The authors suggest that occlusion of blood flow to the whole liver is not necesarily a routine procedure in surgical removal of giant cavernous hemangioma in the 8th segment of liver. An occlusion tape can be placed around the finferior vena cava inadvance. Separtion of inferior vena cava between the diaphragm and the upper surface of liver sometimes is difficult, so that placement of the tape may fail. The procedure which we performed in four patients was intermittent occlusion of blood flow at the first hepatic hilum at room temperature during dissection and removal of the tumor en bloc. This operative method is simple and safe as compared with that of resection of the 8th segment of liver.
OBJECTIVE: To discuss clinical application of the color Doppler ultrasonography in diagnosis and treatment of cavernous hemangioma in deep subcutaneous tissue. METHODS: From 1996, 15 cases of cavernous hemangioma were diagnosed and located with color Doppler ultrasonography and were embolized under monitoring of the ultrasonography or resected by operation before re-examination of the hemangioma via the color Doppler ultrasonography after the intervention. RESULTS: Direct embolization was achieved in 10 cases after pinpoint location of the hemangioma by the ultrasonography, and guided embolization was performed successfully in 2 cases via the monitoring of ultrasonography, and operation had to be adopted to remove the focus. No reoccurrence of the hemangioma was observed in all the cases. CONCLUSION: Cavernous hemangioma in deep subcutaneous tissue could be easily diagnosed and located with color Doppler ultrasonography, and could be removed by embolization under monitoring of the ultrasonography successfully.
【摘要】 目的 探讨脑干海绵状血管瘤患者临床表现及影响预后的相关因素。 方法 回顾分析2008年9月-2010年9月27例脑干海绵状血管瘤患者临床资料。 结果 20例（74.1%）患者CT显示出血及血肿。急性或突然神经功能废损22例，渐进性功能障碍15例，病情平稳4例。显微手术12例，放射治疗6例，保守观察9例。长期随访25例，2例再次出血，无新发病灶，无患者死亡。手术组患者年龄（Plt;0.05）、术前病情严重程度（Plt;0.05）与术后KPS评分相关。非手术组不良预后评分与患者高龄及再出血有关。 结论 展神经麻痹和面瘫患者功能恢复较差。年龄、术前病情严重程度及手术时机影响患者预后，术中全切病灶对复发和并发症发生起主要作用，如何处理合并发生的静脉畸形有待讨论。立体定向放射治疗明显降低再出血风险，但其适应证尚有争议。【Abstract】 Objective To discuss the clinical manifestations and prognostic factors of brain stem cavernous hemangioma. Methods Based on the literature, the clinical data of 27 patients having brain stem cavernous hemangioma from September 2008 to September 2010 were reviewed and analyzed. Results Twenty patients (74.1%) presented with hemorrhage and hematoma in CT scan. Acute or sudden neurological deterioration occurred to 22 patients, progressive in 15 and stable in 4. Twelve patients underwent surgical removal of the lesion; 6 underwent radiosurgery; and 9 continued with conservative management. Twenty-five patients were followed up. Two patients had rehaemorrhagia. There were no de novo lesions or death. The risk factors indicative of a possible poor postoperative KPS score in the operative group included age (Plt;0.05) and the initial clinical condition (Plt;0.05). In the non-operative group, old age and rehaemorrhagia were obviously related to the poor outcome. Conclusions Patients with abducens and facial palsy have poor functional recovery. Age, the initial clinical condition and timing of operation are the major factors correlated to surgical outcome. The factor that affects recurrence and the occurrence of complications is complete resection during the operation. How to deal with the concomitant venous malformation should be further studied. The indications for stereotactic radiosurgery are still controversial, although it has confered a reduction in the risk of rehaemorrhagia.
目的总结肝尾状叶海绵状血管瘤手术切除的指征及技巧。方法对我科2005年9月至2010年9月期间开展的8例肝尾状叶海绵状血管瘤切除病例的临床资料进行分析。结果全组患者均在无血流阻断下顺利完成手术，无手术死亡。术中出血量为1 000～5 000 ml，（2 500±800） ml; 手术时间为3～6 h，(4.2±0.8） h。1例肝硬变患者术后1 d即出现腹水，经积极治疗后得以控制。3例患者术后1周发现右侧胸腔积液，经1～2次胸腔穿刺抽液后治愈。1例患者术后1周出现不全性肠梗阻，经保守治疗1周后痊愈。术后应用B超每半年复查肝脏情况，随访0.5～5年，（2.5±1.2）年，1例失访，1例患者死于心肌梗死，余均存活，仍在随访中。所有病例均未复发。结论肝尾状叶海绵状血管瘤手术应充分显露、精准操作，彻底切除肿瘤，避免大出血和空气栓塞，减少和防止残肝的热缺血再灌注损伤。
【摘要】 目的 探讨治疗肝尾状叶巨大海绵状血管瘤的外科手术方法。方法 通过1 例肝尾状叶巨大海绵状血管瘤外科手术治疗体会并结合文献复习,分析肝尾状叶解剖及影像学特点,探讨外科手术方法。结果 肝尾状叶巨大海绵状血管瘤因肝尾状叶特殊的解剖特点,安全并有效的肝全尾叶血管瘤切除是治疗这类疾病的有效治疗方法。结论 选择合适的手术径路是关键,熟练并精细地解剖、默契的手术配合可以安全切除肝尾状叶巨大海绵状血管瘤。
目的 探讨电化学疗法(EChT)对肝海绵状血管瘤(CHL)的治疗价值。方法 应用EChT在剖腹下治疗8例CHL，17个瘤灶。1例合并结节性肝硬变，5例为多发性CHL，14个瘤灶。结果 治疗过程中肝出血量均不超过20 ml。术后无胆漏、腹腔内出血、黄疸、气体栓塞等并发症产生。治疗后随访5～7年，无1例出现瘤灶复发。结论 EChT是治疗CHL的安全而有效的新方法，适合伴有背景肝病的CHL和多发性CHL的治疗，且易于在基层医院推广。
ObjectiveTo evaluate the effect of the timing of surgery on treating refractory epilepsy caused by cavernomas. Method63 patients with refractory epilepsy caused by intracranial supratentorial cavernomas were retrospectively analyzed on the duration of epilepsy, epileptogenesis sitations, and epileptic seizure types. After resection surgeries of cavernomas, the surgical outcomes were compared between the patients with shorter duration of seizures and the longer ones. ResultThe durations of epilepsy were beteen 3 months and 25 years, median 4.5 years. The temporal epilepsies were 43, frontal 12, parietal 3, occipital 1, cingulate gyrus 1, and multiple lobe 3. The overall ILAE class 1 outcome was 71.4% in 63 patients at 2-year-followup, and ILAE class 1 and 2 outcome was 81.6%. The seizure free rate in the group with epilepsy duration shorter than 5 years was 92.1%, better than the 56.0% in the group with epilepsy duration longer than 5 years. ConclusionOnce the diagnosis of medical refractory epilepsy caused by cavernoma was confirmed, the early surgical operation should be considered seriously.
ObjectiveTo discuss multislice spiral CT (MSCT) features and pathologic basis of the cavernous hemangioma of mediastinum, and further improve the diagnostic accuracy with CT. MethodsWe collected 4 cases of cavernous hemangioma in mediastinum from November 2008 to November 2013. All patients underwent MSCT examination of plain scan and enhanced-contrast scan. The CT manifestations of cavernous hemangioma in mediastinum were observed. The correlation of the CT imaging findings with pathology features was analyzed retrospectively. ResultsTwo of the 4 lesions were located in the anterior mediastinum and the other 2 in the posterior mediastinum. On plain scan, 2 lesions showed homogeneous density, and 2 had heterogeneous density. Vessels could be observed in all lesions on enhanced-contrast CT imaging. ConclusionCavernous hemangioma in mediastinum is often located in the anterior and posterior mediastinum. Calcification and vessels in lesions are its imaging characteristics. Multislice spiral enhanced CT can accurately reflect the characteristics and pathological basis, providing more important information for diagnosis.