School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Cardiovasc Intervent Radiol. 2021 Jan;44(1):80-91. doi: 10.1007/s00270-020-02611-5. Epub 2020 Aug 17.
To evaluate the current evidence for the effectiveness of transarterial embolization (TAE) in treatment of symptomatic hepatic hemangiomas.
A systematic literature review was conducted in PubMed, CINAHL and Scopus databases to identify studies of hepatic hemangiomas treated with transarterial embolization. Main outcome was defined as the mean difference between pre- and post-TAE hemangioma diameters. Treatment agents were categorized as Lipiodol based [bleomycin (L + BE), pingyangmycin (L + PYG) or ethanol (L + ethanol)] and non-Lipiodol based (polyvinyl-alcohol-only). Conventional random-effect meta-analysis technique was applied to analyze data.
Of 3080 initially inspected publications, 21 studies were included in the meta-analysis comprising of 1450 patients with total of 1871 hemangiomas (36.2% male, mean age: 46.3 ± 3.6 years). One hundred and twenty-six, 1666, 41 and 38 lesions were treated with L + BE, L + PYG, L + ethanol and PVA, respectively. Median follow-up time after embolization was 12 months. Lipiodol-based treatments showed significant effect in reducing hemangioma size after TAE compared to PVA (P < 0.001). Pooled diameter reduction (cm) (95% confidence interval) was - 4.37( - 5.32, - 3.42), - 4.70( - 5.70, - 3.71), - 0.93( - 2.02, 0.16) for overall TAE treatment, Lipiodol-based and non-Lipiodol-based treatments, respectively. Main complications included post-embolization syndrome and transient liver enzyme elevation (pooled incidence for Lipiodol-based and non-Lipiodol-based techniques: 36% and 33%; and 37% and 0, respectively). No fatal complications were reported. Symptomatic improvement was reported in 63.3%-100% of the cases with majority of studies (15/21) reporting improvement in all cases (pooled response rate: 98%).
Transarterial embolization with bleomycin, pingyangmycin or ethanol in combination with Lipiodol is safe and associated with reduced size of hemangiomas resulting in symptoms alleviation.
评估经动脉栓塞术（TAE）治疗症状性肝血管瘤的有效性的现有证据。
在 PubMed、CINAHL 和 Scopus 数据库中进行了系统的文献回顾，以确定接受 TAE 治疗的肝血管瘤研究。主要结果定义为 TAE 前后血管瘤直径的平均差异。治疗剂分为基于碘化油的（平阳霉素+碘化油[L+BE]、博莱霉素+碘化油[L+PYG]或乙醇+碘化油[L+乙醇]）和非碘化油的（单纯聚乙烯醇[PVA]）。应用常规随机效应荟萃分析技术对数据进行分析。
在最初检查的 3080 篇文献中，21 项研究纳入荟萃分析，共纳入 1450 例患者，共 1871 个血管瘤（36.2%为男性，平均年龄：46.3±3.6 岁）。126、1666、41 和 38 个病灶分别接受 L+BE、L+PYG、L+乙醇和 PVA 治疗。栓塞后中位随访时间为 12 个月。与 PVA 相比，基于碘化油的治疗在 TAE 后显著缩小血管瘤体积（P<0.001）。汇总直径缩小（cm）（95%置信区间）分别为-4.37（-5.32，-3.42）、-4.70（-5.70，-3.71）和-0.93（-2.02，0.16），分别代表总体 TAE 治疗、基于碘化油和非碘化油的治疗。主要并发症包括栓塞后综合征和短暂性肝酶升高（基于碘化油和非碘化油技术的汇总发生率分别为 36%和 33%，37%和 0%）。未报告致命性并发症。63.3%-100%的病例报告症状改善，大多数研究（21 项中的 15 项）报告所有病例均改善（汇总反应率：98%）。
平阳霉素、博莱霉素或乙醇联合碘化油的经动脉栓塞术是安全的，可使血管瘤缩小，从而缓解症状。
