Akhlaghpoor Shahram, Torkian Pooya, Golzarian Jafar
Pardis Noor Medical Imaging Center, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Cardiovasc Intervent Radiol. 2018 Nov;41(11):1674-1682. doi: 10.1007/s00270-018-2010-4. Epub 2018 Jun 19.
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.
巨大肝血管瘤可引起疼痛和出血等症状。目前对于巨大且有症状的血管瘤的最佳治疗方案尚无共识。本研究的目的是评估经动脉博来霉素-碘油栓塞术（B/LE）在治疗有症状的巨大肝血管瘤中的作用。
我们回顾性分析了2011年7月至2017年8月期间接受治疗的23例患者（29个血管瘤）。经动脉B/LE采用标准三通旋塞将7 - 15毫升碘油与30 - 45国际单位博来霉素混合进行。所有患者均接受临床及影像学随访，平均随访7.5个月。将血管瘤周边博来霉素-碘油的分布模式分为四种不同等级。技术成功定义为栓塞后计算机断层扫描证实博来霉素-碘油正确注入血管瘤。临床成功定义为随访期间血管瘤体积缩小超过50%且症状改善。
技术成功率和临床成功率分别为100%和73.9%（17例患者）。6例患者（26.08%）出现栓塞后短暂综合征。4级血管瘤边界覆盖的患者血管瘤体积显著缩小（P = 0.042）。
经动脉B/LE是控制与巨大血管瘤相关症状的一种安全有效的替代方法。
