A Case Control Study Of Percutaneous Sclerotherapy Versus Hepatic Arterial Embolization For Treatment Of Large Volume Hepatic Hemangioma

Objective: Hepatic hemangioma is a common disease,it is a congenital vascular malformation.The probability of spontaneous hemangiom rupture is low,however,it is lethal once the rupture occurrs.Giant hepatic hemangioma(single lesion diameter >5cm)posing a potential threat to patient health and safety has gained more and more attention in clinical settings.Most patients with diffuse hepatic hemangioma were treated with liver transplantation,and many giant hemangiomas of the liver were managed by surgical resection.Either liver transplantation or surgical resection,there are many disadvantages,such as extensive invasion,large bleeding and high risk.In recent years,with the development of minimally invasive medical technology,interventional therapy has been widely accepted by clinical physicians as well as patients in the treatment of hepatic hemangioma due to its advantages of small trauma,low risk and remarkable curative effect.It has become one of the main methods for the treatment of hepatic hemangioma.Percutaneous liver sclerotherapy and percutaneous transhepatic arterial embolization for hepatic hemangioma are widely used in interventional treatment of huge hepatic hemangioma.However,the comparison between the two methods is rare.The purpose of this study was to compare the two kinds of non-surgical methods in the effect,the incidence of complications and quality of life,and provide evidence of the clinical treatment.Methods: Twenty-two cases of patients with hepatic hemangioma(8 cases of solitary lesion,maximum diameter of single lesion were >5cm)were divided into two groups randomly,11 cases underwent percutaneous injection of bleomycin sclerotherapy(sclerosis group),11 patients underwent DSA guided hepatic artery bleomycin lipiodol embolise treatment(embolization group).The procedure time,the average cost,the postoperative curative effect,complications and quality of life score were reviewed.Statistical analysis was performed by SPSS17.0 statistical software(Windows Version,Chicago).The continuous variables were expressed by mean +standard deviation(x + s).Two independent samples were measured by t test,and categorical variables were compared by Fisher exact probability method.The difference was set as P<0.05 statistically significant.Results: The average procedure time of sclerotic group was shorter than that of embolization group(15.6 + 6.4 min vs 51.5 + 7.2 min),and the difference was statistically significant(P<0.05).The average hospitalization and hospital expenseswere also significantly different.The average hospitalization in sclerotherapy group was shorter(3.4 + 1 D vs 6.8 + 1.7 d),and the average cost was lower(6380 +630RMB vs 12540 + 1480RMB)than embolization group,with statistical difference(P<0.05).Comparison of the efficacy of the two groups,enhanced CT or MRI patients were followed up for 6 months,all patients with tumor size were decreased,the effective rate of treatment group was 81.8%(9/11),the effective rate of treatment was 90.9% embolization group(10/11),the difference was not statistically significant(P>0.05).In the sclerosing group,10 cases were found with partial enhancement of lesion edge,indicating a rate of 90.9%.In the embolization group,there were 8 cases with partial enhancement of the lesion,showing a rate of 72.7%,and the difference was not statistically significant.The postoperative complications of the two groups were compared.The proportion of hepatic dysfunction in the embolization group was more than that in the sclerotherapy group(10/11vs3/11),showing that the ALT and AST increased to 3 times more than upper normal limit on the 3 day after operation,and the difference was statistically significant(P<0.05).After treatment,the liver function improved before discharge.There was no significant difference in the two groups of postoperative pain,fever,and upper abdominal discomfort(nausea,vomiting,etc.).The symptoms of upper abdominal discomfort were relieved after the treatment of metoclopramide.The patients with fever were medium and low level(<38.5 C),disappeared after treatment,and the pain in the liver area was gradually relieved.The satisfaction rate of patients in the sclerosis group(10/11,90.9%)was slightly higher than that of the embolic group(8/11,81.8%),and there was no significant difference.Conclusion: Percutaneous injection of bleomycin via liver puncture and DSA-guided hepatic artery embolization with bleomycin are both effective in the treatment of hepatic hemangioma with diameter greater than 5 cm.Percutaneous liver puncture cirrhosis for hepatic hemangioma has the advantages of simple operation,short operation time and hospitalization time,low treatment cost and good tolerance.