Hepatic hemangioma is the most common benign occupying lesion in the liver, and it can be single or multiple in age group of 30 to 50 years old. 50% to 70% of patients have no clinical symptoms, but a small number of larger tumors may show compression symptoms.
I. Etiology of hepatic hemangioma
The etiology of hepatic hemangioma is not yet clear, and it is mostly thought to be related to congenital developmental abnormalities, which may be associated with the following factors
①Deformation of capillary tissue after infection and capillary dilation;
②Vascular expansion after local necrosis of liver tissue to form a vacuolation; vascular congestion, expansion, and finally vacuolation around the necrotic liver tissue;
③After regional blood circulation stagnation in the liver, the blood vessels form spongy dilation and persistent intrahepatic venous blood stagnation, resulting in venous enlargement;
④ Intrahepatic hemorrhage, hematoma mechanization, and vascular recanalization result in vasodilation;
⑤ Abnormal development of blood vessels leads to spongy expansion of blood vessels, which is the most acceptable theory.
Types of hepatic hemangioma
Hepatic hemangioma varies in size, with small ones often requiring microscopic diagnosis and large ones reaching the pelvis and weighing more than 18 kg. They are usually located in the right lobe and 90% of them are solitary. The tumors are purple-red or purple-blue in color, soft in texture, clear in borders and reticulate in cut surface. Hepatic hemangiomas can be divided into four categories.
(1) Hepatic spongiotic hemangioma: the most common, with a honeycomb section, the cavity of the accumulated sinusoid is separated by fibrous tissue, the wall is covered by endothelial cells, the cavity is filled with blood cells and mechanized thrombus, there are small vessels and residual bile ducts in the fibrous septum, and there may be calcification or venous stone.
②Sclerosing hemangioma: The lumen of the vessel is collapsed or closed, the septum is extremely rich in fibrous tissue, and the hemangioma shows degenerative changes.
③Hepatic capillary hemangioma: rare, with narrowed lumen and abundant septal fibrous tissue.
④Hemangiopericytoma: rare, between benign hemangioma and hepatic hemangioendothelial cell sarcoma.
Clinical manifestations of hepatic hemangioma
The clinical manifestations of hepatic hemangioma are related to the location, size, growth rate and the degree of liver parenchyma involvement of the tumor; small ones are asymptomatic, while large ones may have epigastric discomfort, abdominal pain, abdominal distension, nausea, vomiting, and chronic low fever. Most of the physical examinations have no positive signs, and occasionally abdominal masses can be palpated, which are connected with the liver, with smooth surface, soft texture, cystic sensation and different degrees of compression.
Indications for interventional treatment of hepatic hemangioma
The main interventional treatment for hepatic hemangioma is hepatic artery embolization.
The indications of hepatic artery embolization for hepatic hemangioma treatment: those with symptoms, those with hemangioma rupture and bleeding, those with mass diameter greater than 5cm, those with tumor tendency to increase, or those with mass located under the liver envelope and likely to rupture under external force. Generally, those with small and stable lesions and no clinical symptoms can be clinically observed and not treated for the time being.
V. Contraindications to interventional treatment of hepatic hemangioma
In general, hepatic artery embolization is not absolutely contraindicated in the treatment of hepatic hemangioma, but it should be used with caution in severe hepatic and renal insufficiency.
VI. Advantages of hepatic artery embolization
Hepatic artery embolization is an effective method for treating hepatic hemangioma, with the advantages of wide indications, little damage, fast recovery and good efficacy.
VII. Operation procedure of interventional treatment
After percutaneous puncture, the catheter is inserted from the femoral artery to the hepatic artery, and the hepatic artery is firstly imaged, and then the catheter is super-selected to the target vessel for embolization treatment according to the image. If it is possible to cross the gallbladder artery, anhydrous alcohol or sodium cod liver oil acid can be used, and then gelatin sponge can be used to strengthen the embolization, otherwise it can be used with caution according to the tumor vessels. If it fails to cross the gastroduodenal artery, it is safer to use iodinated oil plus gelatin sponge strips. However, the level of embolization should reach the abnormal blood sinus.