明胶海绵肝动脉栓塞治疗肝脏巨大海绵状血管瘤6例分析

肝脏海绵状血管瘤是一种较为常见的肝脏良性病变.一般认为手术切除是最为有效的方法.但对于巨大海绵状血管瘤,手术难度和风险较大.我们自1994年4月以来,对6例巨大肝脏海绵状血管瘤进行了肝动脉栓塞治疗,现作一初步报告.1 临床资料6例患者中,男3例,女3例,年龄31～58岁,平均42.8岁.其中4例觉肝区疼痛,2例主要感腹胀.病程最长者3年,最短者1月.所有患者均综合B超、动态CT扫描及DSA肝动脉造影资料作出诊断.血管瘤最大径8～17.5cm,其中位于肝右叶者3例,左叶者1例,左右叶均有呈多发性者2例.     

肝海绵状血管瘤26例手术治疗总结

６年手术治疗肝海绵状血管瘤２６例，均治愈，无严重并发症，１例伴有典型的Ｋａｓａｂａｃｈ－Ｍｅｒｒｉ综合征，正确综合应用Ｂ超、ＣＴ及放射性核素血池显像等影像学技术，大多数病例可于术前确诊。手术前应权衡利弊，肿瘤剜出术应为首选。     

巨大肝海绵状血管瘤切除1例报告

1病例资料 患者,女,58岁,因＂上腹部膨隆伴进食后胀满不适1个月＂于2011年8月15日入院。查体：肝肋下5cm处可触及,质硬,边缘钝,表面稍有结节感,无压痛。实验室检查无明显异常,吲哚菁绿（ICG）15 min滞留率为5.8%。腹部增强CT示：     

49例肝海绵状血管瘤缝扎治疗

目的：观察缝扎法治疗肝海绵状血管瘤的临床疗效。方法：对４９例肝血管瘤患者进行缝扎治疗，缝扎针自行设计，于瘤体与肝组织之间的界线（限）进针，针距１．５～２．５ｃｍ行贯穿“８”字缝扎。结果：随诊３８例患者６月至６年，２例半年至一年复查肿瘤消失，１例１４个月复查瘤体中心出现液化坏死；１例２４月复查瘤体大小无变化，其余各例瘤体均有不同程度缩小，平均缩小率为４７．１％，结论：经与同期血管瘤切除病例结果对比，     

肝海绵状血管瘤外科治疗640例

肝海绵状血管瘤外科治疗６４０例吴伯文吴孟超张晓华陈汉姚晓平杨甲梅杨广顺第二军医大学东方肝胆外科医院上海市２００４３３Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｌｉｖｅｒｎｅｏｐｌａｓｍｓ／ｓｕｒｇｅｒｙ；ｈｅｍａｎｇｉｏｍａ，ｃａｖｅｒｎｏｕｓ／ｓｕｒｇｅ...     

肝海绵状血管瘤2例

肝海绵状血管瘤２例汪永录周汉高林珍梅上海市北医院２００４３５主题词脾肿瘤／病理学血管瘤，海绵状／病理学中国图书资料分类号Ｒ７３５７１病例报告例１男，２３岁．因左上腹包块２年，不规则发热２个月，于１９７９－０８－２４入院．患者于１９７７年发现脾肿大...     

碘油、PYM、GF混合乳剂肝动脉栓塞治疗肝海绵状血管瘤48例临床分析

1998年4月～2005年6月,我们采用碘油、平阳霉素（PYM）、明胶海绵（GF）混合乳剂栓塞治疗肝海绵状血管瘤（CHL）48例,疗效满意。现报告如下。     

集束射频治疗肝海绵状血管瘤

集束射频治疗是近年引进的一项治疗肝癌的新技术,自2001年3月以来,我们尝试应用射频治疗肝海绵状血管瘤,取得较好疗效。     

肝海绵状血管瘤48例诊治体会

2000年1月至2003年1月，我们收治肝海绵状血管瘤(以下简称肝血管瘤)48例，现将诊治体会报告如下。     

肝穿活检确诊肝海绵状血管瘤1例

肝穿活检确诊肝海绵状血管瘤１例陈开文朱长宝程一民解放军５１医院四川省南充市６３７０００主题词肝肿瘤／诊断；血管瘤，海锦状／诊断；活组织检查，针吸中国图书资料分类号Ｒ７３５７１病例报告男，５６岁．上腹部胀痛４ａ，伴乏力、纳差、消瘦．１９８９年５月...     

Atypically enhanced cavernous hemangiomas of the liver: centrifugal enhancement does not preclude the diagnosis of hepatic hemangioma

The imaging features of an atypically enhanced hepatic hemangioma have not been well described in the literature, and the presence of such atypia may sometimes cause clinical problems in the differential diagnosis. Herein, we report a case of hepatic hemangioma demonstrating a previously unreported atypical enhancement pattern. On dynamic computed tomography during hepatic arteriography, a centrifugal enhancement pattern and subsequent peritumoral ring-shaped enhancement mimicking corona enhancement were found in cavernous hemangiomas of the liver in a 68-year-old Japanese man. Histopathological diagnosis of cavernous hemangioma of the liver was made on a biopsy specimen. Considering the importance of differentiating benign hepatic tumor from various forms of malignancy, radiologists and hepatologists should be aware of rare enhancement patterns sometimes seen in hepatic hemangioma. Establishing knowledge of the entire spectrum of atypical hepatic hemangioma may benefit the rational approach to future cases.     

螺旋CT诊断肝癌合并门静脉海绵样变性及其在介入治疗中的意义

目的分析门静脉海绵样变性（CPTV）患者的CT表现和特征,探讨螺旋CT诊断该病的价值及临床意义。方法回顾性分析28例经彩色多普勒、MRI或手术证实的CTPV,所有病例均行上腹部螺旋CT平扫及动态增强扫描。结果肝癌合并CTPV的螺旋CT主要表现为：门静脉主干或其分支扩张增粗,门静脉走行区可见迂曲扩张、紊乱的静脉血管影;肝实质动脉期一过性异常灌注;显示原发病灶。结论肝癌合并CTPV有特征性螺旋CT表现,螺旋CT可以诊断门静脉海绵样变性。正确认识其CT表现对肝癌的介入治疗具有重要指导意义：对于肝癌合并门静脉癌栓患者,在有CTPV形成时,经皮肝动脉栓塞治疗是安全、可行的。     

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

Introduction Hemangioma is the most common benign tumor affecting the liver. Although the majority of hepatic hemangiomas never cause symptoms, some may do so because of capsule tension, local necrosis, or compression of adjacent tissues or organs, and even severe complications such as spontaneous rupture, abscess, or consumptive coagulopathy (Kasabach-Merrit syndrome).[1] Inter- ventional therapy for hepatic hemangioma is dangerous,[2] so surgery is still the most effective treatment. Howeve…     

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。     

Clinical experience of hepatic hemangioma undergoing hepatic resection

The indications for surgery on cavernous hemangiomas, the most common benign tumors of the liver, remain unclear. This study reviewed 43 patients with cavernous hemangioma of the liver who underwent hepatic resection from 1984 to 2000. Patients were divided into three groups based on the reasons for surgery. Group I comprised 13 patients whose lesions presented symptoms and dimensions that were the main indications for operation. Group II consisted of 28 patients diagnosed with malignant tumors or who displayed malignant growth that could not be ruled out preoperatively. Group III comprised 2 patients with tumors found incidentally at laparotomy for other malignancies. No surgical mortality related to hepatectomy was noted. Postoperative bile leak was found in 2 (morbidity rate: 4.7%). Patients were followed up from 6 months to 12 years. Thirteen residual tumors progressed in size. The clinical status or symptoms changed only slightly in 10 patients with recurrence. The results suggest that resection therapy is an effective indicator for patients with symptoms and a questionable diagnosis. Hepatic resection may and should be carried out with no mortality and minimal morbidity risks since the lesion is benign.     

Hepatic cavernous hemangioma: underrecognized associated histologic features.

BACKGROUND/AIMS: Cavernous hemangiomas (CH) are typically described as solitary, well-circumscribed lesions and are reported to have a distinct fibrous interface. This study describes underrecognized histological changes of large hepatic hemangiomas that contradict this long-standing view. METHODS: Nineteen cases of hepatic resections for CH were reviewed. Stains for estrogen and progesterone receptors (ER/PR), MIB-1, alpha-smooth muscle actin, collagen IV, and elastic Van Gieson stains were applied to the lesions. RESULTS: The CHs measured 5-31 cm (mean 16.6 cm). Sixteen (84%) CHs had an irregular interface with the liver parenchyma while only three had the well-defined fibrous capsule typically described for CH. Fifteen (79%) CHs had dilated vascular spaces filled with blood 0.1-2.0 cm beyond the confines of the main CH, which we have designated hemangioma-like vessels (HLVs). The histochemical and immunohistochemical stains in both CH and HLVs were similar, with the walls of the vessels composed predominantly of collagen with some faint elastic fibers and smooth muscle, endothelium underlined by collagen IV, negative ER/PR in all components, and a proliferation rate of <5/100 endothelial cells. CONCLUSION: Irregular edges of CH and HLVs in the liver parenchyma adjacent to CH have been underrecognized. No significant differences in staining or proliferative rate were present between CHs and HLVs, suggesting the HLVs are within the spectrum of CH.     

Stereotactic conformal radiotherapy of hepatic metastases:clinical analysis of 8 cases

ＩＮＴＲＯＤＵＣＴＩＯＮＩｔｉｓａｌｗａｙｓａｒｏｕｔｉｎｅｔｏｒｅｓｅｃｔｌｅｓｉｏｎｓｏｆｔｈｅｂｏｄｙｂｙｓｕｒｇｅｒｙ．Ｓｃｉｅｎｔｉｓｔｓｈａｖｅｔｒｉｅｄｔｏｏｂｔａｉｎｔｈｅｓａｍｅｒｅｓｕｌｔｓｗｉｔｈｏｕｔｓｕｒｇｅｒｙ,ｂｕｔｆａ...     

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。