Graham E, Cohen A W, Soulen M, Faye R
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia.
Obstet Gynecol. 1993 May;81(5 ( Pt 2)):813-6.
Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast majority are small (less than 4 cm) and asymptomatic, but there have been a few reported cases of these lesions leading to severe pain and even spontaneous fatal hemorrhage. Estrogen may cause the growth of liver hemangiomas, but there is a paucity of information concerning the effect of pregnancy upon these lesions.
A patient presented at 18 weeks' gestation with the acute onset of vomiting and epigastric pain. A right upper-quadrant ultrasound scan found a 9-cm hypodense lesion within the liver, and magnetic resonance imaging (MRI) suggested a hemangioma. The lesion was believed to be inoperable, and selective catheterization of the common hepatic artery was performed. An angiogram demonstrated a round vascular mass 12 cm in diameter occupying much of the left side of the liver, with the vascular supply from the middle hepatic artery and to a lesser extent from the left hepatic artery. Embolization was performed, and a post-embolization image demonstrated satisfactory occlusion of the vessels treated. The patient's epigastric pain resolved after the procedure. The lesion was observed with monthly ultrasound and regressed to about 50% of its original size. The patient was scheduled for an elective primary cesarean delivery at 39 weeks to avoid possible rupture of the hepatic hemangioma during the second stage of labor. Her cesarean and postpartum course were uncomplicated.
A symptomatic liver hemangioma with intratumor hemorrhage can be successfully treated with embolization during pregnancy. Because of the paucity of reported cases, it is uncertain whether vaginal birth is contraindicated in these patients.
海绵状血管瘤是肝脏最常见的良性肿瘤，约2%的尸检患者可发现。绝大多数血管瘤较小（小于4厘米）且无症状，但有少数病例报告这些病变导致严重疼痛甚至自发性致命出血。雌激素可能导致肝血管瘤生长，但关于妊娠对这些病变影响的信息较少。
一名妊娠18周的患者出现急性呕吐和上腹部疼痛。右上腹超声扫描发现肝脏内有一个9厘米的低密度病变，磁共振成像（MRI）提示为血管瘤。该病变被认为无法手术，遂对肝总动脉进行选择性插管。血管造影显示一个直径12厘米的圆形血管团块占据肝脏左侧大部分区域，血供来自肝中动脉，较少部分来自肝左动脉。进行了栓塞治疗，栓塞后图像显示治疗的血管闭塞良好。术后患者上腹部疼痛缓解。每月通过超声观察病变，其大小缩小至原来的约50%。患者计划在39周时择期行剖宫产，以避免分娩第二产程中肝血管瘤可能破裂。她的剖宫产及产后过程均无并发症。
妊娠期有症状的伴有瘤内出血的肝血管瘤可通过栓塞成功治疗。由于报告的病例较少，尚不确定这些患者是否禁忌经阴道分娩。
