【摘要】 肝血管瘤(HH)作为临床最常见的肝脏良性肿瘤,其治疗模式已由传统外科切除逐步向微创干预演进。其中,经动脉栓塞(TAE)凭借微创、可重复及最大限度保留功能性肝实质等优势,成为主流治疗手段之一,但其规范化应用在临床实践中仍存诸多争议。在适应证界定上,除症状性HH、伴发血小板减少性紫癜及自发性破裂出血为公认的绝对干预指征外,针对直径>10 cm的无症状巨大HH,实施预防性TAE干预以规避潜在脏器压迫风险的策略正逐渐获得学界认可。术前多模态影像学评估对疗效预测至关重要,表现为典型强化且未合并中央型动静脉分流(APS)的病灶,其TAE术后体积缩小更为显著。在技术实施规范方面,以博来霉素或平阳霉素-碘油乳剂联合颗粒栓塞剂的协同方案占据主导,术中需依托微导管行超选择插管,贯彻“封而不死、药在其中”的核心理念,促使硬化剂于血窦内长期滞留以破坏内皮细胞。针对术后疗效评估,亟需摒弃主要适用于细胞增殖性恶性肿瘤的实体瘤疗效评价标准(RECIST),转而构建以临床症状改善为辅、病灶体积缩减率(>50%)为核心的首要影像学评价体系。此外,在多学科治疗博弈中,TAE在处理>10 cm巨大病灶时相较于热消融具备绝对的安全性优势;面对复杂难治性病例,采取TAE联合延期热消融或外科切除的序贯治疗模式,能够切实发挥增效减毒作用,全面提升病人远期的临床获益。更多还原

【Abstract】 As the most common benign liver tumor in clinical practice, the treatment mode of hepatic hemangioma(HH) has gradually evolved from traditional surgical resection to minimally invasive intervention. Among them, transarterial embolization(TAE) has become one of the mainstream treatment methods by virtue of its advantages such as minimal invasiveness, repeatability, and maximum preservation of functional liver parenchyma, but its standardized application still has many controversies in clinical practice. In terms of the definition of indications, in addition to symptomatic HH, concomitant thrombocytopenic purpura, and spontaneous rupture and hemorrhage as recognized absolute indications for intervention, the strategy of implementing prophylactic TAE intervention for asymptomatic giant HH with a diameter >10 cm to avoid the potential risk of organ compression is gradually gaining recognition in the academic community. Preoperative multimodal imaging evaluation is crucial for efficacy prediction. Lesions with typical enhancement and without central arterioportal shunts(APS) show more significant volume reduction after TAE. In terms of technical implementation specifications, the synergistic regimen of bleomycin or pingyangmycin-lipiodol emulsion combined with particulate embolic agents is dominant. Intraoperatively, superselective intubation relying on microcatheters is required, and the core concept of “incomplete embolization with drug retention” is implemented to promote the long-term retention of sclerosing agents in the hepatic sinusoids to destroy endothelial cells. For postoperative efficacy evaluation, it is urgently necessary to abandon the Response Evaluation Criteria in Solid Tumors(RECIST), which is mainly applicable to cell-proliferative malignant tumors, and turn to constructing a primary imaging evaluation system centered on the lesion volume reduction rate(>50%), supplemented by the improvement of clinical symptoms. In addition, in the context of multidisciplinary treatment decision-making, TAE has an absolute safety advantage over thermal ablation when dealing with giant lesions >10 cm; in the face of complex and refractory cases, adopting a sequential treatment mode of TAE combined with delayed thermal ablation or surgical resection can effectively play the role of increasing efficacy and reducing toxicity, comprehensively improving the long-term clinical benefits of patients.更多还原