Case-control study of percutaneous transhepatic sclerotherapy and transcatheter arterial embolization for hepatic hemangioma
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摘要:
目的评价经皮肝穿刺注射硬化治疗与肝动脉栓塞介入治疗肝血管瘤的临床疗效。 方法本院22例肝血管瘤患者(最大病灶直径均≥5 cm)随机分为两组,11例行经皮肝穿刺瘤内注射博莱霉素硬化治疗为硬化组,11例行DSA引导下博莱霉素碘化油肝动脉栓塞治疗为栓塞组,对比两种方法的平均手术时间、费用,术后疗效、并发症及满意度情况。 结果硬化组平均手术时间比栓塞组短(P<0.05),栓塞组术后3 d肝功能异常比例多于硬化组(P<0.05),而硬化组平均住院时间、费用明显少于栓塞组(P<0.01);术后6月,所有患者瘤体均较前缩小,硬化组与栓塞组治疗有效率分别为81.8%、92.3%,差异无统计学意义(P>0.05)。 结论经皮肝穿刺博莱霉素注射硬化与经DSA引导博莱霉素肝动脉栓塞治疗两者在治疗直径≥5 cm的肝血管瘤均有显著疗效。经皮肝穿刺硬化治疗肝血管瘤具有操作简便、手术时间及住院时间短、治疗费用低、耐受性好等优势。 Abstract:ObjectiveTo evaluate the clinical efficacy of percutaneous transhepatic sclerotherapy and transcatheter arterial embolization(TAE) for hepatic hemangioma. MethodsTwenty-two patients with hepatic hemangioma (maximum lesion diameter ≥5 cm) were randomly divided into two groups. 11 patients underwent percutaneous intrahepatic sclerotherapy with bleomycin (hardening group), and 11 patients underwent DSA guidance lower bleomycin iodized oil hepatic artery embolization (embolic group). The average operation time, cost, postoperative efficacy, complications and satisfaction of the two methods were compared. ResultsThe mean operative time of the sclerosing group was shorter than that of the embolization group (P<0.05). The proportion of abnormal liver function 3 days after embolization group In the sclerosing group was greater than that of sclerosing group (P<0.05). The average length of hospital stay and cost in the sclerosing group was significantly less than that in the embolization group (P<0.01). At 6 months after surgery, the tumors of all patients were smaller than before. The effective rates of the sclerosing group and the embolization group were 81.8%, 92.3%, with no significant difference (P>0.05). ConclusionPercutaneous liver puncture bleomycin injection sclerotherapy and DSA-guided bleomycin hepatic artery embolization have a curative effect in the treatment of hepatic hemangioma with diameter≥5 cm. Percutaneous transhepatic sclerotherapy for hepatic hemangioma has the advantages of simple operation, short operation time and hospitalization time, low treatment cost and good tolerance. -
Key words:
- hepatic hemangioma /
- percutaneous sclerotherapy /
- hepatic artery embolization /
- bleomycin
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表 1 两组患者术前临床资料对比
分组 年龄(岁, Mean±SD) 性别(n,男/女) 瘤体最大径(cm, Mean±SD) 单发/多发(n) 上腹部不适(有/无) 硬化组 50.3±8.7 3/8 6.8±1.5 5/6 4/7 栓塞组 52.5±12.4 5/6 7.0±1.4 3/8 6/5 t 0.751 0.659 0.216 0.659 0.67 P >0.05 表 2 硬化组与栓塞组患者术前肝功能对比(Mean±SD)
项目 硬化组 栓塞组 t P 总胆红素(μmol/L) 13.4±5.7 14.4±4.5 0.438 >0.05 直接胆红素(μmol/L) 3.4±1.8 3.9±1.7 0.633 白蛋白(g/L) 44.4±3.3 44.6±3.0 0.181 谷丙转氨酶 (U/L) 17.2±7.4 19.6±11.0 0.608 谷草转氨酶 (U/L) 21.1±5.5 22.2±7.1 0.435 碱性磷酸酶 (U/L) 63.6±19.1 68.7±16.8 0.661 谷氨酰氨基转移酶 (U/L) 22.0±10.5 29.7±12.1 1.578 总胆汁酸 (μmol/L) 2.7±1.8 3.4±2.4 0.716 胆碱酯酶 (U/L) 8 459±1 925 8 750±2 368 0.315 表 3 两组患者围术期指标对比(Mean±SD)
分组 博莱霉素(万单位) 碘化油(mL) 造影剂(mL) 手术时间(min) 住院时间(d) 术后住院时间(d) 住院费(元) 自付费用(元) 硬化组 2.1±0.8 0 0 15.6±6.4 3.4±1.0 1.8±1.0 6 380±630 1 819±425 栓塞组 2.3±0.8 6.5±3.9 85±34 51.5±7.2 6.8±1.7 2.6±0.5 12 540±1 480 4 117±904 t 0.408 8.482 8.596 7.625 3.442 2.191 12.029 5.139 P >0.05 <0.01 <0.01 <0.01 <0.05 <0.05 <0.01 <0.01 表 4 两组患者疗效对比(n=11)
分组 疗效 有效率(%) CR PR MR NC 硬化组 0 9 2 0 81.8 栓塞组 0 10 1 0 90.9 P >0.999 CR:可见的瘤体病灶完全消失;PR:病灶的最大垂直径与最大直径的乘积缩小50%以上,无新病灶出现;MR:病灶的两径乘积缩小≥25%,但<50%,无新病灶出现;NC:病灶的两径乘积缩小或增大均<25%,无新病灶出现. 表 5 硬化组与栓塞组术后病灶增强扫描对比(n=11)
组别 术后病灶强化 显示率(%) + – 硬化组 10 1 90.9 栓塞组 8 3 72.7 P 0.586 表 6 两组患者术后并发症比较 [n=11,n(%)]
组别 肝功能变化 发热 肝区
疼痛恶心
呕吐出血 气胸 动静脉瘘或
假性动脉瘤硬化组 3(27.3) 5(45.5) 3(27.3) 4(36.4) 0 0 / 栓塞组 10(90.9) 6(54.5) 4(36.4) 5(45.5) 0 / 0 P 0.008 >0.999 >0.999 >0.999 -
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