介入栓塞术治疗肝海绵状血管瘤8例报告

1999年4月～2002年2月，我们分别用无水酒精，碘油 明胶海绵，碘油乳化剂(PLE)栓塞治疗肝海绵状血管瘤(CHL)患者8例，现将其疗效、术后肝功变化及并发症分析报告如下。     

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。     

~(125)I-碘油栓塞照射联合体外局部放射治疗肝癌

目的探讨核素(125)~Ⅰ-碘油经肝动脉插管化疗栓塞(TACE)联合体外局部照射治疗原发性 HCC 的临床疗效、毒副作用及肿瘤血供的变化.方法 36例患者随机分成2组,治疗组(18例)经肝动脉给予碘油抗癌药乳剂及(125)~Ⅰ-碘油栓塞后择期体外局部照射(40-60Gy),术前、后作彩超测定肿瘤血供变化.对照组(18例)除不予外照射外,其余同治疗组.结果治疗组瘤体缩小率(CR PR MR)为72.2%,部分缓解率50%,均高于对照组(33.3%,16.7%)(P<0.05);治疗组1,2年累计生存率(88.3%,66.7%)显著高于对照组(77.8%,14.8%),P<0.01%;治疗组肿瘤血供减少程度显著大于对照组.富血 HCC 血供减少程度与瘤体缩小程度显著相关.副作用主要为可酎受的肝功能异常.结论化疗栓塞内照射联合局部外照射治疗 HCC 疗效高于化疗栓塞内照射,富血 HCC 血供的变化可以辅助评价疗效及预后.     

125Ⅰ-碘油栓塞照射联合体外局部放射治疗肝癌

目的 探讨核素125Ⅰ-碘油经肝动脉插管化疗栓塞(TACE)联合体外局部照射治疗原发性HCC的临床疗效、毒副作用及肿瘤血供的变化.方法36例患者随机分成2组,治疗组(18例)经肝动脉给予碘油抗癌药乳剂及125Ⅰ-碘油栓塞后择期体外局部照射(40-60Gy),术前、后作彩超测定肿瘤血供变化.对照组(18例)除不予外照射外,其余同治疗组.结果治疗组瘤体缩小率(CR+PR+MR)为72.2%,部分缓解率50%,均高于对照组(33.3%,16.7%)(P＜0.05);治疗组1,2年累计生存率(88.3%,66.7%)显著高于对照组(77.8%,14.8%),P＜0.01;治疗组肿瘤血供减少程度显著大于对照组.富血HCC血供减少程度与瘤体缩小程度显著相关.副作用主要为可耐受的肝功能异常.结论化疗栓塞内照射联合局部外照射治疗HCC疗效高于化疗栓塞内照射,富血HCC血供的变化可以辅助评价疗效及预后.     

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。     

胆囊动脉供血肝癌TACE治疗45例

目的:评估经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗不能切除的、由胆囊动脉供血肝细胞癌(hepatocellular carcinoma,HCC)的安全性、插管成功率及其疗效.方法:收集我院45例经TACE治疗的由胆囊动脉供血的肝癌患者.36例患者以前曾行2-8次TACE术(平均4次),自初次治疗后的存活期为4-69 mo(平均24 mo).9例患者在首次血管造影时即发现胆囊动脉寄生.TACE技术只有在微导管能插入肿瘤供血动脉分支,并且造影不出现胆囊壁染色时才能进行.我们对其治疗效果及并发症作了回顾性分析.结果:28个肿瘤完全由胆囊动脉供血,17个由肝动脉及胆囊动脉共同供血.60%(n=27)的患者可以观察到肝动脉的变细或闭塞.32例患者(71%)成功地进行了栓塞治疗而无严重并发症出现.28例患者(62%)有足够的碘油聚集.这28例患者在平均随访18mo后仅有6例(21%)肿瘤局部进展.对于栓塞不成功的13例(29%)患者,分别给予经皮注射无水乙醇治疗(n=6),放疗(n=4)以及胆囊切除术后的TACE(n=3).结论:71%的患者经胆囊动脉行TACE治疗是安全可行的.如果肿瘤能获得足够的碘油聚集,理想的治疗效果还是值得期待的,本组有62%(n=28)的患者获取良好的碘油聚集.     

左膈下动脉供血在肝癌介入治疗中的价值

目的 探讨左膈下动脉(LIPA)对肝癌的供血及其介入性栓塞在肝癌治疗中的价值.评价经导管做LIPA栓塞化疗的安全性和效果.方法 对22例经血管造影确认有LIPA参与肝癌供血者进行动脉栓塞化疗(TACE).结节型20例,巨块型2例.术前行CT或MRI平扫及增强扫描,术中常规做腹腔动脉-肝动脉及膈下动脉造影,在确认供血范围后将导管超选择至供血支,先用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海绵碎粒或PVA颗粒.观察术后临床经过、相关实验室检查和影像学表现,并与血管造影进行对照分析.结果 病灶位于肝左叶18例(81.8%):7例位于S3,7例位于S2,4例位于S4.病灶位于肝右叶(S5)4例(18.2%).22例患者左膈下动脉TACE全部成功.9例进行LIPA化疗栓塞时发现肝动脉完全阻塞.2例术后发生左下肺叶盘状肺不张和少量胸腔积液.结论 LIPA参与肝癌供血多见于多次行TACE的病人并且肿块位于肝左叶.栓塞左膈下动脉的安全性很高,并发症少且多为自限性.     

超选择动脉栓塞治疗肝血管瘤中两种不同栓塞剂的疗效观察

目的探讨平阳霉素碘油乳剂和Embosphere微球两种不同栓塞剂超选择动脉栓塞治疗肝血管瘤的临床疗效。方法 40例肝血管瘤患者随机分成两组行超选择性动脉栓塞治疗,其中A组（20例）采用平阳霉素碘油乳剂作为栓塞剂,B组（20例）采用Embosphere微球作为栓塞剂,比较两组治疗效果。结果所有患者治疗前有临床症状者治疗后缓解或消失。所有患者栓塞治疗后6个月复查肝脏彩超或CT,A组中瘤体缩小15例,稳定5例,无效0例;B组中瘤体缩小16例,稳定4例,无效0例;两组疗效差异没有统计学意义。两组术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症。结论平阳霉素碘油乳剂和Embosphere微球两种栓塞剂超选择性动脉栓塞治疗肝血管瘤均安全有效。     

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。     

肝动脉栓塞术治疗三种类型肝血管瘤患者疗效及安全性分析

目的探讨采取肝动脉栓塞术治疗对高、中和低血供型肝血管瘤患者的疗效及安全性。方法 2013年1月～2017年8月我院收治的肝血管瘤患者100例,其中高血供型37例(A组),中等血供型34例(B组)和低血供型29例(C组),均行肝动脉栓塞术治疗,经股动脉插管,注射博来霉素碘化油乳剂行栓塞术,随访12个月。结果在术后6个月和12个月,A组总有效率分别为64.9%和81.1%,均显著高于B组的61.8%和67.7%或C组的3.5%和10.3%(P0.05);A组、B组和C组患者博来霉素碘化油用量分别为(11.4±2.6) ml、(9.7±1.9) ml和(4.3±1.0) ml,差异显著(P0.05);在术后12个月,C组患者病灶直径为(6.6±0.7) mm,显著大于A组的(2.8±0.2) mm或B组的(3.2±0.3) mm(P0.05);术后A组近期肝损伤等并发症发生率为18.9%,显著高于B组的8.8%或C组的3.4%(P0.05)。结论采取肝动脉栓塞术治疗不同血供类型的肝动脉瘤患者可能疗效不同,对富血供的血管瘤疗效较好,研究提示对乏血供的血管瘤,应采取其他方法治疗。     

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

AIM: To investigate the source of the blood supply in carvenous hemangioma of liver (CHL), and provide a feasible treatment for CHL via thehepatic artery.METHODS: (1) Portovenography, hepatic arteriography and portal vein staining were performed in 5 patients to determine the origin of the blood supply. Two casts of hepatic blood vessels from resected specimens were observed. (2) Clinical data from 75 patients (30 males, 45 females, aged 25-57 years, mean of 37.4) were obtained. Of these, 56 were of solitary type (44 on the right lobe, 12 on the left, with 4 having intraparenchyma), and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty-two patients were treated with sclerosis, 50 by embolization via hepatic artery, and 3 were excised.RESULTS: In the 5 cases where portography was used, the contrast medium did not enter the tumor, and the tumor appeared as low density area, with the intrahepatic branches of the portal vein pushed aside. In the 5 cases with where portal vein staining was used, the normal liver parenchyma stained a deep blue; however, the tumor was not stained. The tumor area appeared as a round vacant cavity in the 2 specimen casts. For the 72 patients treated with sclerosis 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 embolization decreased in size or got fibrotic.     

What is changing in indications and treatment of hepatic hemangiomas. A review

Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. Patients affected by hemangioma usually have their tumor diagnosed by ultrasound abdominal examination for a not well defined pain, but pain persist after treatment of the hemangioma. The causes of pain can be various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease.The malignant trasformation is pratically inexistent. Different imaging modalities are used to diagnosis liver hemangioma including ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging, and less frequently scintigraphy, positron-emission tomography combined with CT (PET/CT) and angiography. Imaging-guided biopsy of hemangioma is usually not resorted to except in extremely atypical cases. The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.     

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。     

Strategy for pancreatic endocrine tumors

BACKGROUND/AIMS: The endocrine tumors of the pancreas are rare diseases and there is no established standard therapy for the liver metastasis of pancreatic endocrine tumors. In this study, the therapy for the pancreatic endocrine tumors was evaluated. METHODOLOGY: The endocrine pancreas tumors of 13 patients had been surgically treated. All primary tumors were completely resected. The liver metastasis was recognized in 4 patients. Partial resection of the liver was performed in 2 patients. Lipiodol-transcatheter arterial embolization was performed for synchronous unresectable liver metastases in the other 2 patients. RESULTS: The patients with no liver metastases survived without recurrence (max: 18.8 yr; mean follow-up: 9.2 yr). The patient with resected synchronous solitary liver metastasis died of recurrent multiple liver metastases 5 months after surgery. The other patient with the metachronous liver metastasis completely resected survived 13.9 years. In the 2 patients with unresectable numerous liver metastases, after lipiodol-transcatheter arterial embolization, tumor necrosis rate was more than 90% in both cases and serum gastrin level was normalized. CONCLUSIONS: Complete resection of liver metastasis is favorable, whereas lipiodol-transcatheter arterial embolization is effective for unresectable liver metastases from pancreatic endocrine tumors as palliation. Complete resection of the primary site is recommended even in the cases with unresectable numerous liver metastases.     

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.     

平阳霉素碘油乳剂栓塞甲状腺动脉的实验研究

观察平阳霉素碘油乳剂(PLE)栓塞犬甲状腺动脉的效果。结果提示PLE栓塞甲状腺效果良好,反应较轻,并发症较少,是一种可供选择的甲亢栓塞剂。     

Necrosis of a large hepatic tumor after hemorrhage and subsequent selective arterial embolization

INTRODUCTION Hepatocellular adenomas are uncommon benign liver tumours that are present mainly in women of reproductive age[1]. Their existence is associated with the use of oralcontraceptives[2]. The first clinical presentation of the tumour can consist …     

Malignant insulinoma presenting a non-functioning metastatic liver tumor 14 years after resection of the primary tumor

A 58-year-old woman who had undergone resection of insulinoma 14 year earlier visited our clinic complaining of abdominal discomfort. Computerized tomographic scan showed multiple liver tumors, and a diagnosis of metastatic tumor of malignant islet cell tumor was confirmed histologically. No oversecretion of hormones or hypoglycemic episode was observed on readmission. Thus, the insulinoma seemed to have transformed to a clinically non-functioning tumor. The patient was treated with transcatheter arterial embolization, resulting in clinical improvement with marked reduction in tumor size. Features of interest in this case included; (1) transformation to non-functioning metastatic liver tumor 14 years after resection of insulinoma, (2) the usefulness of transcatheter arterial embolization for multiple metastatic tumor of malignant islet cell tumor. (Received Oct. 6, 1997; accepted Apr. 24, 1998)     

Aggressive hepatectomy for complete remission of metastatic germ cell tumor following chemotherapy: report of a case

A 12-year-old girl presented with hemoperitoneum caused by disseminated liver tumors accompanying a retroperitoneal germ cell tumor and was rescued by transcatheter hepatic arterial embolization. Following systemic chemotherapy, the liver tumors decreased in size and number, although the retroperitoneal tumor was resistant to therapy. We simultaneously resected the retroperitoneal tumor, and the liver lesions by extended left lobectomy combined with resection of the three major (right, middle, and left) hepatic veins, while preserving the inferior right hepatic vein. The postoperative course was uneventful, and liver regeneration evaluated by serial computed tomography was almost completed by three months following surgery. Pathological examination of the resected tumors revealed benign (mature) teratomas. Since complete removal of tumors critically influences the outcome in patients with mature teratoma, aggressive surgery is advocated for extensive tumors. The present case clearly demonstrated that extended hepatectomy with resection of three major hepatic veins is feasible and provides an opportunity for achieving complete remission in patients with metastatic germ cell tumor of the liver.     

Iodized oil accumulation in the hypovascular tumor portion of early-stage hepatocellular carcinoma after ultraselective transcatheter arterial chemoembolization

Purpose  We evaluated iodized oil accumulation in the hypovascular portion of early-stage hepatocellular carcinoma (HCC) after ultraselective transcatheter arterial embolization (TACE). Materials and methods  Forty-seven HCC lesions with hypovascular portions were treated by TACE at the distal level of the sub-subsegmental artery of the liver. Portal blood in the hypovascular portion was classed in two grades by computed tomography (CT) during arterial portography: decreased and preserved. Iodized oil accumulation was classed into three grades on CT obtained 1 week after TACE: (1) dense accumulation in the almost entire tumor, including the hypovascular portion (grade 2); (2) dense accumulation in hypervascular portions but sparse accumulation in hypovascular portion (grade 1); and (3) sparse accumulation or no accumulation (grade 0). Findings on serial follow-up CT images were also analyzed. Results  Portal blood in the hypovascular portion was decreased in 32 lesions, and preserved in 15 lesions. On CT 1 week after TACE, 32 tumors (68.1%)—23 with decreased portal blood and 9 with preserved portal blood—were classed as grade 2. Twelve tumors (25.5%), six with decreased portal blood and six with preserved portal blood, were classed as grade 1. Three tumors (6.4%) with decreased portal blood were classed into grade 0. In total, 25 tumors (53.2%), 22 in grade 2 and 3 in grade 1, were well controlled by ultraselective TACE during the mean follow-up of 15.8 months. Conclusions  Iodized oil accumulation and retention in the hypovascular portion of early-stage HCC was frequently observed after ultraselective TACE, mainly in the hypovascular portion with decreased portal blood.