CAJ | 학술논문

目的评价平阳霉索碘化油乳剂(PLE)肝动脉栓塞硬化治疗肝海绵状血管瘤(CHL)的远期疗效及其影响因素.方法回顾性分析行PLE肝动脉栓塞和(或)硬化治疗、并有完整随访资料的CHL患者105例共156个瘤灶.按照瘤灶最大径,分为A组(≤3 cm)25个、B组(>3 cm且<5 cm)32个、C组(≥5 cm且<10 cm)58个、D组(≥10 cm)41个;异常血窦丰富型90个、较丰富型57个、稀少型9个.105例共行135次治疗,其中治疗1次者75例、2次者30例.术后全部患者均经超声和CT或MRI或DSA检查随访3~8年(平均4年).以显效、有效、好转和无效作为疗效评价标准,计算总有效率.A、B组和C、D组治疗1次者总有效率之间的比较以及D组治疗1次和2次者总有效率之间的比较皆采用X~2检验,并对瘤灶大小、异常血窦富乏和治疗次数对疗效的影响进行了分析.结果 156个瘤灶的治疗总有效率为92.95%(145/156).接受1次治疗后的A、B两组总有效率为100%(57/57),C、D两组为85.86%(85/99),差异有统计学意义(X~2=8.8553,P<0.01);D组中接受2次治疗者总有效率为100.00%(30/30),而1次治疗者则为72.73%(8/11),差异有统计学意义(X~2=5.2642,P<0.05).随访期间105例无复发,未见肝功能损害及严重并发症发生.结论经肝动脉PLE栓塞和(或)硬化治疗异常血窦丰富的CHL小瘤灶,可获得治愈的远期疗效;对于巨大、多发弥漫的CHL,特别是异常血窦丰富或较丰富者,通过重复治疗也可获得满意和肯定的远期疗效.
목적 평개평양매색전화유유제(PLE)간동맥전새경화치료간해면상혈관류(CHL)적원기료효급기영향인소.방법 회고성분석행PLE간동맥전새화(혹)경화치료、병유완정수방자료적CHL환자105례공156개류조.안조류조최대경,분위A조(≤3 cm)25개、B조(>3 cm차<5 cm)32개、C조(≥5 cm차<10 cm)58개、D조(≥10 cm)41개;이상혈두봉부형90개、교봉부형57개、희소형9개.105례공행135차치료,기중치료1차자75례、2차자30례.술후전부환자균경초성화CT혹MRI혹DSA검사수방3~8년(평균4년).이현효、유효、호전화무효작위료효평개표준,계산총유효솔.A、B조화C、D조치료1차자총유효솔지간적비교이급D조치료1차화2차자총유효솔지간적비교개채용X~2검험,병대류조대소、이상혈두부핍화치료차수대료효적영향진행료분석.결과 156개류조적치료총유효솔위92.95%(145/156).접수1차치료후적A、B량조총유효솔위100%(57/57),C、D량조위85.86%(85/99),차이유통계학의의(X~2=8.8553,P<0.01);D조중접수2차치료자총유효솔위100.00%(30/30),이1차치료자칙위72.73%(8/11),차이유통계학의의(X~2=5.2642,P<0.05).수방기간105례무복발,미견간공능손해급엄중병발증발생.결론 경간동맥PLE전새화(혹)경화치료이상혈두봉부적CHL소류조,가획득치유적원기료효;대우거대、다발미만적CHL,특별시이상혈두봉부혹교봉부자,통과중복치료야가획득만의화긍정적원기료효.
Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL)and its influence factors.Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper.All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma)by the authors as follows; A group(≤3 cm, n=25); B group(>3 cm and<5 cm, n =32) ;C group(≥5 cm and<10 cm, n=58); and D group(> 10 cm, n=41) .According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types: abundant type (n=90) ; sparse type (n=9) and the middle type (n=57) .Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures (including single procedure in 75 patients, twice procedures in 30 patients).All of the 105 patients were followed up 3 to 8 years(mean 4 years) using US, CT or MRI or DSA.The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate.Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by X~2 test respectively.And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively.Results The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156).After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X ~2=8.8553, P<0.01).In the D group, the total effective rate in group with twice procedures (100.00%,30/30) was significant higher (X~2 =5.2642,P<0.05) than those of group with single procedure (72.73%,8/11).Of this series, during the period of following-up, no recurrent or severe complications were observed.Conclusions A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE.