Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.
Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Br J Surg. 2019 Sep;106(10):1362-1371. doi: 10.1002/bjs.11213. Epub 2019 Jul 17.
Hepatocellular adenoma (HCA) larger than 5 cm in diameter has an increased risk of haemorrhage and malignant transformation, and is considered an indication for resection. As an alternative to resection, transarterial embolization (TAE) may play a role in prevention of complications of HCA, but its safety and efficacy are largely unknown. The aim of this study was to assess outcomes and postembolization effects of selective TAE in the management of HCA.
This retrospective, multicentre cohort study included patients aged at least 18 years, diagnosed with HCA and treated with TAE. Patient characteristics, 30-day complications, tumour size before and after TAE, symptoms before and after TAE, and need for secondary interventions were analysed.
Overall, 59 patients with a median age of 33.5 years were included from six centres; 57 of the 59 patients were women. Median tumour size at time of TAE was 76 mm. Six of 59 patients (10 per cent) had a major complication (cyst formation or sepsis), which could be resolved with minimal therapy, but prolonged hospital stay. Thirty-four patients (58 per cent) were symptomatic at presentation. There were no significant differences in symptoms before TAE and symptoms evaluated in the short term (within 3 months) after TAE (P = 0·134). First follow-up imaging was performed a median of 5·5 months after TAE and showed a reduction in size to a median of 48 mm (P < 0·001).
TAE is safe, can lead to adequate size reduction of HCA and, offers an alternative to resection in selected patients.
直径大于 5 厘米的肝细胞腺瘤 (HCA) 出血和恶变的风险增加，被认为是切除的指征。作为切除的替代方法，经动脉栓塞术 (TAE) 可能在预防 HCA 并发症方面发挥作用，但它的安全性和疗效在很大程度上尚不清楚。本研究旨在评估选择性 TAE 在 HCA 治疗中的结果和栓塞后效应。
这是一项回顾性、多中心队列研究，纳入了至少 18 岁、诊断为 HCA 并接受 TAE 治疗的患者。分析了患者特征、30 天并发症、TAE 前后肿瘤大小、TAE 前后症状以及需要进行二次干预的情况。
来自 6 个中心的 59 例患者，中位年龄为 33.5 岁，纳入本研究；59 例患者中 57 例为女性。TAE 时的肿瘤中位大小为 76mm。6 例患者（10%）发生主要并发症（囊肿形成或脓毒症），可通过最小的治疗得到解决，但延长了住院时间。34 例患者（58%）在就诊时存在症状。TAE 前的症状与 TAE 后短期（3 个月内）评估的症状无显著差异（P=0.134）。TAE 后中位 5.5 个月进行了首次随访影像学检查，显示肿瘤大小缩小至中位 48mm（P<0.001）。
TAE 是安全的，可以使 HCA 的大小得到充分缩小，为选择的患者提供了切除的替代方法。
