What are the advances in the treatment of hepatic hemangioma

  Hepatic hemangioma is a benign tumor of the liver, with hepatic cavernous hemangioma being the most common, accounting for 84% of benign liver tumors according to Adam et al. It is more common in females and 4.5~5 times more common than males. Most commonly seen in 30-60 years old. It may be clinically asymptomatic and found occasionally during physical examination. Huge tumors may compress the surrounding organs and cause epigastric distension, pain and discomfort and other corresponding symptoms, and there is a risk of liver rupture due to elevated liver tension. Hepatic cavernous hemangioma is 90% solitary and 10% multiple. The diameter varies from 2 mm to 20 cm, and those exceeding 5 cm are called giant cavernous hemangiomas.  Hepatic cavernous hemangioma is composed of blood-filled, dilated sinusoids with slow blood flow, mainly supplied by hepatic artery. Therefore, through selective hepatic artery cannulation, embolic agent enters the tumor through hepatic artery, fills and stays in it for a long time, forming thrombus, and thrombus mechanization and fibrosis can transform the tumor into fibroid-like structure, occluding the pathological blood sinusoids and playing a permanent embolic role, while some embolic agents can also cause Some embolic agents can also cause necrosis of endothelial cells and perivascular tissues, and disintegration and stagnation of blood.  This can lead to extensive obstruction of the blood sinuses and secondary thrombosis of the main blood supplying arteries in the tumor, and eventually lead to shrinkage of the tumor or occlusion of the tumor cavity, relief of clinical symptoms, and avoidance of the risk of rupture and bleeding. For hepatic cavernous hemangiomas with larger tumors or lesions, embolization can be performed in stages to reduce the incidence of complications; TAE cannot completely remove the hemangioma, and long-term follow-up may reveal that some of the tumor blood supply arteries are recanalized or collateral circulation is established, and the tumor may increase in size again and clinical symptoms may recur, at which time embolization can be repeated. LP is a liquid peripheral embolic agent with good X-impermeable linearity and tumor tropism, and it can also be used as a drug carrier. PYM is a bleomycin-like antitumor antibiotic produced by Streptomyces pinyonii, a mild vascular sclerosing agent with the function of inhibiting abnormal endothelial cell proliferation and destroying endothelial cell structure.  Intratumoral injection of PYM can rapidly inhibit the proliferation of endothelial cells and induce degeneration of hemangioma. PYM has the function of destroying tissue blood vessels, which is medically known as vascular expectorant effect. PYM accumulates in the abnormal blood sinus of CHL for a long time, and the local PYM concentration is high and released slowly for a long time, which destroys the tumor vascular endothelial cells and causes calcification and fibrosis of the tumor to achieve the purpose of treatment.  After more than 30 years of development, TAE for CHL has become more and more technically advanced, especially due to the application of microcatheters, the superselection technique has been further improved; the interventional devices have become more and more advanced, making the operation simpler and faster, and the damage to blood vessels has been further reduced; more and better embolic agents have been discovered and used, making the efficacy more significant, the incidence of postoperative complications has been reduced, and various postoperative adverse effects have become less severe. It can effectively relieve or even eliminate various signs and symptoms of CHL patients, with wide indications, safety, less physical damage to patients, and fast postoperative recovery, which patients are happy to accept.