三例婴儿肝血管瘤伴高输出量心力衰竭的成功治疗与文献复习  

Successful treatment of infantile hepatic hemangioma with high-output heart failure: report of 3 cases and literature review

作　　者：杨健 戴小科[2] 张明满[2] 熊强[2] YANG Jian;DAI Xiaoke;ZHANG Mingman;XIONG Qiang(Department of Pediatric Surgery,Yongchuan District Maternal and Child Health Hospital,Chongqing,402160;Department of Hepatobiliary Surgery,National Clinical Research Center for Child Health and Disorders,Key Laboratory of Child Development and Disorders of Ministry of Education,Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases,Children’s Hospital of Chongqing Medical University,Chongqing,400014,China)

机构地区：[1]重庆市永川区妇幼保健院儿外科,重庆402160 [2]重庆医科大学附属儿童医院肝胆外科,国家儿童健康与疾病临床医学研究中心,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿童代谢与炎症性疾病重庆市重点实验室,重庆402160

出　　处：《陆军军医大学学报》2024年第22期2569-2575,共7页Journal of Army Medical University

基　　金：国家临床重点专科建设项目:国卫办医政函[2024]189号。

摘　　要：目的总结婴儿肝血管瘤(infantile hepatic hemangioma,IHH)伴高输出量心力衰竭的临床特点、治疗方案以及治疗效果。方法收集2020年10月至2023年10月在重庆医科大学附属儿童医院肝胆外科收治的3例婴儿肝血管瘤伴高输出量心力衰竭病例,并分析其病例特点、治疗方案和治疗效果。同时,通过中国知网、万方数据库和中华医学期刊全文数据库及PubMed数据库检索国内外报道的病例并进行分析总结。结果3例患儿中,男性1例,女性2例,年龄分别为1 d、19 d和80 d,主要临床症状为呼吸急促和呼吸困难。所有患儿入院后迅速进展为呼吸衰竭、肺动脉高压和心力衰竭。诊断弥漫性IHH 2例,局灶性IHH 1例,其中1例弥漫性IHH接受了经皮肝动脉栓塞术的介入治疗,手术当天心肺功能恢复,并脱离呼吸机。另外2例患儿在使用普萘洛尔联合激素药物治疗后,估算右室收缩压和二尖瓣流量比在心脏彩超监测中最为敏感。文献复习共纳入24例患儿,其中4例治疗失败死亡,3例缓解,17例完全恢复。结论普萘洛尔联合激素药物治疗以及经皮肝动脉栓塞术是治疗IHH伴高输出量心力衰竭的有效方法。通过估算右室收缩压和二尖瓣流量比进行血流动力学监测,可能是潜在的评估药物治疗效果的早期敏感指标。Objective To summarize the clinical characteristics,treatment regimen and clinical outcomes of infantile hepatic hemangioma(IHH)with high-output heart failure(HHF).Methods A retrospective analysis was conducted on 3 IHH infants with concomitant HHF admitted to the Children’s Hospital of Chongqing Medical University during October 2020 and October 2023.The characteristics,treatment plans and efficacy were analyzed in the 3 cases.CNKI,WANFANG DATA,Chinese Medical Association Journal Full-text Database,and PubMed databases were retrieved to search domestic and foreign literature concerning the diseases,and the enrolled cases were analyzed and reviewed.Results Among the 3 infants,they were 1 male and 2 females,and aged 1 d,19 d and 80 d,respectively.The main clinical symptoms were dyspnea and respiratory distress.All 3 patients rapidly progressed to respiratory failure,pulmonary hypertension and heart failure after admission.Diffuse IHH was diagnosed in 2 cases and focal IHH in 1 case.One case of diffuse IHH underwent percutaneous hepatic artery embolization,and the cardiopulmonary function recovered on the day of surgery,and the ventilator was removed.In the other 2 cases,propranolol combined with steroid medication was used,and the estimated right ventricular systolic pressure and E wave to A wave mitral flow ratio(E/A)were the most sensitive indicators in echocardiographic monitoring.There were 24 cases included in literature review,with 4 cases of treatment failure and death,3 cases of remission,and 17 cases of complete recovery.Conclusion Propranolol combined with steroid medication and percutaneous hepatic artery embolization are effective in treating IHH complicated with HHF.Right ventricular systolic pressure and E/A during drug therapy might be early sensitive marker for the early evaluation of potential therapeutic effects of drugs.

关 键 词：婴儿肝血管瘤 心力衰竭 介入 普萘洛尔 

分 类 号：R725.416[医药卫生—儿科] R726.573[医药卫生—临床医学] R732.2