Disagreement of interventional therapy of hepatic hemangioma
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摘要: 肝血管瘤是常见病,目前认为是一种先天性脉管畸形,其自发破裂的概率低,但一旦破裂有致命危险,近年来随着微创医学技术的发展,介入治疗以其创伤小、风险低、疗效显著的优势在肝血管瘤治疗中被临床与患者广泛接受,已成为治疗肝血管瘤的主要方法之一。然而肝血管瘤的介入治疗的适应症尚存争议,临床治疗中否存在过度治疗的问题有待进一步讨论,治疗方式的选择未有统一指南,治疗药物的选择及药物浓度的控制尚需进一步研究,治疗术后的疗效评估目前缺乏统一标准。本文就目前肝血管瘤介入治疗存在的几点分歧进行综述。Abstract: Liver hemangioma is a common disease. It is a congenital vascular malformation, the probability of spontaneous rupture of the low, but once the rupture is lethal, in recent years with the development of minimally invasive medical technology, interventional treatment with its small trauma, low risk, significant effect of the advantages in the treatment of liver hemangioma is widely accepted in clinical with the patient, has become one of the main methods for treatment of liver hemangioma. However, the interventional treatment of hepatic hemangioma indications are still controversial, over treatment issues to be discussed further the existence of the clinical treatment, treatment options no uniform guidelines, and control the concentration of drug therapy needs further study, evaluation of curative effect after treatment of the lack of unified standard. This article reviews the current differences in interventional therapy for hepatic hemangioma.
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Key words:
- Hepatic hemangioma /
- Interventional therapy /
- Disagreement
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表 1 应用平阳霉素碘化油乳剂超选择性肝动脉栓塞治疗肝血管瘤的疗效分析
来源 例数 疗效(n) 有效率(%) CR PR MR NC 李旭彤[15] 30 10 16 4 0 100 卢桂龙[16] 30 0 18 5 7 76.7 闫妍[17] 28 0 28 0 0 100 赵昌[18] 50 0 38 6 6 88 独建库[19] 38 6 28 0 4 89.5 蒋旭远[13] 139 2 115 20 2 84.2 郭曦[14] 42 0 4 31 7 83.3 王振虹[20] 45 6 37 2 0 100 NC: 无效, 病灶两径乘积缩小或增大均<25%,无新病灶出现; MR: 有效, 病灶两径乘积缩小≥25%,但小于50%,无新病灶出现; PR: 显效, 病灶最大直径及其最大垂直径的乘积缩小50%以上,无新病灶出现; CR: 治愈, 可见的病灶完全消失. -
[1] Zhao W, Guo X, Dong J. Spontaneous rupture of hepatic hemangioma: a case report and literature review[J]. Int J Clin Exp Pathol, 2015, 8(10): 13426-8 [2] 欧阳墉, 程永德, 张学军, 等. 肝海绵状血管瘤病理属性及治疗[J]. 介入放射学杂志, 2015, 24(11): 933-8 doi: 10.3969/j.issn.1008-794X.2015.11.001 [3] Dasgupta R, Fishman SJ. ISSVA classification[J]. Semin Pediatr Surg, 2014, 23(4): 158-61 doi: 10.1053/j.sempedsurg.2014.06.016 [4] Yamashita S, Okita K, Harada K, et al. Giant cavernous hepatic hemangioma shrunk by use of sorafenib[J]. Clin J Gastroenterol, 2013, 6(1): 55-62 doi: 10.1007/s12328-012-0343-0 [5] 肖年军, 余 强, 段伟东, 等. 肝血管瘤直径与手术风险的关系[J]. 中华消化外科杂志, 2015, 14(9): 737-40 doi: 10.3760/cma.j.issn.1673-9752.2015.09.010 [6] Dong J, Zhang M, Chen JQ, et al. Tumor size is not a criterion for resection during the management of giant hemangioma of the liver[J]. Eur J Gastroenterol Hepatol, 2015, 27(6): 686-91 doi: 10.1097/MEG.0000000000000344 [7] 李廷军. 争议之中的肝血管瘤治疗指征[J]. 肝胆胰外科杂志, 2017, 29(2): 173-6 [8] 周成明, 张金辉, 任伟新, 等. 514例肝血管瘤的治疗与临床评分[J]. 中华消化外科杂志, 2015, 14(2): 102-5 doi: 10.3760/cma.j.issn.1673-9752.2015.02.004 [9] 占大钱, 黄志勇, 赵银峰, 等. 动脉栓塞治疗肝血管瘤系统分析[J]. 华中科技大学学报:医学版, 2011, 40(5): 623-5, 封3 [10] 董 健, 朱 迎, 王万里, 等. 肝血管瘤128例外科治疗分析[J]. 中华肝胆外科杂志, 2014, 20(8): 595-8 doi: 10.3760/cma.j.issn.1007-8118.2014.08.013 [11] Zhang X, Yan L, Li B, et al. Comparison of laparoscopic radiofrequency ablation versus open resection in the treatment of symptomatic-enlarging hepatic hemangiomas: a prospective study[J]. Surg Endosc, 2016, 30(2): 756-63 doi: 10.1007/s00464-015-4274-y [12] Klotz T, Montoriol PF, Da Ines D, et al. Hepatic haemangioma: common and uncommon imaging features[J]. Diagn Interv Imaging, 2013, 94(9): 849-59 doi: 10.1016/j.diii.2013.04.008 [13] 蒋旭远, 徐 克. 平阳霉素碘油乳剂动脉栓塞治疗肝血管瘤的中远期疗效评价[J]. 介入放射学杂志, 2012, 21(1): 31-4 doi: 10.3969/j.issn.1008-794X.2012.01.007 [14] 郭 曦, 王家平, 孔 鹏, 等. 平阳霉素加碘化油经肝动脉栓塞治疗肝血管瘤42例临床体会[J]. 昆明医学院学报, 2012, 33(2): 74-6 doi: 10.3969/j.issn.1003-4706.2012.02.018 [15] 李旭彤, 吴宝音, 李伟男, 等. 介入栓塞治疗不同体积肝血管瘤的临床疗效及血流动力学特征[J]. 肝脏, 2016, 21(6): 485-8 doi: 10.3969/j.issn.1008-1704.2016.06.018 [16] 卢桂龙, 任庆云. 不同栓塞方法在肝血管瘤介入治疗中的效果[J]. 中国医药导报, 2015, 12(35): 71-4 [17] 闫 妍, 钱林学, 袁 莉, 等. 超声引导下平阳霉素瘤体内注射与DSA引导下平阳霉素肝动脉栓塞治疗肝血管瘤对比分析[J]. 中国医学影像技术, 2015, 31(10): 1558-62 [18] 赵 昌, 马亦龙, 欧盛秋, 等. 介入联合血管栓塞疗法治疗肝血管瘤的疗效[J]. 南昌大学学报:医学版, 2013, 53(10): 50-2 [19] 独建库, 何伟华, 李冠海, 等. 不同栓塞材料在治疗肝血管瘤中的疗效对比[J]. 中国现代医学杂志, 2013, 23(36): 100-2 doi: 10.3969/j.issn.1005-8982.2013.36.025 [20] 王振虹, 毕卫群, 王 燕. 超选择性肝动脉栓塞治疗肝血管瘤的临床观察[J]. 青岛大学医学院学报, 2008, 44(6): 513-4, 517 [21] 肖晋昌, 祖茂衡, 徐 浩, 等. 平阳霉素瘤体内注射治疗肝血管瘤60例临床分析[J]. 介入放射学杂志, 2013, 22(4): 334-6 doi: 10.3969/j.issn.1008-794X.2013.04.018 [22] 丁汇清, 张海军, 杨立民, 等. 巨大肝血管瘤的双重介入治疗[J]. 中国介入影像与治疗学, 2009, 6(2): 127-30 [23] 邹 华. 射频消融术与腹腔镜切除术治疗巨大肝血管瘤的前瞻性对照研究[D]. 第三军医大学, 2013. [24] Brown G. Specialist multidisciplinary team working in the treatment of cancer[J]. BMJ, 2012, 344(11): e2780-7 [25] 高 君, 王劭宏, 柯 山, 等. 腹腔镜下射频消融辅助瘤体内切除巨大肝血管瘤[J]. 中华肝胆外科杂志, 2017, 23(4): 268-9 [26] 周伟平, 吴孟超. 防止肝脏良性肿瘤的过度治疗[J]. 中华消化外科杂志, 2015, 14(2): 97-8 doi: 10.3760/cma.j.issn.1673-9752.2015.02.002 [27] Schnipper LE, Smith TJ, Raghavan D, et al. American society of clinical oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology[J]. J Clin Oncol, 2012, 30(14): 1715-24 doi: 10.1200/JCO.2012.42.8375 [28] 李雪松, 夏 锋. 肝血管瘤治疗选择[J]. 肝胆外科杂志, 2015, 23(1): 7-9 [29] 王宝堂, 刘芝艳, 张建明. 介入栓塞治疗肝血管瘤[J]. 中国医学影像技术, 2014, 30(4): 549-51 [30] 闫 妍, 钱林学, 袁 莉, 等. 超声引导平阳霉素瘤体内注射治疗肝血管瘤[J]. 中国介入影像与治疗学, 2015, 12(9): 580-1 [31] 金 亮, 蔡 飞, 李 琪, 等. 肝血管瘤患者瘤体剥除与介入栓塞术后生存质量对比评价[J]. 中国普通外科杂志, 2016, 25(1): 103-8 [32] 顾亚奇, 余红东. 介入栓塞与手术切除治疗巨大肝血管瘤临床疗效对比[J]. 肝脏, 2015, 20(7): 507-9 doi: 10.3969/j.issn.1008-1704.2015.07.002 [33] 刘端祺. 导言: 肿瘤适宜治疗之本——尊重生命 尊重患者 尊重实践[J]. 医学与哲学: B, 2013, 34(11): 8-12
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