PDF(1212 KB)
PDF(1212 KB)
PDF(1212 KB)
经动脉栓塞治疗肝血管瘤的共识与争议
Consensus and controversies on transarterial embolization for hepatic hemangioma
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。
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.
肝血管瘤 / 经动脉栓塞 / 适应证 / 疗效评估 / 联合治疗
hepatic hemangioma / transarterial embolization / indications / efficacy evaluation / combined therapy
| [1] |
|
| [2] |
国际肝胆胰协会中国分会肝血管瘤专业委员会. 肝血管瘤诊断和治疗多学科专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(8):761-765.DOI:10.19538/j.cjps.issn1005-2208.2019.08.01.
|
| [3] |
Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs.A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management.HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection.HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms.© 2022. The Society for Surgery of the Alimentary Tract.
|
| [4] |
Kasabach–Merritt Phenomenon (KMP) refers to the clinical constellation of thrombocytopenia, consumptive coagulopathy and purpura associated with Kaposiform haemangioedothelioma or tufted angioma, but not the more common infantile haemangioma. It shows a variable and unpredictable response to traditional pharmacological agents, such as steroids, vincristine or interferon alpha 2a or 2b. More recently, the interaction between platelets and endothelial cells and the proangiogenic phenotype that results has been recognized to underly the pathogenesis of this disorder. Recent efforts have attempted to target the platelet by using antiplatelet agents and by the withholding of platelet transfusions even in those patients who have significant thrombocytopenia and laboratory evidence of coagulopathy. Excellent response rates and prompt results have been achieved by combining antiplatelet therapy with vincristine, without the need for steroid use. This synergistic approach moves away from the conventional wisdom of treating the underlying lesion to control the coagulopathy. Sirolimus, which is directed against the PI3/AKT/mTOR downstream signalling pathway involved in lymphangiogenesis, has also shown promising results, although further study is needed.
|
| [5] |
Intratumoral hemorrhage of hepatic hemangioma is very rare.The case of a 54-year-old female with fever and anemia. Initial ultrasound was suggestive of liver abscess, but antibiotic treatment and blood transfusion did not alleviate the patient's symptoms. After abscess puncture and drainage, the patient was admitted to our hospital due to bleeding effusion. The diagnosis of hepatic hemangioma with subacute intratumoral hemorrhage was considered by enhanced magnetic resonance imaging (MRI). The patient's condition was managed with routine liver protection, anti-infection, fluid infusion and two transarterial embolization (TAE) sessions using pingyangmycin-lipiodol emulsion. After the treatment, the patient's symptoms were resolved, the body temperature was normal and the anemia was corrected. Subsequently, we continued periodic follow-up of the patient for four years. The patient was generally in good condition, and there were no symptoms related to hepatic hemangioma, such as fever and anemia. The volume of hepatic hemangioma was reduced by half, and the intratumoral hematoma was obviously absorbed.For patients with previous history of hemangioma, timely MRI can provide higher diagnostic accuracy after they develop symptoms such as fever and anemia. TAE is also a safe and reliable alternative to surgical resection.2022 Translational Cancer Research. All rights reserved.
|
| [6] |
European Association for the Study of the Liver(EASL). EASL clinical practice guidelines on the management of benign liver tumours[J]. J Hepatol, 2016, 65(2):386-398. DOI: 10.1016/j.jhep.2016.04.001.
|
| [7] |
Few long-term data describe the natural history of hepatic hemangiomas. Because these lesions are frequently imaged repetitively on studies performed for other indications, health care professionals are commonly confronted with the problem of a growing hemangioma. Because the rate and magnitude of normal growth is not well characterized, it is difficult to recognize lesions growing at an abnormal rate, which may require further evaluation or intervention.To establish quantitatively the expected growth rate of hepatic hemangiomas and to define a measure of hemangioma growth that could be used clinically to help identify hemangiomas for which growth is more than expected.Retrospective cohort study at an academic hospital tertiary referral center evaluating the growth rate of hepatic hemangiomas on cross-sectional imaging studies during a 10-year period (1997-2007). The mean (SD) follow-up time was 3.7 (1.9) years. The radiology information system was searched in a 10-year period for hemangioma. Patients with hepatic hemangiomas that were 1 cm or larger as seen on cross-sectional imaging (computed tomography or magnetic resonance imaging), and 1 year or more apart were selected. Images with the longest interval between studies were selected for further review. Each study was rereviewed for diagnostic confirmation and to ensure consistency in measurement technique. Lesions were remeasured in 3 dimensions, and volumes were calculated using 3-dimensional software.Primary outcomes include the fraction of hepatic hemangiomas that demonstrated growth during long-term follow-up and the annual growth rate of those lesions.A total of 163 hemangiomas were identified in 123 patients. The mean (SD) initial size was 3.2 (3.1) cm. During follow-up, 39.3% of hemangiomas grew 5% or more in mean linear dimension. The mean (SD) annual linear growth rate was 0.03 (0.21) cm for all lesions and 0.19 (0.23) cm for those that grew 5% or more. By volume, 44.7% of lesions grew 5% or more. The mean (SD) annual volumetric growth rate was 2.8% (21.0%) for all lesions and 17.7% (22.8%) in those that grew 5% or more. The initial size predicted the growth in linear dimension and volume (P <.001). There was no significant change in growth rate over time, indicating uniform growth (R = 0.00843; P =.92).Nearly 40% of hepatic hemangiomas grow over time. Although the overall rate of growth is slow, hemangiomas that exhibit growth do so at a modest rate (2 mm/y in linear dimension and 17.4% per year in volume). Further research is needed to determine how patients with more rapidly growing hemangiomas should be treated.
|
| [8] |
To evaluate the safety and effectiveness of image-guided therapies-including transarterial chemoembolization (TACE), radiofrequency (RF) ablation, microwave ablation, and percutaneous sclerotherapy-for the treatment of giant hepatic hemangiomas (GHHs).A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients that reported image-guided treatment of GHHs. Primary outcomes included technical success, adverse events (AEs; classified according to the Society of Interventional Radiology [SIR] system), clinical success (symptom relief without additional intervention), and radiologic success (≥50% size reduction and/or lack of enhancement on follow-up imaging). A subgroup analysis was performed for GHHs of ≥10 cm. Outcomes were analyzed using a random-effect meta-analysis.Twenty-eight studies (2,617 patients; 32.5% men; mean age, 46.1 years [SD ± 3.2]) with 2,996 GHHs, ranging from 4 to 30 cm, were included. Of these, 22 were noncomparative, and 6 compared either 2 image-guided therapies or surgery, reporting outcomes for TACE (n = 13), RF ablation (n = 7), microwave ablation (n = 6), and percutaneous sclerotherapy (n = 4). The pooled technical success rate was 99.9%. Grade 2-4 AEs occurred in 1.64%, with TACE having the lowest rate (0.2%) and RF ablation the highest (2.1%). Clinical success at final follow-up was 99.9%, while radiological success was 85.7%. Grade 2-4 AEs were significantly higher in the subanalysis of GHHs of ≥10 cm (10.6%; P <.001), despite similar technical success and radiological and clinical outcomes.Image-guided therapies are safe and effective for GHHs, achieving high technical, clinical, and radiological success with minimal Grade 2-4 AEs. However, for GHHs ≥10 cm, AE rates were higher.Copyright © 2025 SIR. Published by Elsevier Inc. All rights reserved.
|
| [9] |
|
| [10] |
|
| [11] |
Background:Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma.
|
| [12] |
|
| [13] |
Large hepatic hemangiomas can cause symptoms such as pain and bleeding. No consensus currently exists on the optimal management of large and symptomatic hemangiomas. The purpose of this study was to evaluate the role of transarterial bleomycin-lipiodol embolization (B/LE) in the treatment of symptomatic large hepatic hemangioma.We retrospectively reviewed 23 patients (29 hemangiomas) treated between July 2011 and August 2017. Transarterial B/LE was performed using 7-15 cc of Lipiodol mixed with 30-45 IU of bleomycin by standard three-way stopcocks. All patients were followed clinically and by imaging for an average of 7.5 months. Patterns of bleomycin-lipiodol distribution in the periphery of hemangiomas were categorized into four different grades. Technical success was defined as proper delivery of bleomycin-lipiodol into the hemangioma confirmed by post-embolization computed tomography. Clinical success was defined as more than 50% reduction of hemangioma volume and symptom improvement during follow-ups.Technical success and clinical success were 100 and 73.9% (17 patients), respectively. Six patients (26.08%) experienced transient post-embolization syndrome. Significant size reduction was seen in patients with grade 4 hemangioma border coverage (P = 0.042).Transarterial B/LE is a safe and efficient alternative for controlling symptoms related to large hemangiomas.
|
| [14] |
This prospective study evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) for the treatment of symptomatic cavernous hemangiomas of the liver. The technique, its complications, and effectiveness also were analyzed.Eight patients (five male, three female; mean age +/- SD = 47.75 +/- 8.59 years) with symptomatic cavernous hemangiomas of the liver were treated by TAE with polyvinyl alcohol particles or gelfoam and steel coils (single session) followed by supportive treatment. Tumor characterization (including the extent and number of lesions) was done on triple-phase helical computed tomography or gadolinium-enhanced dynamic magnetic resonance imaging.The lesions were located in the right lobe in five patients, left lobe in one, and both lobes in two. The largest diameter of the lesions was 6-18 cm (9.28 +/- 5.13 cm). The treatment response was assessed on follow-up ultrasound and color Doppler and/or contrast-enhanced helical computed tomography. There were no treatment-related deaths and morbidity was minimal. Embolization was the only method of treatment in seven patients; however, one patient had surgery after TAE because the symptoms were only partly relieved. Indications for embolization were abdominal pain (eight patients), rapid tumor enlargement (four of eight), and recurrent jaundice (one of eight). Symptomatic improvement was documented in all patients after embolization. Symptoms did not worsen in any patient. The mean size of the tumor did not show any statistically significant change on follow-up radiologic examinations. However, in one patient, the tumor significantly regressed in size after embolization.TAE of hepatic cavernous hemangioma is a useful procedure in the therapy of symptomatic hemangiomas.
|
| [15] |
|
| [16] |
|
| [17] |
The purpose of the study is to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) with pingyangmycin-lipiodol emulsion for the treatment of symptomatic giant hepatic haemangioma. Four hospitals (The Second Hospital of Shandong University, Qilu Hospital of Shandong University, Shandong Provincial Hospital and Jinan Municipal Hospital) participated in this study during 2002-2012. A total of 836 patients with symptomatic giant haemangioma were treated with pingyangmycin-lipiodol emulsion via selective TACE. The patients were followed-up for 12 months-10 years. The effectiveness of the treatment was evaluated by symptom assessments and upper abdominal magnetic resonance imaging or computed tomography. TACE was successfully performed for a total of 1120 lesions in 836 patients. Success rate of the procedure was 100 %. The mean diameter of the haemangiomas was significantly reduced after the interventional therapy (mean diameter 9.6 ± 0.8 vs. 3.6 ± 0.5 cm; P < 0.05). Symptom relief was achieved in all the patients during the follow-up period. No mortality was identified. TACE with pingyangmycin-lipiodol emulsion is a safe, feasible, and effective treatment for the giant symptomatic hepatic haemangioma.
|
| [18] |
|
| [19] |
Despite remarkable advancement in the surveillance and treatment of hepatocellular carcinoma (HCC) and the availability of novel curative options, a great proportion of HCC patients are still not eligible for curative treatment due to an advanced tumor stage or poor hepatic functional reserve. Therefore, there is a continuing need for effective palliative treatments. Although practiced widely, it has only recently been demonstrated that the use of transarterial chemoembolization (TACE) provides a survival benefit based on randomized controlled studies. Hence, TACE has become standard treatment in selected patients. TACE combines the effect of targeted chemotherapy with the effect of ischemic necrosis induced by arterial embolization. Most of the TACE procedures have been based on iodized oil utilizing the microembolic and drug-carrying characteristic of iodized oil. Recently, there have been efforts to improve the delivery of chemotherapeutic agents to a tumor. In this review, the basic principles, technical issues and complications of TACE are reviewed and recent advancement in TACE technique and clinical applicability are briefed.
|
| [20] |
|
| [21] |
To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas.Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36 months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3 years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images.A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73 mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6 cm (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15 years.TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up.© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
|
| [22] |
The management of patients with giant haemangioma of the liver remains controversial. Although the usual treatment method for symptomatic giant haemangioma is surgery, the classical paradigm of operative resection remains. In this study, we evaluated the symptomatic improvement and size-reduction effect of embolisation with bleomycin mixed with lipiodol for the treatment of symptomatic giant hepatic haemangioma.This study included 26 patients [21 female, five male; age 41-65 years (mean 49.83 ± 1.53)] with symptomatic giant haemangioma unfit for surgery and treated with selective embolisation by bleomycin mixed with lipiodol. The patients were followed-up (mean 7.4 ± 0.81 months) clinically and using imaging methods. Statistical analysis was performed using SPSS version 16.0, and p < 0.05 was considered to indicate statistical significance.Embolisation of 32 lesions in 26 patients was performed. The mean volume of the haemangiomas was 446.28 ± 88 cm(3) (range 3.39-1559 cm(3)) before intervention and 244.43 ± 54.38 cm(3) (range 94-967 cm(3)) after intervention. No mortality or morbidity related to the treatment was identified. Symptomatic improvement was observed in all patients, and significant volume reduction was achieved (p = 0.001).The morbidity of surgical treatment in patients with giant liver hemangioma were similar to those obtained in patients followed-up without treatment. Therefore, follow-up without treatment is preferred in most patients. Thus, minimally invasive embolisation is an alternative and effective treatment for giant symptomatic haemangioma of the liver.
|
| [23] |
Treatment of hepatic hemangiomas is a controversial topic, and traditionally treatment is by surgical excision. Transcatheter arterial embolisation (TAE) and transcatheter arterial chemoembolisation (TACE) have been reported as minimally invasive treatment methods. To our knowledge, there are no studies comparing use of TACE and TAE for hepatic hemangioma treatment. The aim of the study is to compare symptom resolution, size reducing effects and complications of TACE and TAE for the treatment of giant hepatic hemangiomas.104 patients underwent TACE using bleomycin and 108 patients underwent TAE. The patients were followed-up for 2 year and follow-up images at 6 months, 12 months and 24 months were acquired. Lesion volumes in both follow-up images were calculated. The patients were examined for any possible procedure related complications as well as the status of their initial symptoms.The shrinkage period was determined to have ended after 12. month in the both group. The results of the Two-Way Mixed ANOVA showed that there was significant main effect of procedure type (p = <0.001) on hemangioma volumes. Similarly, there was a significant interaction between procedure and time (p = <0.001).Both methods are effective in symptomatic relief in properly selected patients. However, TACE causes greater volume reduction with less pain and therefore is the better endovascular treatment option.
|
| [24] |
|
| [25] |
|
| [26] |
Purpose: To evaluate the medium and long-term efficacy of superselective transcatheter arterial embolization (TAE) with lipiodol–bleomycin emulsions (LBE) for giant hepatic hemangiomas. Methods: A total of 241 patients who had underwent TAE with LBE for hepatic hemangiomas from January 2010 to December 2016 were retrospectively reviewed. Blood tests were performed 3 and 7 days after TAE and procedural-related complications were recorded. The patients were followed up by enhanced CT or MRI imaging at 6, 12, 36, and 60 months post-TAE, respectively. Technical success of TAE was defined as successful embolization of all identifiable arteries supplying to the hemangiomas. Clinical success was defined as improvement of the abdominal symptoms and indications on the imaging examinations that the hemangiomas had decreased by more than 50% in maximum diameter. Results: TAE was performed successfully in all patients without serious complications. Improvement of the abdominal symptoms was recorded in 102/102 cases (100%). The reduction rate of the tumor maximum diameter with >50% at 6, 12, 36, and 60 months was 88.1% (190/210), 86.7% (170/196), 85.2% (124/142), and 86.5% (45/52), respectively. There was a significant change from pre-TAE to follow-up values in maximum diameter (p < 0.05). Conclusion: TAE with LBE was feasible and effective for giant hepatic hemangiomas. The reductions of the tumor maximum diameter with >50% at medium (≥3 years) and long-term (≥5 years) follow-up were satisfactory, with 85.2% and 86.5%, respectively.
|
| [27] |
Transarterial (chemo-)embolization/lipiodolization (TAE/TAL) might be an attractive minimally invasive alternative to surgery in the treatment of symptomatic hepatic haemangioma. This review assesses the efficacy and safety of TAE/TAL as primary treatment for symptomatic hepatic haemangioma.A systematic search of the literature was performed by two reviewers following the PRISMA guidelines. Cohort studies and case reports were identified; outcomes of cohort studies were reported. The primary efficacy outcome was tumour size before and after TAE/TAL. Improvement of symptoms and quality of life (QoL) were secondary outcomes; the primary safety outcome was complications. The Downs and Black statement was used for quality assessment.Eighteen cohort studies were identified, including 1284 patients. TAE/TAL led to a decrease in tumour size in 1100/1223 (89.9%) patients and to improvement or disappearance of symptoms in 1080/1096 (98.5%) patients. A significant decrease in tumour size from 9.79 ± 0.79 cm to 4.00 ± 1.36 cm (p < 0.001) was shown. Grade 3 complications occurred in 37/1284 (2.9%) patients. Surgical treatment was necessary in 35/1284 (2.7%) of patients.TAE/TAL appears to be a promising and safe treatment to decrease tumour size of hepatic haemangioma. The technique might also provide partial relief of symptoms, although no randomized clinical trials or prospective studies using validated QoL questionnaires are available. TAE/TAL may be considered as a viable alternative to resection.
|
| [28] |
To compare the efficacy and postoperative recovery outcomes of microwave ablation (MWA) and transcatheter arterial embolization (TAE) using a bleomycin-lipiodol emulsion combined with gelatin sponge particles in the treatment of hepatic hemangioma.In this retrospective study, 255 patients with hepatic hemangioma treated between January 2020 and June 2024 were analyzed. Patients were assigned to either the MWA group (n = 135) or the TAE group (n = 120). Evaluated parameters included operative characteristics, liver function changes, recovery metrics, complications, treatment efficacy, quality of life, and patient satisfaction.MWA resulted in a higher overall efficacy rate compared to TAE (76.30% vs. 61.67%, P = 0.011), but was associated with significantly elevated postoperative alanine aminotransferase (ALT) levels (P < 0.001), indicating greater hepatocellular injury. Although ablation procedures were longer (P = 0.005), they were associated with reduced intraoperative blood loss (P = 0.010). TAE was linked to faster recovery, reflected in shorter hospital stays (P = 0.003). The MWA group experienced fewer overall complications, though hemolysis was uniquely observed in this cohort. The TAE group had higher rates of fever and ischemic events. Both groups showed improved quality of life post-treatment, with the MWA group demonstrating greater gains in physical functioning (P = 0.004). Patient satisfaction was comparable between groups.MWA and TAE are both effective treatment options for hepatic hemangioma, each with distinct advantages. MWA offers superior lesion control at the expense of greater hepatic stress, while TAE facilitates quicker recovery with a higher incidence of transient complications.AJCR Copyright © 2025.
|
| [29] |
|
| [30] |
Transarterial embolization of liver hemangiomas has not been considered to be consistently effective.The charts of 25 patients who underwent superselective transarterial chemoembolization with the bleomycin-lipiodol emulsion were evaluated retrospectively.Twenty-two patients had abdominal pain; asymptomatic/vaguely symptomatic enlargement was the treatment indication in three patients. A single session was conducted in 17 patients, two sessions in 7 and three sessions in one. After the first session, lesion volume decreased by median (range) 51% (10-92%) from median (range) 634 (226-8435) to 372(28-4710) cm (p < 0.01), after a median period of 4 months (range 2-8). A second session was performed in eight patients (median (range) initial volume 1276 (441-8435) cm) with persistent complaints and/or large lesions receiving feeders from both right and left hepatic arteries (staged treatment). Median (range) lesion size decreased further from 806 (245-4710) to 464 (159-2150) cm (p < 0.01). Three patients experienced a postembolization syndrome that persisted after the first week. Seventeen of the 22 symptomatic patients (77%) reported resolution or marked amelioration of complaints. Regrowth after initial regression was not observed during median (range) 14 (8-39) months of follow-up (n:18).Transarterial chemoembolization with the bleomycin-lipiodol emulsion is a potential alternative to surgery for symptomatic/enlarging liver hemangiomas. Volume reduction is universal, and symptom control is satisfactory. Centrally located and very large (>1000 cm) lesions may require two sessions.
|
| [31] |
Hemangiomas are most common benign liver tumor. Most patients have an excellent prognosis because of the small size and benign nature of tumor. On some occasions, giant liver hemangioma may cause symptoms and significant challenges due to its complication. We report a case of giant liver hemangioma treated with minimal invasive approach by transarterial embolization (TAE). Following three TAE sessions over a specific timeframe, the patient was successfully managed, addressing that TAE may be a useful alternative to hepatic surgery in such cases.© 2024. Japanese Society of Gastroenterology.
|
| [32] |
This study aims to systematically evaluate the efficacy and safety of different bleomycin administration routes for treating GHHs, with a subgroup analysis comparing Transarterial chemoembolization (TACE) and percutaneous sclerotherapy (PS).A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science from inception through May 6, 2025. Studies included reporting clinical and radiological outcomes after PS and TACE for GHHs (≥ 4 cm). Primary outcomes included technical success (complete and accurate application as predetermined in the study protocol), safety outcomes, clinical (symptom relief without additional intervention), and radiological success (≥ 50% size reduction and/or lack of enhancement on follow-up imaging). The outcomes were analyzed using a random-effects meta-analysis 106 1586.A total of 17 studies, including 1692 patients (1586 treated with TACE and 106 with PS) and 1825 GHHs, were included. Among these, 13 studies assessed TACE, and four studies evaluated PS. The overall technical success rate was 100%, with pooled clinical and radiological success rates of 96.93% and 81.75%, respectively. In subgroup analyses, both TACE and PS achieved 100% technical success. TACE showed slightly higher clinical success, at 99.9%, compared to PS at 89.73%, although the difference was not statistically significant (p = 0.15). Radiological success was comparable (TACE: 81.9%, PS: 81.29%). Major complications were rare (0.27%, 95% CI: 0-0.55%). No significant differences were observed in major complication rates (TACE: 0.26%, PS: 0.85%, p = 0.67), total complications (p = 0.48), or procedure-related morbidity.Both TACE and PS are effective treatments for GHHs, with PS showing a lower systemic complication rate.© 2025. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
|
| [33] |
|
| [34] |
李馨慈, 曾小军, 陈洪彬, 等. 肝动脉栓塞联合延期腹腔镜肝切除治疗巨大肝血管瘤临床疗效分析[J]. 中国实用外科杂志, 2024, 44(4):467-472.DOI:10.19538/j.cjps.issn1005-2208.2024.04.18.
|
利益冲突 所有作者均声明不存在利益冲突
/
| 〈 |
|
〉 |
