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%（P<0.05）;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（P<0.05）;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（P<0.05）;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%（P<0.05）。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。

Impact of blood supply on efficacy of hepatic artery embolization in treatment of patients with hepatic hemangioma

Objective To investigate the impact of blood supply on efficacy of hepatic artery embolization in treatment of patients with hepatic hemangioma. Methods 100 patients with hepatic hemangioma were recruited in our hospital between January 2013 and August 2017,and the patients were divided into group A（n=37） with rich blood supply,group B （n=34） with moderate blood supply and group C （n=29） with poor blood supply. All the patients with hepatic hemangioma received transcatheter hepatic arterial embolization with pingyangmycin and iodized oil. All the patients were followed-up for 12 months. Results At the end of six and twelve months,the efficient rate in group A were 64.9% and 81.1%,significantly higher than 61.8% and 67.7% in group B or 3.5% and 10.3% in group C （P<0.05）;the volumes of pingyangmycin and iodized oil in group A,group B and group C were （11.4±2.6） ml,（9.7±1.9） ml and （4.3±1.0） ml,significantly different among the three groups （P<0.05）;at the end of twelve month,the diameter of focus in group C was （6.6±0.7） mm,much larger than （2.8±0.2） mm in group A or （3.2±0.3） mm in group B（P<0.05）;the short-term post-operational complications such as liver injury in group A was 18.9%,significantly higher than 8.8% in group B or 3.4% in group C（P<0.05）. Conclusion The therapeutic effect of hepatic artery embolization for different blood supply types of hepatic aneurysms should be obviously different. In clinical practice,it should pay attention to choosing reasonable therapeutic methods according to the blood supply tipu to improve the therapeutic effect and safety.