肝巨大海绵状血管瘤的介入栓塞治疗

 目的　探讨肝脏巨大海绵状血管瘤 (HHCH)的介入治疗与疗效。方法　经导管注入超液化碘油和平阳霉素 (PYM )混合乳剂 ,再用明胶海绵颗粒适量栓塞肿瘤周围小血管治疗肝巨大海绵状血管瘤 12例。结果　所有病例术前肝动脉造影显示“枝上挂果、早出晚归”的异常血管湖样改变 ;术后肿瘤均有缩小 ,其中 10例明显缩小 ,异常血管湖消失。结论　采用超液化碘油和PYM混合剂加适量明胶海绵颗粒联合栓塞是治疗肝巨大海绵状血管瘤较为理想的方法     

平阳霉素碘油乳剂栓塞治疗肝血管瘤的疗效分析

目的探讨平阳霉素碘油乳剂栓塞治疗肝血管瘤的临床疗效。方法对86例肝血管瘤患者行栓塞治疗,行股动脉穿刺,超选择性插管肝血管瘤供血动脉,注入平阳霉素碘油乳剂。结果所有患者在术后3、6和12个月复查CT,见瘤体内碘油沉积良好,瘤体明显缩小,碘油聚集征象明确。83例患者瘤体缩小约80.0%～90.0%,另3例患者瘤体缩小约40.0%～50.0%。86例患者的临床症状完全缓解率为100%。术后均未出现胆囊坏死、肝脓肿、肝坏死等严重并发症。结论平阳霉素碘油乳剂经肝动脉栓塞治疗肝血管瘤疗效肯定,并发症少,成功率高,是一种较为理想的治疗方法。     

平阳霉素碘油乳剂超选择动脉栓塞治疗肝血管瘤的观察

为了探讨平阳霉素碘油乳剂超选择栓塞化疗治疗肝血管瘤(HCH)的临床疗效和治疗体会,对23例HCH患者采用平阳霉素碘油乳剂超选择性动脉插管动脉栓塞治疗,观察治疗前和治疗后6、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症.23例患者在术后6和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘油聚积征象.术前血管瘤直径为(8.1±2.2)cm,术后6个月血管瘤直径为(5.4±1.3)cm,术后12个月血管瘤直径为(3.4±1.2)cm.治疗前有临床症状者治疗后缓解或消失,术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生.初步研究结果提示,超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大HCH是一种疗效肯定、相对安全较为理想的治疗方法.     

Fe3O4微粒碘油平阳霉素乳剂介入栓塞治疗海绵状肝血管瘤的疗效观察

目的 探讨Fe3O4微粒碘油平阳霉素乳剂介入肝动脉栓塞术治疗的海绵状肝血管瘤的疗效.方法 随访观察3年来在我院行Fe3O4微粒碘油平阳霉素乳剂介入肝动脉栓塞术治疗海绵状肝血管瘤的患者61例,对海绵状肝血管瘤患者介入栓塞术成功率、治疗前后CT复查的瘤体大小的变化、术后并发症、肝功能等进行统计分析.结果 本组患者的介入栓塞术成功率为100%,病灶随术后时间的增加呈进行性缩小.木组研究患者(n=61),术前瘤体直径(8.47±2.27)cm,术后3个月时瘤体直径(5.75±1.40)cm,术后6个月时瘤体直径(3.51±0.82)cm,3个时期瘤体直径大小差异均有统计学意义(P<0.05).治疗对肝功能无影响,除部分患者出现术后低热和肝区疼痛外,无严重并发症.结论 Fe3O4微粒碘油平阳霉素乳剂介入栓塞治疗海绵状肝血管瘤是一种安全、有效、微创的治疗方法.     

碘油乳剂经动脉栓塞治疗16例肝海绵状血管瘤

目的：探讨碘油乳剂经动脉内栓塞治疗肝海绵状血管瘤的临床应用。方法：16例肝海绵状血管瘤患者用动脉栓塞治疗。结果：所有病例均栓塞成功，14例患者栓塞后碘油沉积良好。治疗后14例取得最佳疗效。全部病例临床症状消失，瘤体平均缩小50％，且未见胆囊坏死等并发症。结论：磺油乳剂动脉栓塞治疗肝海绵状血管瘤是安全、简便、并发症少且十分有效的治疗方法。     

经动脉栓塞治疗巨大肝血管瘤效果分析

目的评价经动脉栓塞治疗巨大肝血管瘤的疗效。方法53例患者共行78次动脉内栓塞治疗，所用栓塞剂为平阳霉素 超液化碘化油乳剂。结果每次治疗后4～6周CT复查，所有病灶均有不同程度缩小，其中21例缩小达50％。结论经肝动脉栓塞治疗巨大血管瘤是一种行之有效的方法。     

经肝动脉栓塞治疗肝海绵状血管瘤（附26例）

目的：观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性。方法：对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应。结果：26例患者介入治疗成功率100％,肿瘤完全消失者6例,瘤体缩小〉50％者17例,瘤体缩小不足50％者2例,瘤体无变化者1例,无瘤体进展者;总有效率为95．1％;所有患者未出现严重并发症。结论：经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法。     

经肝动脉栓塞治疗肝海绵状血管瘤(附26例)

目的:观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性.方法:对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应.结果:26例患者介入治疗成功率100%,肿瘤完全消失者6例,瘤体缩小＞50%者17例,瘤体缩小不足50%者2例,瘤体无变化者 1例,无瘤体进展者;总有效率为95.1%;所有患者未出现严重并发症.结论:经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法.     

肝血管瘤肝动脉栓塞的疗效评价

目的评估经肝动脉途径超选择介入栓塞肝血管瘤的临床疗效。方法对采用经动脉介入治疗的42例肝血管瘤患者进行回顾性分析。全部病例采用Seldinger穿刺插管行超选择性肝动脉或肠系膜上动脉造影并行栓塞术。栓塞材料采用液化碘油＋博来霉素＋海藻酸钠微球。结果随访6～48个月。40例经1次治疗后,临床症状逐渐减轻至消失;2例经第二次治疗后,临床症状消失;12个月后行CT复查,部分患者病灶内仍有碘化油沉积,经CT加强扫描显示：10例肝血管瘤完全消失,30例肝血管瘤明显缩小,2例稳定,无一例出现严重的栓塞综合征。术后住院3～5d。结论经肝动脉途径超选择介入栓塞肝血管瘤临床疗效确切,手术创伤小,操作安全、简便,患者痛苦少、恢复快,住院时间短。     

超选择性肝动脉插管治疗巨大型肝血管瘤

 目的 超选择性肝动脉插管技术,化疗及栓塞联合治疗巨大型肝血管瘤的疗效观察.方法 采用Seldinger经皮股动脉穿刺插管法,在引导导丝的导向下,导管超选择至2～3级肝动脉内,超选困难者,采用SP超微同轴导管,直到最接近肿瘤的主供血动脉;灌注平阳霉素8～16 mg,缓慢推注鱼肝油酸钠与超液状碘油混合硬化栓塞剂.结果 本组对11例巨大型肝血管瘤治疗后临床症状消失,有效率100%,治疗后肿瘤内皮细胞变性、萎缩、退化,微血管损害破坏,纤维化,复查B超及CT肿瘤平均缩小5.15 cm×8.95 cm,术后随访16个月以上均健在,未见肿瘤复发.结论 超选择性肝动脉插管治疗巨大型肝血管瘤操作简便,损伤性小,是安全有效的方法.     

MSCTA供血动脉成像在肝脏常见肿瘤中的临床应用

目的:探讨多层螺旋CT血管造影（multi-slice spiral CT angiography,MSCTA）供血动脉成像在肝脏常见肿瘤诊断及术前评估中的应用。方法:收集2010年至2013年间肝脏肿瘤性病变患者30例,常规平扫后增强扫描。扫描完成后薄层重建原始数据,行VR、MPR、MIP等重建方式,观察肝脏肿瘤供血动脉情况及肝动脉变异征像。结果:30例患者中,26例发现供血动脉,其中肝癌14例,肝母细胞瘤2例,肝血管瘤6例,局灶性结节增生（focal nodular hyperplasia,FNH）3例,肝血管平滑肌脂肪瘤1例,其中1例发现肝动脉变异。结论:运用MSCTA技术,可以确切的观察肝脏肿瘤一支或多支供血动脉及其形态表现,并可清晰显示动脉变异,对肿瘤病变术前诊断及手术、介入治疗方案设计具有重要的指导意义。     

平阳霉素治疗头颈部血管瘤132例临床分析

目的总结平阳霉素瘤内注射治疗头颈部各种血管瘤的疗效。方法收集我科自1996年3月至2003年12月以平阳霉素注射治疗头颈部毛细血管型、海绵状及混合性等血管瘤132例(155个瘤体)的临床资料进行分析。结果经过6个月～8年随访，治愈和基本治愈率为82．57％，好转11．36％，总有效率为93．93％。毛细血管型、海绵状和混合性血管瘤的治愈和基本治愈率分别为84．0％、88．5％、76．1％。发热反应为8．33％。结论平阳霉素治疗毛细血管型、海绵状和混合性血管瘤疗效高，疗程短，是一种简便、安全有效的方法。     

A differential approach to the surgical treatment of liver hemangiomas]

Treatment results and indications for surgery were analysed in 50 cases of hepatic hemangioma versus pattern of hemangiomatosis and size, site and extent of tumor. Surgery was performed in 41 (82%) patients. Radical surgery was possible and justified in as few as one-third of them. Palliative treatment including ligation and roentgen-endovascular occlusion of the hepatic artery and its branches, local ferromagnetic embolization of tumor and suturing and sclerotherapy of hemangioma were performed in 28 cases. End results were analysed in 33 cases followed up to as long as 8 years posttreatment. The extent and type of surgery for hepatic hemangioma should be different for each of the four patterns of the disease identified.     

小肝肿瘤的诊断和术中定位

本文复习经B型超声、CT及AFP诊为小肝肿瘤36侧,内肝细胞癌23例,海绵状血管瘤11例,转移癌2例。肿瘤最大径<3cm者14例,3—5cm22例,位于右肝叶22例,左肝叶14例。 CT对肝细胞癌和肝转移癌的诊断准确率为100％,对肝海绵状血管瘤的准确率为72.7％;B型超声为81.8％。AFP在23例肝细胞癌的阳性率为66.6％。 本文介绍了在术中不能看见或不能触到的小肝肿瘤的寻找方法,7例由此发现而顺利作了切除术,计肝细胞癌4例,海绵状血管瘤2例,转移癌1例。     

解剖第3肝门切除巨大肝海绵状血管瘤

Objective:To estabhsh 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 hemihepatectornies in 5 cases, right upper segnentectomies in 7 cases, right posterior lobectomies 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. Duringoperation the key step is dissection of the short hepatic veins.     

Emergency embolization of spontaneous ruptured hepatocellular carcinoma: Correlation between survival and Child−Pugh classification

From February 1994 to April 2000, 29 emergency gelfoam embolizations for spontaneous ruptured hepatocellular carcinoma (HCC) performed in 28 patients were retrospectively reviewed. There were 11 patients in Child's A , 11 in Child's B and six in Child's C classification of cirrhosis. The duration of the procedure, artery embolized and complications were reviewed, and the Child?Pugh classification of each patient was correlated with their mean survival period. Embolization was done in 12 right hepatic arteries, two left hepatic arteries and 15 proper hepatic arteries. In one patient, the left hepatic artery was embolized initially but the proper hepatic artery was also embolized because another subcapsular liver tumour was found after reviewing the preangiogram CT scan. The entire procedure took 40?170 min (mean = 86 min) with no periprocedural complication. Following embolization, the mean survival period for Child's A class was 218.3 days, Child's B class was 83.4 days and Child's C class was 11.0 days. Transcatheter embolization is an effective treatment to arrest bleeding in spontaneous ruptured HCC. Patients with Child's A class cirrhosis have the longest survival. Selective embolization of either the right or the left hepatic artery alone carries the potential risk of missing multifocal HCC that might not be easily appreciated during angiography.     

Embolization of the hepatic artery in hemangiomas of the liver

Embolization of the proximal part of the hepatic artery was carried out in three patients with hemangioma of the liver who did not meet the criteria for radical surgery. Metal spirals were used for this purpose. Response was observed in all the cases. Patients were followed for 9-36 months. The data obtained suggest that embolization of the hepatic artery is effective and may be used for the treatment of inoperable vascular tumors of the liver.     

"Variable echo sign" (ultrasonographical alteration of echogenicity) in cavernous hepatic hemangioma.

There are few reports describing cavernous hepatic hemangiomas with alteration of ultrasonographical imaging during examinations. We performed ultrasonographic examination of 64 cavernous hepatic hemangiomas and recognized 26 cases (41%) with an alteration of echogenicity during the examinations. We refer to this alteration of echogenicity of cavernous hepatic hemangioma as a "variable echo sign". We performed angiography of the cavernous hepatic hemangiomas with variable echo sign. Most of these imaging patterns showed mild or moderate pooling, suggesting that the alteration of echogenicity might be based on a slow blood flow exchange. We suggest that a variable echo sign is specific to ultrasonographic imaging with cavernous hepatic hemangioma and may be useful to differentiate cavernous hepatic hemangioma from other tumors.