用肝动脉介入注射平阳霉素碘油乳剂栓塞硬化，观察两种方法术后1年临床治愈率。结果术后6月，观察组有7例（17．9％，7／39）血管瘤有血供，进行第2次微波消融术。对照组16例（66．7％，16／24）血管瘤有血供，进行2次介入治疗（P〈0．01）。术后12个月，观察组28例患者瘤体缩小超过50％，治愈率为71．8％（28／39）；对照组15例瘤体缩小超过50％，治愈率为62．5％（P〉0．05）。结论采用B超引导下冷循环微波刀局部消融治疗肝海绵状血管瘤效果确切。     

生物微球联合碘油经肝动脉栓塞化疗治疗原发性肝癌临床观察

目的观察生物微球联合碘油经肝动脉栓塞化疗(TACE)治疗不能手术切除的原发性肝癌患者的临床疗效。方法选择本院2010年1月至2012年12月40例行选择性肝动脉栓塞化疗时使用生物微球联合碘油栓塞化疗的原发性肝癌患者和42例行选择性肝动脉栓塞时使用碘油栓塞化疗的患者,每例行栓塞术4次以上,于首次术后1、3、6、12和24 m随访生存患者肝功能、甲胎蛋白、腹部增强CT等变化,比较治疗后病灶缩小程度,观察肿瘤部分缓解率及患者生存率。结果在首次术后3个月时,微球联合组肿瘤缓解率为(57.44%),明显高于TACE组[(45.23%),P0.05],6个月时微球联合组AFP为(296.7±96.3)ng/ml,明显低于TACE组[(346.9±118.3)ng/ml,P0.05],12个月时微球联合组肿瘤直径为(3.36±1.37)cm,明显低于TACE组[(4.98±1.87)cm,P0.05],24个月时微球联合组生存率为(15.0%),明显高于TACE组[(2.3%),P0.05]。结论生物微球联合碘油栓塞化疗治疗患者病灶缩小程度、AFP下降水平、肿瘤部分缓解率及患者生存率明显高于单纯碘油栓塞化疗组,生物微球联合碘油栓塞化疗治疗中晚期原发性肝癌疗效确切,临床疗效优于单纯栓塞化疗,且安全可行。     

平阳霉素乙碘油瘤体灌注联合明胶海绵动脉栓塞治疗颌面部多发性海绵状血管瘤(附1例报告)

对于多发性海绵状血管瘤，尚无有效治疗方法。近来，我们采用平阳霉素乙碘油瘤体灌注联合明胶海绵动脉栓塞治疗颌面部多发性海绵状血管瘤1例，疗效较好。现报告如下。     

Segmental transcatheter arterial embolization for primary hepatocellular carcinoma

ＩＮＴＲＯＤＵＣＴＩＯＮＳｅｇｍｅｎｔａｌｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｅｍｂｏｌｉｚａｔｉｏｎ（ＳＬｐＴＡＥ）ｈａｓｂｅｃｏｍｅｏｎｅｏｆｅｘｃｅｌｅｎｔｉｎｔｅｒｖｅｎｔｉｏｎａｌｍｅｔｈｏｄｓｆｏｒｐｒｉｍａｒｙｈｅｐａｔｏｃｅｌ...     

高温碘油热栓塞治疗原发性肝癌患者

目的 探讨高温碘油血管栓塞及热杀伤作用对原发性肝癌的疗效。方法 将131例原发性癌患者随机分为两组：热碘油栓塞组63例，化疗栓塞组68例。采用Seldinger方法，将导管超选择插入肿瘤供血动脉：（1）用110℃稀释热碘油脉冲式热栓塞；（2）用碘油化疗药物乳剂栓塞。结果 热栓塞组肿瘤小率和甲胎蛋白（AFP）复常率高于化疗栓塞组，而且术后临床不良反应轻，肝功能损害不明显，生存期较长。结论 高温稀释碘油流动性增加，对肿瘤滋养血管栓塞更为彻底，比热提高，对肿瘤细胞热杀伤作用增强。治疗原发性肝癌疗效好，不良反应轻，适应证广。     

Pancreatic tissue damage by transcatheter arterial embolization for hepatoma

We analyzed the serial changes in serum pancreatic enzyme activities by transcatheter arterial embolization (TAE) in 20 hepatoma patients with liver cirrhosis in an attempt to evaluate the incidence of the pancreatic tissue damage by TAE. Serum amylase activities increased in two (10%) cases, elastase 1 levels in six (30%) cases, and trypsin and pancreatic secretory trypsin inhibitor (PSTI) levels in each of five (25%) cases. Consequently, TAE resulted in the elevation of at least more than one serum pancreatic enzyme in eitht (40%) of 20 cases, although none had clinical symptoms related to pancreatitis When the adverse effect on the pancreatic tissue was compared among 6 cases of the superselective TAE and 14 cases of the nonsuperselective TAE, which were perfomed from the segmental and the nonsegmental hepatic arteries, respectively, the elevation of serum pancreatic enzymes was caused only by nonsuperselective TAE, not by superselective TAE. The volumes of Spongel and lipiodol used or the injected doses of the anticancer agent mitomycin C were not different between the two groups. These results indicate that TAE for the treatment of hepatoma frequently causes pancreatic tissue damage, and the position of the inserted catheter tip is very important to avoid the pancreatic tissue damage by TAE.     

Spontaneous Rupture of Hemangioma of the Liver: Treatment with Transcatheter Hepatic Arterial Embolization

A case of spontaneous rupture of a cavernous hemangioma of the liver with a successful hepatic resection after transcatheter hepatic arterial embolization is reported. Twenty-eight cases of spontaneous rupture of hepatic hemangioma have been reported in the medical literature. Each of the cases (19 adults and nine children) were reviewed, including the present one reported here. Surgical treatments were carried out on 20 patients, of whom only five survived. Ruptured hemangiomas ranged in size from 3.0 to 25.0 cm, and many were located on the inferior surface of the liver. Surgical resection should be considered for a large hepatic hemangioma located on the inferior surface of the liver if the tumor has a high probability of rupture. Once the hemangioma has ruptured, emergent hepatic resection is recommended for low-risk patients, whereas high-risk patients should receive transcatheter hepatic arterial embolization prior to elective hepatic resection.     

38例原发性肝癌动-静脉瘘介入治疗的疗效分析

目的回顾性评价超选择性动脉插管栓塞原发性肝癌合并动-静脉瘘的疗效,以期提高患者的生存质量和延长生存期。方法本院近2年实施经动脉插管栓塞化疗的原发性肝癌425例,其中合并动-静脉瘘38例,采用超选择性动脉插管分别对动-静脉瘘以无水乙醇或无水乙醇＋明胶海绵颗粒、对肿瘤病灶以无水乙醇＋碘油（1：1）或碘油＋2～3种化疗药物实施栓塞。观察术后的临床表现,并随访复发率与生存率。结果425例原发性肝癌合并动脉-门静脉瘘38例（8．9％）,其中,高流量型21例（55％）,低流量型17例（45％）,同时伴有肝动脉-肝静脉瘘8例（21％）。38例均成功实施动-静脉瘘及肿瘤病灶的超选择性动脉插管栓塞术,其中,35例经过2～3次治疗。术后肝功能好转23例（61％）;腹水消失13例（34％）,腹水明显减少20例（53％）;6个月生存率84％（32例）,1年生存率61％（23例）。结论超选择性动脉插管栓塞术治疗肝癌伴动-静脉瘘,能缓解其导致的门静脉高压及其严重后果,疗效肯定,并且为同期实施的肿瘤病灶栓塞治疗奠定了基础,该方法可明显提高患者的生存质量,延长生存期。     

Gastroesophageal junction cancer with hepatic metastasis: Effective Treatment using microsphere embolization combined with transarterial infusion chemotherapy

PurposeTo determine the safety and efficacy of microsphere embolization plus transarterial infusion chemotherapy for the treatment of gastroesophageal junction cancer with hepatic metastasis.MethodsSixty patients with gastroesophageal junction cancer and hepatic metastasis were randomly divided into two groups: group A (treatment group), which was treated with transarterial infusion chemotherapy plus microsphere embolization for gastroesophageal cancer, and with transarterial chemoembolization for hepatic metastasis; and group B (control group), which was treated with transarterial infusion chemotherapy for gastroesophageal cancer, and with transarterial chemoembolization for hepatic metastasis. The chemotherapy regimen used consisted of oxaliplatin plus FUDR. The embolization agent used for gastroesophageal cancer and the hepatic metastasis were Embosphere and ultra-liquefied lipiodol, respectively.ResultsThe median survival time of patients in group A was 19 months, with survival rates at 12, 18, and 24 months of 93.3%, 60.0%, and 23.3%, respectively. The median survival time of patients in group B was 13 months, with survival rates at 12, 18, and 24 months of 60.0%, 30.0%, and 3.3%, respectively. There was a significant difference in survival between the two groups (P = 0.00). One month after treatment, the severity of dysphagia was significantly less in group A, as compared to that in group B (p < 0.001).ConclusionTreatment of gastroesophageal junction cancer with hepatic metastasis by transarterial infusion chemotherapy plus microsphere embolization can rapidly reduce tumor size near the gastroesophageal junction. This treatment is an effective therapeutic option for these patients as it can relieve dysphagia and improve long-term survival rate.     

Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery

BACKGROUND: The aims of the study were to compare (i) the effects of transcatheter arterial embolization on initial hemostasis and the control of rebleeding in the treatment of hemorrhage due to hepatic artery injury; and (ii) the outcomes of embolization by different locations. METHODS: Subjects were 32 patients with suspected hepatic artery injury who were transferred to Chi-Mei Foundation Medical Center for hepatic angiography and embolization. The causes of arterial injury included liver trauma (n = 15) and iatrogenic injury (n = 17). The sites of embolization were classified into four groups: group 1 (n = 8) was classified as 'combined outlet, target and inlet control' with embolization of the vascular lesion (target) and hepatic artery distal (outlet) and proximal (inlet) to the vascular lesion simultaneously; group 2 (n = 11) as 'combined target and inlet control'; group 3 (n = 8) as 'combined outlet and inlet control'; group 4 (n = 5) as 'inlet control' only. RESULTS: Successful initial hemostasis was achieved in 30 of the 32 patients (93.8%), with two failures, both of which were caused by liver injury and occurred in subjects in group 4. Rebleeding was seen in three patients who had successful initial hemostasis: two of them in group 4 (66.7%) and one in group 1 (12.5%). All rebleedings were successfully managed by repeat embolization. Abscess formation was found in two group 1 patients, and both were successfully managed by percutaneous drainage. CONCLUSIONS: Transcatheter arterial embolization is an effective method for hemostasis in hepatic artery hemorrhage for both patients with liver trauma and patients with iatrogenic injuries to the hepatic artery. Based on this experience, embolization of the vascular lesion and/or the arterial lumen distal to the vascular lesion combined with inlet control is recommended for preventing recurrent hemorrhage, but studies with larger sample sizes will be required to validate this conclusion.     

Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

BACKGROUND: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of superselective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. PATIENTS AND METHODS: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast-enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. RESULTS: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with superselective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. CONCLUSIONS: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen.