【作者】 张学军； 欧阳墉； 马和平； 朝鲁孟； 甄彦利； 郑宇；

【机构】 内蒙古自治区医院介入科；

【摘要】 目的评价平阳霉素碘油乳剂(Pingyangmycin-lipodol emulsion,PLE)肝动脉栓塞术治疗肝海绵状血管瘤(cavernous hemangioma ofthe liver,CHL)的远期疗效及其影响因素。方法收集本院11年间有完整资料并经影像学检查或手术病理确诊的CHL 105例,共计156个瘤灶,平均瘤灶大小6.8cm×6.5cm(最小者1.5cm×1.0cm,最大者30.5cm×20.5cm)。105例156个瘤灶中,A组(≤3cm)25个,B组(<5cm)32个,C组(≥5cm)58个和D组(≥10cm)41个;异常血窦丰富型90个、较丰富型57个和稀少型9个。105例皆行经肝动脉PLE栓塞治疗,共计135疗次,其中1疗次者75例、2疗次者30例。术后全部病例均经US和CT/MRI或DSA检查随访3年或3年以上。根据瘤灶大小、血窦多少、疗次等进行疗效评价和统计学处理分析。结果以特效、显效、好转和无效作为疗效评价标准。156个瘤灶总有效率为94.87%(148/156)。接受单疗次后的A、B两组总有效率为96.49%(55/57),C、D两组为85.86%(85/99),两者间有显著差异(x~2=4.4429,P<0.05);接受二疗次后的D组总有效率为100%,而单疗次后D组则为85.37%,总有效率差异也有明显相关性(x~2=4.4956,P<0.05)。对于血窦丰富、<5cm瘤灶,单疗次往往即可达到治愈。随访期间105例无一例复发,未见肝功能损害及严重并发症发生。结论经肝动脉PLE栓塞治疗<5cm的血窦丰富的CHL可获得近乎完全治愈的远期疗效;对于血窦丰富、瘤灶巨大或多发弥漫的CHL,通过重复治疗也可获得满意和肯定的远期疗效。更多还原

【Abstract】 Objective To evaluate the long-term effect of hepatic arterial embolization with Pingyangmycin-lipiodol emulsion(PLE)in cavernous hemangiomas of the liver(CHL)and its influence factors.Methods 156 hemangiomas of 105 patients with complete data that were diagnosed by imaging examinations or confirmed pathologically by surgery were present in this paper.Of the 156 hemangiomas,the smallest one was 1.5cm×1.0cm and the largest was 30.5cm×20.5cm(mean size 6.8cm×6.5cm).Therefore,156 hemangiomas were divided into four groups according to its variant size by the authors as follows:A group(≤3cm),25;B group(<5cm),32;C group(≥5cm),58;and D group(≥10cm),41.And according to the number of abnormal sinusoids filled with the contrast medium in the angiography,156 hemangiomas of this series were further classified as three types:abundant type,90;sparse type,9 and the middle type,57.Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures(included of single procedure in 75 patients,twice procedures in 30 patients).All of the 105 patients were followed up three years or more than 3 years using US,CT/MRI or DSA.Then,the long-term effect of 105 patients with CHL and its influence factors were analysed and evaluated.Results The criteria for the evaluation of curative effect was classified as excellent,best,good and no change.The total effective rate of the 156 hemangiomas was 94.87%(148/156).After single procedure of hepatic arterial embolization with PLE,the total effective rate of A,B groups and C,D groups were 96.49%(55/57)and 85.86%(85/99)respectively,the difference of both were significant(x~2=4.4429,P<0.05).And in the D groups,the total effective rate of the hemangiomas that received twice procedures of hepatic arterial embolization with PLE was higher(100%)then those hemangiomas that only recieved single procedure of treatment(85.37%),the difference of both were also significant(x~2=4.4956,P<0.05).A complete cure of the hemangioma was usually obtained in those small hemangiomas(<5cm)with abundant abnormal sinusoids.Of this series,during the period of following-up,no case was recurrent and no severe complication was seen.Conclusion A excellent or best long-term curative effects were usually obtained in those small hemangiomas(<5cm)with abundant abnormal sinusoids,and a satisfactory long-term curative effects can also be achieved in the larger or multiple hemangiomas with repeat procedures of hepatic arterial embolization with PLE.更多还原