Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2013 May 21;19(19):2974-8. doi: 10.3748/wjg.v19.i19.2974.
Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. A 21-year-old Asian man visited our hospital for left upper quadrant pain. Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity, with a maximum diameter of 31.5 cm. Embolization of the left hepatic artery was performed and confirmed a decrease in its size. However, the patient was readmitted to our hospital one month after embolization for intestinal obstruction. A left hepatectomy was completed through a herringbone incision, and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight. Pre-operative arterial embolization is effective for reducing tumor size, but a close follow-up to decide the time for hepatectomy is important.
肝血管瘤是肝脏最常见的良性肿瘤。大多数肝血管瘤无症状,无需治疗。然而,有明确并发症、诊断不确定和引起症状的巨大肝血管瘤,通常被认为是手术切除的绝对指征。我们报告了一例经导管动脉栓塞后发生肠梗阻的巨大肝血管瘤病例,通过该治疗,肝血管瘤的体积明显缩小,并通过左半肝切除术完全切除。一名 21 岁的亚裔男性因左上腹疼痛就诊于我院。首诊检查发现肝脏左叶血管瘤占据整个腹腔,最大直径 31.5cm。进行了左肝动脉栓塞术,证实其体积缩小。然而,栓塞一个月后,患者因肠梗阻再次入院。通过人字切口完成左半肝切除术,安全切除了一个 26.5cm×19.5cm×12.0cm 大小、重 3690g 的巨大肝血管瘤。术前动脉栓塞对于缩小肿瘤体积是有效的,但密切随访以决定肝切除术的时间很重要。