Hepatic hemangioma (Hepatic hemangioma), is a benign tumor of the liver. Hepatic cavernous hemangioma is the most common. Hepatic cavernous hemangiomas are usually solitary, mostly occurring in the right lobe of the liver; about 10% are multiple, and may be distributed in one lobe of the liver or bilaterally. Hemangiomas appear as dark reddish, bluish-purple sac-like elevations in the liver. It is lobulated or nodular, soft, compressible, and most of them are clearly demarcated from neighboring tissues. Patients usually have no conscious symptoms. Most of the small liver hemangiomas have no clinical symptoms, and dynamic observation of its static non-development, generally will not rupture bleeding, that is, not serious, non-life-threatening, regular review can be. If there are obvious symptoms, such as huge hemangioma compressing the adjacent organs such as gastrointestinal tract, causing abdominal distension, abdominal pain, belching, poor appetite, nausea and vomiting and other symptoms, then surgery can be considered. A few hepatic hemangiomas may be combined with coagulation dysfunction, such as depletion of coagulation factors, platelets, etc., which can also be treated surgically. If there is hemorrhage of hepatic hemangioma tumor, which is life-threatening, then surgical treatment is necessary. In recent years, with the development of interventional technology, instruments and materials, transcatheter arterial sclerosing embolization (TASE) for hepatic hemangioma has achieved good efficacy, and has become the preferred treatment option for hepatic hemangioma because of its small trauma, short hospitalization time, precise effect and other advantages, which is more and more favored by the families of the majority of children with the disease. TASE has become the first choice of treatment for hepatic hemangioma. Initial consultation: AFP, CT scanning + enhancement examination of the upper abdomen (cost about 1000 RMB). After the initial diagnosis of hepatic hemangioma, an appointment was made for admission to the hospital for interventional therapy. Admission 1. Preoperative tests were completed after admission: blood routine + blood typing, organ function 1, coagulation tetralogy, pre-transfusion tetralogy (normal feeding was possible after blood draw). Stool routine, urine analysis, imaging tests: chest X-ray, electrocardiogram (the cost of the examination is about 1000 RMB). Review AFP and abdominal CT if necessary. After admission, the nurse explains the precautions for hospitalization (including electricity safety, anti-theft, fire prevention, no smoking, etc.). During the admission period, you need to sign the informed consent for surgery, the informed consent for disposable consumables, the consent for 72-hour conversation and the informed consent for anesthesia. 2. If the examination results are normal, surgery will be performed within 1 to 3 days after admission. Fasting and drinking were prohibited before the operation, and the specific operation time and the time of fasting and drinking were notified by the nurse. Surgery: image-guided puncture biopsy and/or transcatheter atherosclerotic embolization (the cost of the surgery is about 11,000 RMB), the surgery time is about 1~2 hours (including anesthesia+surgery+resuscitation), anesthesia: sacral anesthesia+intravenous general anesthesia or general anesthesia with tracheal intubation. (The cost ranges from about 1,000 to 2,500 RMB). The details will be decided by the anesthesiologist according to the condition of the child. 3.After the operation, send the patient to the recovery room, and return to the ward after the patient is awake, observe the general condition of the patient, abdominal symptoms and signs, record the 24-hour urine output, pay attention to the puncture point with or without blood seepage and hematoma, and give liver protection and symptomatic supportive treatment. 4. On the 3rd to 5th day after the operation, if the child’s mental state recovers, there is no fear of cold, fever (fever does not exceed 38.5°C), no nausea, vomiting, and the blood test and organ function are generally normal, the child can be discharged from the hospital. Outpatient review after discharge Usually, hepatic hemangioma needs 2 to 4 times of interventional therapy, and the doctor in charge will make an appointment directly with you for the next hospitalization (usually 4 to 6 weeks apart), and the review items are mainly alpha-fetoprotein and abdominal CT. Frequently Asked Questions 1. Why does TASE for hepatic hemangioma not cause extensive necrosis of the normal liver? Normal liver has two sets of blood supply systems, portal vein and hepatic artery, 75% of the blood in normal liver tissue comes from portal vein and 25% from hepatic artery, whereas the main blood supply of hepatic hemangioma comes from hepatic artery, basically, portal vein is not involved in blood supply (rarely, it is blood supply from portal vein), so embolization of hepatic artery won’t cause extensive necrosis of normal liver tissue. 2.How does TASE work on tumor? Hepatic hemangioma is mainly composed of blood-filled and enlarged hepatic sinusoids. The embolic agent injected by TASE enters and stays in these sinusoids to destroy the endothelial cells of hemangioma sinusoids, thrombus is formed, and the sinusoids are permanently occluded. Then the tumor will shrink or disappear, and will not rupture and bleed, which can achieve the therapeutic effect. Meanwhile, TASE has no effect on the blood supply of normal liver tissues, and the normal liver tissues have the possibility of compensatory enlargement. 3.Is there any adverse reaction after TASE? All children with TASE in our department have short-term fever after surgery, with body temperature about 37.5℃～40℃, which usually improves after 2～16 days, which is caused by the absorption of necrotic tissues of the tumor; nausea and vomiting of different degrees can be seen, which can be relieved in about 1～3 days; some of them have transient loss of appetite; no sepsis occurs. 4.Can hepatic hemangioma become cancerous? According to histological classification, hepatic hemangioma is divided into cavernous hemangioma, sclerosing hemangioma, capillary hemangioma and vascular endothelial cell tumor. Among them, it is very clear that hepatic cavernous hemangioma will not be malignant, hepatic hemangioendothelioma has the possibility of malignancy, and whether other hepatic hemangiomas such as sclerotic and capillary type are malignant has not been clarified yet.