说明：大部分肝脏血管瘤血供较丰富，介入栓塞均能达到确切疗效，此类血管瘤不在本文讨论范围，而少部分血管瘤为少血供，以往认为介入栓塞不能达到预期疗效，而我们以介入栓塞结合瘤体内注射药物对这类少血供血管瘤进行治疗，同样达到了预期疗效，并于2007年成文报道，发表于本专业的《介入放射学杂志》，现将此文摘要转贴于此。

肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤

目的 探讨少血供性肝海绵状血管瘤经肝动脉栓塞后进行瘤体内注射博莱霉素治疗的安全性和有效性。方法 前瞻性研究9例少血供性肝海绵状血管瘤的经肝动脉栓塞结合经皮经肝瘤体内药物注射介入治疗情况。对于CT/MRI明确诊断的肝海绵状血管瘤(直径>5cm)，且CT增强扫描时仅有点状或少许斑片状强化而大部分无强化且延迟扫描时仍然如此的9例患者，先行肝动脉插管栓塞术，栓塞剂为超液化碘油(10ml)与博莱霉素粉(8mg)的混悬剂，实际用量为5~10ml。栓塞后4天开始行经皮经肝瘤体内穿刺多点注射博莱霉素8~16mg，间隔3~4 天再次注射，连续2~3次，1月后复查CT，以后3、6个月及1年不定期复查CT。 结果 9例患者DSA上所见血管瘤染色与CT增强扫描表现一致，碘油沉积呈散在点状分布，治疗后1个月瘤体均明显缩小，以后会继续缩小，1年后复查基本稳定不再缩小。2例患者出现急性胆囊炎，对症处理后痊愈。1例出现栓塞后胆汁瘤，随访观察未进一步进展未作特殊处理。结论 经肝动脉栓塞联合瘤体内博莱霉素注射治疗少血供性肝血管瘤是简便、安全并有效的方法。

【关键词】肿瘤,肝脏;血管瘤,海绵状;放射学,介入性;博莱霉素

Treatment of hypovascular cavernous hemangiomas of liver by combination of selective hepatic arterial embolization and percutaneous injection of bleomycin

【Abstract】 -ive To assess the safety and effectiveness of combination of transarterial embolization (TAE) and percutaneous injection of bleomycin for the treatment of cavernous hemangiomas of liver(CHL). Methods In this prospective study, 9 cases of hypovascular CHL (diameter>5cm) as diagnosed by CT/MRI were treated by percutaneous injection of bleomycin after TAE. On enhanced CT scan, only little punctuate or plaque-like enhancement was detected in the foci, which remained stable during the delayed phase. TAE with emulsion of ultra-fluid lipiodol (10ml) and bleomycin (8mg) was performed first. The actual dosage of the emulsion used in TAE was 5-10ml. Percutaneous multi-point injection with bleomycin (8-16mg) solution was performed 4 days after TAE, and repeated 2-3 times every 3-4 days. Each case was studied by CT scan at 1, 3, 6 and 12 months after the procedure. Results DSA features of all 9 cases were the same as those of enhanced CT/MRI scan. Lipiodol aggraded in the foci dispersedly. All foci reduced in size markedly one month after the therapy, and continued to shrink gradually until at one year when they remained stable. Post-TAE cholecystitis developed in 2 patients and was cured after symptomatic treatment. Intrahepatic biloma was found in one patient; as no progression was observed during the follow-up period, it was not treated specially. Conclusion Transarterial embolization combined with percutaneous injection of bleomycin seems to be a safe and effective strategy for the treatment of hypovascular CHL.

【Key words】 Neoplasms, liver; Hemangioma, cavernous; Radiology, interventional; Bleomycin

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