乏血供型肝血管瘤的介入治疗疗效分析及治疗模式探讨  

Analysis of therapeutic efficacy and treatment model of interventional treatment in hepatic hemangiomas with poor blood supply

作　　者：贾科峰[1] 于长路[1] 孙诚[1] 宋德钊 王森[1] 高忠嵩 Jia Kefeng;Yu Changlu;Sun Cheng;Song Dezhao;Wang Sen;Gao Zhongsong(Department of Radiology, Tianjin Third Central Hospital)

机构地区：[1]天津市第三中心医院放射科,天津市肝胆疾病研究所,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,300170

出　　处：《中华消化杂志》2018年第12期835-840,共6页Chinese Journal of Digestion

摘　　要：目的通过分析乏血供型肝血管瘤的介入治疗疗效和并发症发生情况,探讨其治疗模式。方法纳入天津市第三中心医院2013年5月至2016年10月行介入治疗的82例乏血供型肝血管瘤患者,分成介入组、穿刺组和联合组。介入组按照常规肝动脉插管,微导管超选择至血管瘤瘤体内注入平阳霉素碘化油混合乳剂;穿刺组采用在超声引导下经皮肝穿刺,于瘤体内注入平阳霉素碘化油混合乳剂;联合组则先采用介入治疗方法,然后经皮肝穿刺在瘤体碘化油沉积缺失区再次注入平阳霉素碘化油混合乳剂。治疗后评价3组患者的并发症和疗效,分析随访阶段患者脱落的原因。统计学分析采用方差分析、卡方检验或Fisher确切概率法。对于脱落患者的处理,采用意向性治疗分析与符合方案分析。结果82例乏血供型肝血管瘤患者中,介入组27例,穿刺组24例,联合组31例。7例患者发生肝功能衰竭等严重并发症。术后3个月,联合组的总体有效率为29.0%(9/31),高于介入组的7.4%(2/27)和穿刺组的4.2%(1/24),差异均有统计学意义(χ2=6.296,P=0.014;χ2=5.622,P=0.031);术后6个月,联合组(意向性治疗分析、符合方案分析)的总体有效率分别为70.3%(26/37)、71.0%(22/31),分别高于介入组的40.9%(9/22)和穿刺组的7/18,差异均有统计学意义(意向性治疗分析χ2=4.929、4.969,符合方案分析χ2=4.789、4.851;P均<0.05)。术后12个月,3组共脱落41例患者。3组脱落患者中临床效果评价无效者占63.4%(26/41),高于显效者的12.2%(5/41)和有效者的24.4%(10/41),差异均有统计学意义(χ2=22.873、12.676,P均<0.01)。结论乏血供型肝血管瘤患者单纯采用介入治疗的疗效欠佳,在选择合适治疗方法的同时应注意并发症的发生。Objective To analyze the efficacy and complications of interventional treatment in hepatic hemangiomas with poor blood supply, and to explore the mode of treatment. Methods From May 2013 to October 2016, at Tianjin Third Central Hospital, 82 patients with hepatic hemangiomas with poor blood supply were enrolled and divided into intervention group, puncture group and combination group. Conventional hepatic artery intubation was performed in intervention group, using a microcatheter to superselect to hemangioma and injecting pingyangmycin-lipiodol emulsion into the tumor of hemangioma. Patients of puncture group underwent the ultrasound-guided percutaneous liver puncture, and the pingyangmycin-lipiodol emulsion was injected into the tumor. The patients of combination group first received intervention treatment, and the pingyangmycin-lipiodol emulsion were injected again into the tumor area lacking of iodized oil deposition through percutaneous transhepatic puncture. After treatment, the complications and clinical efficacy of patients in three groups were evaluated and the reasons of patients lost to follow-up were analyzed. The analysis of variance, Chi-square test and Fisher′s exact test were performed for statistical analysis. For patients lost to follow up, intention-to-treat (ITT) analysis and per protocol (PP) analysis were used. Results Among 82 patients with hepatic hemangiomas with poor blood supply, there were 27 in intervention group, 24 in puncture group and 31 in combination group. Seven patients developed serious complications such as liver failure. At three months after the treatment, the overall efficacy of combination group (20.9%, 9/31) was higher than that of intervention group (7.4%, 2/27) and puncture group (4.2%, 1/24), and the differences were statistically significant (χ2=6.296, P=0.014; χ2=5.622, P=0.031). At six months after the treatment, the overall efficacy of combination group (ITT analysis 70.3%, 26/37; PP analysis 71.0%, 22/31) was still higher than that of intervention group (40.

关 键 词：肝血管瘤 乏血供型 治疗模式 疗效分析 心理因素 

分 类 号：R735.7[医药卫生—肿瘤]