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目的评价经导管动脉栓塞(TAE)联合CT导引无水乙醇注射(CT-PEI)治疗肝血管瘤的安全性及疗效。方法32例病人,共42个肝血管瘤,均经CT扫描及血管造影诊断为肝血管瘤。6例活检证实为肝血管瘤,其中1例活检10分钟后发生失血性休克,经急诊TAE治疗后恢复。肿瘤体积1.80～572.00cm3,平均166.80±125.80cm3。患者先经1次导管动脉超液化碘油及明胶海绵超选择栓塞治疗,然后行CT导引注射无水乙醇与超液化碘油(10:1)混合液,42个肝血管瘤共行CT-PEI治疗178次,平均4.24±2.14次/肿瘤,肿瘤体积的无水乙醇注射量平均为0.53ml/cm3,单次用量平均18.34±7.27ml。结果治疗后3个月复查肝脏CT扫描,37个肿瘤完全坏死,42个肿瘤体积缩小74.46%±11.43%,P值<0.01。对5个有部分存活的肿瘤又进行了CT-PEI治疗共8次;6个月复查肝脏CT扫描,40个肿瘤完全坏死,肿瘤体积缩小88.21%±6.18%,t=8.23,P<0.01。患者随诊10～96个月,平均51.34±21.41个月,肿瘤进一步缩小,2个肿瘤在肿瘤边缘出现新生肿瘤组织。结论TAE联合CT-PEI治疗肝血管瘤可使肿瘤完全坏死,是肝血管瘤一种安全、有效的治疗方法。
Objective To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) and CT-guided absolute ethanol injection (CT-PEI) in the treatment of hepatic hemangiomas. Methods 32 patients with 42 hemangiomas were diagnosed as hepatic hemangiomas by CT scanning and angiography. Six cases of biopsy confirmed liver hemangiomas, of which 1 case of biopsy 10 minutes after hemorrhagic shock, recovery after emergency TAE treatment. Tumor volume 1.80 ~ 572.00cm3, an average of 166.80 ± 125.80cm3. Patients were treated with transcatheter arterial liquefaction with lipiodol and gelatin sponge in one embolization. CT guided injection of absolute alcohol and ultra-liquefied lipiodol (10: 1) PEI treatment of 178 times, an average of 4.24 ± 2.14 times / tumor, the average volume of ethanol injection of tumor volume of 0.53ml / cm3, an average of 18.34 ± 7.27ml. Results The CT scan of the liver was reviewed at 3 months after treatment. Thirty-seven tumors were completely necrotic. The size of 42 tumors was reduced by 74.46% ± 11.43%, P <0.01. Five of 5 survived tumors were treated with CT-PEI for a total of 8 times. Liver CT scan was performed 6 months later, and 40 tumors were completely necrotic. The tumor volume was reduced by 88.21% ± 6.18%, t = 8.23, P <0.01. Patients followed up 10 to 96 months, an average of 51.34 ± 21.41 months, the tumor further reduced, two tumors appear in the edge of the tumor of new tumor tissue. Conclusion TAE combined with CT-PEI in the treatment of hepatic hemangiomas can completely necrotic tumor, which is a safe and effective treatment for hepatic hemangiomas.