| The hepatic hemangioma is one of the commonly known hepatic benign tumors. When the tumor is big enough it may result in the deformation of the adjacent viscera and further rupturing and bleeding. Traditional surgery has some shortcomings such as low successful rate, extensive damage and high risk. The study aims at discovering a new non - surgical therapeutic method for hepatic hemangioma by using bleomycin A5 - lipiodol emulsion (BLE) in arterial embolization and evaluating its clinic efficacy.MATERIALS AND METHODThere were 5 4 patients (16 men , 3 8 women ) , average age : 4 6 . yrs (27 -66yrs). All cases were diagnosed by contrast CT. 44 with single lesions, 10 with multiple lesions, all single lesions' diameters are more than 5. 0cm; the biggest diameter of multiple lesions is more than 5. 0cm, average diameter is 10. 54cm. All the cases' hepatic functions were tested and collagen fiber series (PC III,IVC,HA,LN) were tested both pre - and post - procedure in 15 of the 54 patients. BLE was prepared by mixing bleomycinAS (16 -24mg) , lipiodol (5 -8ml) and fluorouracil (3ml -5ml) together. The dosage of BLE depends on the diameter and blood supply of the hepatic hemangioma. First, we carried out indirect portal angiography and hepatic arterialangiography, then inserted catheter to blood - supplying artery of he-mangioma and injected BLE. After the procedure, antibiotics and hepatic recovering treatments were done for 3 -5days. The cases' hepatic functions, collagen fiber series were tested and/or CT scanning were done after 1 week ,3,6 and 12 months respectively.RESULTSThe indirect portal angiography indicates that portal vein deforms under pressure, portal vein branches are sparse in hemangioma region and not available for the blood supply to hemangioma. Arterial angiography displays that the blood - supplying artery of hemangioma gets little thicker, intra - tumor appears the sign of " appear early and disappear lately". Neither arterial - portal shunt nor arterial - venous shunt is observed. The fade of dye is delayed. All the 54 cases a-chieved satisfactory effect. During the procedure 8 cases suffered from abdominal pain and 2 patients suffered from dyspnea. Termination of infusing BLE, oxygen inhalation and anodyne injection can relieve the symptoms above. 31 patients suffered from post - embolization syndromes (fever, nausea, vomit, pain) , but all these syndromes get relieved in the first week after procedure. The symptom caused by pressure on the viscera disappears after 3 months. CT scanning of liver shows that the lesion shrinks obviously and there is no trend of hepato-cirrhosis. In the group with the lesion's diameter of 5 - 8cm (n = 16), pre - procedure diameter of lesion was 6. 67 0. 79cm; 3 months after procedure was 4.21 0.38cm ( P <0.001) , 6 months 3.65 0.38cm(P<0.001),12months2.89 0.336cm(P<0.001); In the group with the diameter of lesion > 8cm (n = 38 ) , pre - proce-dure diameter of lesion was 12.17 3.49cm, 3 months after procedure 8.13 2.19cm (P<0.001), 6 months 6.54 1.89cm(P< 0.001) , 12months 5.45 1.60cm (P <0.001). Hepatic functions testing ( n = 54 ) : Liver function test: follow up liver function exam were performed for all of the 54 patients in 1 week , three months , six months and 12 months after the treatment respectively. 37 of the 54 cases have mild abnormal liver function 1 week after the therapy and recover to normal level in three months. Collagen fibers Series examination; 15 of the 54 patients underwent collagen fibers Series examination before and after the treatment. Statistical analysis shows that this treatment had a tendency of resulting in liver fibrosis. However, CT found no patient with liver fibrosis.Conclusion1. The therapeutic effect of percutaneous hepatic arterial emboli-zation with Bleomycin A5 - lipiodol emulsion to treat the huge hepatic cavernous hemangioma is satisfactory. Side effect is less. It is a safe, efficiency and micro - traumatic therapeutic technique.2. Supper selection was recommended to avoid sid... |
PDF Full Text Request