论文部分内容阅读
目的:探讨小儿肝血管瘤的临床特点、治疗方式和预后，为肝血管瘤的治疗提供临床依据。方法:回顾性分析2015年1月至2019年12月天津市儿童医院普通外科诊治的39例肝血管瘤患儿的临床资料，包括性别、确诊年龄、临床症状、辅助检查、治疗方式及预后情况，并结合文献对其进行分析。结果:本组39例中，男18例，女21例；确诊中位年龄4月龄；11例于孕期超声检查发现，16例查体偶然发现，其他原因就诊12例。超声检查表现为高回声19例，低回声14例，混杂回声6例；边界清晰27例；形态规则25例；血流信号丰富16例；有钙化灶6例。局灶型37例，多发型1例，弥漫型1例。25例患儿给予保守观察，其中9例血管瘤消失，9例缩小，7例无变化。7例患儿采用口服普萘洛尔治疗，其中2例血管瘤消失，3例直径缩小，1例无变化，1例血管瘤逐渐增大后行手术切除。1例弥漫型肝血管瘤给予口服雷帕霉素及泼尼松治疗，因出现肺感染而停药，后给予肝动脉栓塞术，复查肿瘤直径较前明显缩小。7例患儿行手术切除，术后无并发症，随访均未见肿瘤复发。结论:小儿肝血管瘤大多预后良好，应根据患儿的临床症状、肿瘤直径以及分型制定个体化的治疗方案。“,”Objective:To explore the clinical characteristics, treatments and prognoses of hepatic hemangiomas in children.Methods:From January 2015 to December 2019, clinical data were analyzed retrospectively for 39 children with hepatic hemangiomas at Tianjin Children's Hospital. Gender, diagnostic age, clinical symptoms, auxiliary examinations, treatments and prognoses were analyzed along with a literature review.Results:There were 18 boys and 21 girls with a median diagnostic age of 4 months. The detection methods included ultrasound during pregnancy (n=11), routine physical examinations (n=16) and other causes (n=12). Ultrasonographic lesions were hyperechoic (n=19), hypoechoic (n=14), mixed echo (n=6), distinct boundary (n=27), regular morphology (n=25), strong hemodynamic signal (n=16) and calcification (n=6). The clinical types were focal (n=37), multifocal (n=1) and diffuse (n=1). Twenty-five children were conservatively observed. The outcomes were disappearance (n=9), shrinking (n=9) and unchanged (n=7). Among 7 children receiving propranolol, the outcomes were disappearance (n=2), shrinking (n=3), resection after enlarging (n=1) and unchanged (n=1). For one child with diffuse hepatic hemangioma, rapamycin and prednisone were discontinued due to pulmonary infection and transcatheter arterial embolization was performed. Tumor diameter significantly decreased. Seven children undergoing surgical resection had neither postoperative complications nor tumor recurrence during follow-ups.Conclusions:The prognosis of hepatic hemangiomas in children is generally excellent. Individualized treatments should be offered according to clinical symptoms, tumor diameter and clinical classification.