不同血供特点肝血管瘤介入治疗的效果及并发症分析

摘要

Objective To analyze the impact of the differences in blood supply to hepatic hemangiomas on interventional treatment effectiveness and complications.Methods A retrospective study was conducted on 322 patients with liver hemangiomas treated from January 2008 to December 2015 in Tianjin Third Central Hospital.The hemangiomas were diagnosed and classified into 3 groups according to the blood supply to the hemangioma:the rich blood supply group (n =128),the moderate blood supply group (n =104) and the poor blood supply group (n =90).The hemangiomas were embolized via the hepatic artery,and the therapeutic effect and complication were compared and analyzed among the 3 different groups.The mean follow-up was 12 months.Results The therapeutic effect of hepatic artery embolization was optimal for the rich blood supply group in the first 3-months of follow-up (the significant efficiency,effective rates were 18.8％ and 35.2％ respectively).There was no significant difference between the rich blood supply group and the moderate blood supply group at 12th month follow-up.The treatment effect on the poor blood supply group was significantly worse than the other two groups on follow-up.Complications after treatment occurred most commonly in the rich blood supply group and it was the least common in the poor blood supply group (the incidence rates were 43.8％,36.6％ and 8.9％ respectively).However,severe post-treatment complications were apparently more common in the poor blood supply group than the other two groups.Conclusions The therapeutic effects of transcatheter arterial embolization on hepatic hemangioma can differ because of the diversity in blood supply.In clinical practice,attention should be paid to the proper choice of treatment according to the blood supply to the lesion.Serious complications can occur after treatment.%目的 分析不同血供特点肝血管瘤介入治疗的效果及并发症.方法 回顾性分析天津市第三中心医院2008年1月至2015年12月收治的322例肝血管瘤患者资料.根据肿瘤血供的不同将患者分为富血供型(n=128)、中等血供型(n=104)及乏血供型(n=90)三组,均采用经肝动脉栓塞术治疗.分析比较三组患者的治疗效果及并发症发生情况.平均随访时间为12个月.结果 术后3个月随访显示富血供肝血管瘤的疗效最优(54.0％).术后12个月富血供与中等血供型的临床疗效差异无统计学意义.乏血供型血管瘤不同随访期所示疗效明显低于其他两型.治疗后一般并发症所占比例富血供型最大(43.8％),中等血供型次之(36.6％),乏血供最少(8.9％).但严重并发症的发生率乏血供型组明显高于其他两组.结论 经肝动脉栓塞治疗肝血管瘤的疗效因其血供特点不同而存在差异.临床应注意根据瘤体血供选择更为适合的治疗方式,术后可能出现的严重并发症值得引起重视.