Iyer C P, Stanley P, Mahour G H
Division of Pediatric Surgery, Childrens Hospital Los Angeles, CA 90027, USA.
Am Surg. 1996 May;62(5):356-60.
From 1958 through 1992, 30 patients with hepatic hemangiomas were seen and treated at Children's Hospital Los Angeles. The majority of the patients were less 1 month of age (90 % younger than the first year of life) and there was no difference in sex distribution. Patients presented with coagulopathy, heart failure, abdominal mass, and respiratory distress. Eleven patients (33%) had hemangiomas in other sites. Fourteen patients were treated with steroid therapy. Of these, eight patients did not respond and received radiotherapy. Eleven patients who had the hemangioma confined to an anatomical lobe had resection of the hemangioma by liver lobectomy. Five of the most recent patients were successfully treated with hepatic artery embolization. Two other patients who were seen many years ago underwent diagnostic laparotomy and biopsy of the lesion before treatment with steroids. In one patient who presented with ruptured hepatic hemangioma, hepatic arterial ligation was performed. In another patient, seen recently, treatment with interferon alpha-2 was initiated, but the patient died. There were six deaths in the series. Four patients died of intractable congestive heart failure, steroids are given first. Course of steroid therapy may be repeated if necessary. Whereas formerly radiation therapy was added to the treatment of a patient resistant to steroids, therapeutic hepatic arterial embolization is a very good alternative for these patients. Surgical excision of the lesion can be performed by liver lobectomy if there is a solitary hemangioma within the boundaries of the surgical excision. Recently, in massive hemangioma with intractable thrombocytopenia, interferon alpha-2 therapy has been used, but so far our experience of this mode of therapy is limited.
1958年至1992年期间，洛杉矶儿童医院共诊治了30例肝血管瘤患者。大多数患者年龄小于1个月（90%小于1岁），性别分布无差异。患者表现为凝血功能障碍、心力衰竭、腹部肿块和呼吸窘迫。11例患者（33%）在其他部位也有血管瘤。14例患者接受了类固醇治疗。其中，8例患者无效并接受了放射治疗。11例血管瘤局限于一个肝叶的患者通过肝叶切除术切除了血管瘤。最近的5例患者通过肝动脉栓塞术成功治愈。另外2例多年前就诊的患者在接受类固醇治疗前进行了诊断性剖腹手术和病变活检。1例肝血管瘤破裂的患者进行了肝动脉结扎术。在另1例最近就诊的患者中，开始使用α-2干扰素治疗，但患者死亡。该系列中有6例死亡。4例患者死于难治性充血性心力衰竭，首先给予类固醇治疗。如有必要，类固醇治疗疗程可重复。以前，对于对类固醇耐药的患者，会加用放射治疗，而治疗性肝动脉栓塞术是这些患者的一个很好的替代方案。如果手术切除范围内有单个血管瘤，可通过肝叶切除术进行病变的手术切除。最近，对于伴有难治性血小板减少症的巨大血管瘤，已使用α-2干扰素治疗，但到目前为止，我们对这种治疗方式的经验有限。
