Hepatic cavernous hemangioma, commonly known as hepatic hemangioma, is the most common benign neoplastic lesion of the liver with a high clinical incidence. Its growth is slow, accounting for about 0.4% to 7.0% of the occupying lesions in the liver. Hepatic hemangioma may not have any clinical symptoms when it is small. When the tumor is large, it invades the liver on one hand and presses the neighboring organs on the other hand (hemangioma with diameter greater than 5 cm is called giant hemangioma), and symptoms such as pain, belching, nausea, vomiting, vomiting blood, black stool and jaundice may occur. If the hemangioma ruptures and bleeds, shock and peritonitis may occur, which may even be life-threatening. In the past, the traditional treatment method was mainly surgical resection, but it was not accepted by most patients because of its trauma, long hospital stay and many complications, and multiple hemangiomas were even more difficult to treat surgically. However, with the development of interventional radiology in the past two decades, super-selective hepatic artery cannulation embolization has provided a safe and effective way to treat hepatic cavernous hemangiomas, especially multiple hemangiomas. Its growth and progression can be effectively controlled after aggressive treatment measures are taken. Interventional treatment is therefore very popular with both patients and physicians, and is currently recognized as the most effective clinical treatment that is less invasive and more effective. Hepatic cavernous hemangioma is mainly supplied by the hepatic artery. They are divided into two types: thick-walled and thin-walled. The former tends to show marginal filling when embolized; the latter tends to show complete filling when embolized. Hepatic cavernous hemangioma is composed of many dilated vessels and sinusoidal cavities. The hemangioma lacks a reticuloendothelial system and lymphatic system, phagocytosis and scavenging. The slow rate of contouring of materials entering through the blood vessels provides a theoretical basis for the hepatic arterial route for the treatment of hepatic hemangiomas. When the drug iodinated oil emulsion is perfused through the hepatic artery, it can be easily deposited in the blood sinusoid for a long time, causing fibrosis, terminating the tumor growth and achieving the purpose of cure. 2, the choice of embolic substance and material Through reviewing the literature, we found that in recent years, most of the embolic substances used in the interventional treatment of hepatic hemangioma in major and medium-sized hospitals in China are Pingyangomycin iodinated oil emulsion. Pingyangmycin is an antitumor antibiotic of the bleomycin class produced by Streptomyces pingyangensis, and is also a slow sclerosing agent. According to research Pingyangmycin has the effect of destroying vascular endothelial cells, promoting platelet adhesion, microthrombosis, and subsequently fibrosis. Because pindamycin is not tracer under X-ray, it cannot be used alone to complete embolization. In contrast, super-liquid iodinated oil is both a high-density contrast agent and a medium-acting embolic agent, which is pro-tumorigenic and can be selectively deposited in hepatic hemangiomas, but can be absorbed and decomposed in the normal organism. Therefore, if pinyamycin and iodinated oil are mixed in a certain ratio, and iodinated oil is used as a carrier to selectively introduce the drug into the tumor for embolization treatment by taking advantage of its X-ray impermeability and tumor tending properties, ideal therapeutic effects can be obtained. The combination of these two drugs will eventually lead to the formation of thrombus in the hepatic hemangioma and the atrophy and occlusion of the blood sinusoids, which will stop the growth of the hemangioma, prevent the rupture and bleeding of the tumor, and relieve the clinical symptoms. 3 .Adverse reactions and complications Pingyangmycin iodide oil emulsion is less irritating and has a slow sclerosing effect. Therefore, the intraoperative injection technique is easy to master, with less risk and less adverse reactions. Patients usually have only mild liver function impairment, and the transaminases return to normal after 1 month. Symptoms such as pain and discomfort in the liver area, nausea, vomiting and hypothermia may occur and may resolve on their own after 2 to 7 days or after symptomatic treatment. According to the literature, the more serious complications after interventional embolization of hepatic hemangioma are biliary liver abscess and biliary tract injury. However, through the author’s clinical observation and a large number of literature reports, it is believed that these serious complications can be avoided by paying attention to the following aspects of interventional treatment: ① Liquid embolic agents, such as anhydrous ethanol, should be avoided as much as possible because of their strong destructive effects on tissues; ② Improving the insertion rate is an important factor to ensure the embolization effect. The catheter should be inserted as close as possible to the blood supplying artery of the lesion to achieve complete and dense embolization of the blood sinusoid and blood supplying artery of the tumor. At the same time, the normal liver tissue should be protected to the maximum extent. The injection speed and dosage of embolic agent must be strictly controlled, and the embolic agent should be injected slowly under X-ray fluoroscopy during the operation. The principle of small amount, intermittent and slow injection should be strictly followed, generally not more than 0.5 ml/s. The injection should be stopped when the flow rate is slowed down and gradually stopped. The dose used should not exceed the limit, and prevent the emergence of reflux phenomenon. ④Intraoperative operation should be as gentle as possible to prevent damage to the liver vessels and hemangioma wall. ⑤ Strictly grasp the indications for fractionated embolization to avoid liver failure. For tumors larger than 15 cm or distributed across the liver lobe, patients older than 60 years old with abnormal liver function, or tumors with multiple blood supplies that are difficult to embolize in a single session, split embolization treatment can be considered. In conclusion, the treatment of hepatic cavernous hemangioma by embolization of hepatic artery with pinyamycin iodide emulsion has many advantages such as less trauma, simpler operation, less pain for patients, less side effects, shorter hospital stay, lower cost, wider indications, faster recovery, safe and minimally invasive, and definite curative effect. It has been clinically proven to be a safe and effective method for the treatment of hepatic hemangioma.
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