肝血管瘤血流动力学特征与个性化介入治疗的临床研究

摘要

目的 探讨肝血管瘤血流动力学特征与个性化介入治疗的临床价值. 方法 2007年1月～2010年2月,对81例肝血管瘤应用彩色多普勒血流显像(color Doppler flow imaging,CDFI)进行血流动力学评估,根据CDFI将其分为三型:富血供型、少血供型、乏血供型.根据CDFI评估结果采取个性化介入治疗方案:富血供型肝血管瘤行肝动脉栓塞术,采用平阳霉素超液化碘化油乳剂行肝动脉栓塞；乏血供和少血供型肝血管瘤,超声引导下经皮肝穿刺瘤内注入平阳霉素,分3次治疗,间隔10 d(瘤体≤7.0 cm,药物剂量分别为16、24、16 mg；瘤体＞7.0 cm,药物剂量分别为16、24、24 mg). 结果 CDFI示富血供型占25.9％ (21/81),少血供型占54.3％(44/81),乏血供型占19.8％(16/81).60例乏血供和少血供型肝血管瘤,采用超声引导下经皮肝穿刺瘤内注入平阳霉素,术后6个月瘤体消失21例(CR),39例形成1.5 ～1.0 cm的瘢痕结节(PR),总有效率100％.21例富血供型肝血管瘤行肝动脉栓塞,术后6个月19例瘤体缩小率＞75％(PR),2例瘤体缩小50％左右(WR),总有效率90.5％( 19/21). 结论应用CDFI评估肝血管瘤的血流动力学特征,并以此为依据采取个性化介入治疗方案,在肝血管瘤介入治疗中具有重要的临床价值.%Objective To investigate the hemodynamic characteristics of hepatic hemangioma and the clinical value of individulized interventionsl therapy. Methods The hemodynamics of 81 cases of hepatic hemangioma were evaluated by color Doppler flow imaging (CDFI), and then the patients were classified into three types by CDFI; hypervascular, hypovascular and nonvascular hemangioma. Individualized interventional therapy was then carried out accordingly: hypervascular hemangiomas were treared by hepatic artery embolization by PYM, while hypovascular and nonvascular types were treared by ultrasound-guided percutaneous intratumoral injection of PYM, which were delivered every 10 days for three times. When the tumor size ≤7.0 cm in diameter, the doses of PYM were 16,24 and 16 mg respectively for the three times. If the tumor was larger than 7.0 cm in diameter, the doses of PYM were 16, 24 and 24 mg respectively. Results According to CDFI results: hypervascular type accounted for 23. 9% of our patients (21/81 ) , while hypovascular and nonvascular types accounted for 54. 3% (44/81 ) and 19. 8% ( 16/81 ) , respectively. Totally 60 cases of hypovascular and nonvascular hepatic hemangioma were treared by ultrasound-guided percutaneous intratumoral injection of PYM; in these patients, the tumor disappeared in 21 cases (CR) , and a 1.5- to 1.0-cm nodule of scar was formed in 39 cases ( PR) ; the total effective rate was 100% . In the 21 hypervascular cases, who received hepatic artery emobolization, 19 cases achieved a reduction ratio of 75% or higher (PR) in 6 months, 2 cases had a reduction ratio near to 50% (WR) , and the total effective rate was 90. 5% ( 19/21 ) . Conclusion It is valuable to assess hemodynamics of hepatic hemangioma by CDFI, and carrying out individualized interventional therapy based on the assessment.