【作者】 王光磊；

【导师】 李巍；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2025， 硕士

【摘要】 背景:肝血管瘤(hepatic hemangioma,HH)是肝脏最常见的良性肿瘤,随着医疗水平的不断提高以及人们健康理念的变化,HH开始受到了更多的关注。但到目前为止,关于HH的治疗指征和方法的选择仍然是专家们争论的问题,尚未达成共识。在近年来的一系列临床研究中发现,博莱霉素-碘油栓塞术治疗HH的效果得到肯定,具有创伤小、恢复快、费用低等优势,尤其对于多发和较大的HH不失为首选的治疗方法。目的:本研究目的旨在通过回顾性分析本中心采用博来霉素-碘油栓塞术治疗的HH临床病例,评价博来霉素-碘油栓塞术治疗HH的疗效和可行性,以期为今后HH的治疗方法的选择提供有价值的参考。数据和方法:回顾性分析2020-2024年于吉林大学中日联谊医院收治的采用博来霉素-碘油栓塞术治疗的51名HH患者(共62处病灶)的临床资料。所有入组患者均基于超声、三期CT或动态增强核磁共振成像等检查明确诊断为HH,并通过栓塞期间观察到的特征性血管造影特征进一步证实HH的诊断;均具有完整的临床资料,包括年龄、性别、相关影像学资料、术前及术后肝功、凝血、血常规等相关血化验结果等。手术后进行血液检查(血常规、肝功能、肾功能和凝血功能),并记录栓塞术后相关并发症(如发热、疼痛、过敏反应等)。对所有患者于术后1、3、6、9、和12个月通过临床症状观察、超声、CT或MRI成像等结果进行综合随访,根据放射影像评估血管瘤体积。技术的成功被定义为从HH供血动脉中选择性地应用博莱霉素-碘油混合物,成功栓塞了所有数字减影血管造影(Digital Subtraction Angiography,DSA)下可识别的供应血管瘤的动脉。治疗后,病灶体积缩小50%以上且相关症状消失,则认为是达到了预期治疗效果。进一步评估栓塞术治疗HH的有效性和安全性。统计学数据分析采用曼-惠特尼检验、克鲁斯卡尔-沃利斯检验以及配对t检验。结果:51名被纳入研究的HH患者中,女性占76.5%,男性占23.5%,平均年龄49.5±9.5岁。其中,9例治疗前伴有腹部症状,占比17.65%。对这51例患者(平均随访6.6±5.9个月)的62处病灶进行分析,技术成功率达100%。术后各时间点病灶体积及最大直径均显著缩小:术后1、3、6、9、12个月体积平均缩减率分别为55.8%(n=11)、60.2%(n=22)、70.0%(n=22)、72.6%(n=12)、70.3%(n=7);最大径平均缩减率分为25.7%(n=11)、31.9%(n=22)、43.3%(n=22)、34.9%(n=12)、43.9%(n=7)。82.3%(51/62)的病灶治疗后平均6.3个月后体积缩减超50%(治疗前254.2±254.5cm~3vs治疗后75.4±106.0cm~3),其中40.3%(25/62)的病灶治疗后平均7.9个月后缩减超80%(治疗前206.2±220.9cm~3vs治疗后25.9±24.1cm~3),随访期间所有病灶均未复发。术后血清转氨酶(ALT)升高占9.8%、血浆胆红素(TB)升高占7.8%、栓塞后综合征(Post-Embolization Syndrome,PES)占25.5%,白细胞、中性粒细胞等炎症指标升高占31.4%,均在短时间内恢复正常。随访期间所有患者均未出现病灶复发情况,均未观察到严重并发症。结论:博来霉素-碘油栓塞术治疗HH是一种安全、有效、可行的治疗方法。不仅创伤小,费用低,恢复快,而且最大限度的保留了患者正常肝组织和肝功能。更多还原

【Abstract】 Background:Hepatic hemangioma(HH)is the most common benign tumor in the liver.Alone with the continuous improvement of health standards and concepts,HH has been received more attention recently.However,so far,the selection of treatment indications and methods for HH is still controversy among experts and no consensus has been reached.It has been reported that Bleomycin-Iodized Oil Embolization was effective in HH therapy,especially for multiple lesions and larger lesions,and was a preferred treatment method.Aims:The purpose of this study is to evaluate the efficacy and feasibility of Bleomycin-Iodized Oil Embolization for the treatment of HH by retrospectively analyzing clinical cases treated with this procedure at our center,in order to provide valuable reference for the selection of treatment methods for HH in the future.Materials and Methods:A retrospective analysis was conducted on 51 HH patients(with a total of 62 lesions)treated with Bleomycin-Iodized Oil Embolization at the China-Japan Union Hospital of Jilin University from 2020 to 2024.All enrolled patients were definitively diagnosed with HH based on ultrasound(B-mode),three-phase CT,or dynamic contrast-enhanced MRI,and further confirmed by characteristic angiographic features observed during embolization.All patients had complete clinical data,including age,gender,relevant imaging data,preoperative and postoperative liver function,coagulation,and complete blood count results.Blood tests(complete blood count,liver function,renal function,and coagulation function)were performed after surgery,and post-embolization complications(such as fever and pain)were recorded.Comprehensive follow-up was conducted on all patients at 1,3,6,9,and 12 months after surgery based on clinical symptom observation,ultrasound,CT,or MRI imaging results,and the tumor volume was evaluated based on radiographic imaging.Technical success was defined as the selective application of the Bleomycin-iodized oil mixture from the feeding artery and successful embolization of all arteries supplying the hemangioma identifiable on DSA.After treatment,if the volume of the lesion shrinks by more than 50%and the related symptoms disappear,it is considered that the expected treatment effect has been achieved.The effectiveness,safety,and CT changes of hemangiomas after embolization were evaluated.Statistical analysises were made by using the Mann-Whitney test,Kruskal-Wallis test,and paired t-test according to the type of data.Results:Among the 51 HH patients included in the study,76.5%were female and23.5%male,with a mean age of 49.5±9.5 years.Nine patients(17.65%)presented with abdominal symptoms prior to treatment.Analysis of 62 lesions in these 51patients(mean follow-up 6.6±5.9 months)revealed a 100%technical success rate.Significant reductions in lesion volume and maximum diameter were observed at all postoperative time points:average volume reduction rates at 1,3,6,9,and 12 months postoperatively were 55.8%,60.2%,70.0%,72.6%,and 70.3%,respectively,while maximum diameter reduction rates averaged 25.7%,31.9%,43.3%,34.9%,and43.9%.There were 82.3%of lesions achieved>50%volume reduction((pretreatment volume 254.2±254.5 cm~3vs post-treatment 75.4±106.0 cm~3)at a mean of 6.3months,with 40.3%of lesions showed>80%reduction(pretreatment 206.2±220.9cm~3vs post-treatment 25.9±24.1 cm~3)over a mean 7.9 months.No recurrence occurred during follow-up.Postoperative complications included transient serum transaminase elevation(ALT)(9.8%),plasma bilirubin elevation(TB)(7.8%),post-embolization syndrome(25.5%),and elevated inflammatory markers such as leukocytes and neutrophils(31.4%),all of which normalized within a short period.No severe complications or lesion recurrences were observed during follow-up.Conclusion:Bleomycin-Iodized Oil Embolization is a safe,effective,and feasible treatment option for HH.It is minimally invasive and cost-effective,with a rapid recovery.Moreover,it maximizes the preservation of normal liver volume and liver function.更多还原