ABSTRACT
Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL)and its influence factors.Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper.All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma)by the authors as follows; A group(≤3 cm, n=25); B group(>3 cm and<5 cm, n =32) ;C group(≥5 cm and<10 cm, n=58); and D group(> 10 cm, n=41) .According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types: abundant type (n=90) ; sparse type (n=9) and the middle type (n=57) .Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures (including single procedure in 75 patients, twice procedures in 30 patients).All of the 105 patients were followed up 3 to 8 years(mean 4 years) using US, CT or MRI or DSA.The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate.Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by X~2 test respectively.And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively.Results The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156).After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X ~2=8.8553, P<0.01).In the D group, the total effective rate in group with twice procedures (100.00%,30/30) was significant higher (X~2 =5.2642,P<0.05) than those of group with single procedure (72.73%,8/11).Of this series, during the period of following-up, no recurrent or severe complications were observed.Conclusions A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE.
ABSTRACT
In this paper,adverse drug reaction(ADRs)of two groups using ionic contrast media(ICM)and nonionic contrast media(NICM)respectively for conventional an- giography(CA),DSA and contrast enhanced CT(CTE)were analysed and compared with the recent literature. The results of this study indicated that(1)using ICM for CA,DSA and CTE,the in- cidence of ADRs is higher than that of NICM because of its high osmolarity,the effect of electric charge and chemotoxicity;however,even in the at-risk patients the incidence of ADRs; can be significantly decreased by using NICM.(2)the incidence of ADRs in patients with rapidly intraarterial injection is higher than that of intravenous injection;(3)the patients with ADRs to ICM previously could be reexamined by using NICM without inducing the ADRs (4)using lower concentration or/and volume of NICM than that of ICM may obtain superior images than the equivalent ICM because of the little influence of NICM on the plasma volume and the concentration of intravascular contrast midia;and(5)though NICM is surely a safe and ideal contrast midia,it still must be careful to use in at-risk patients. Because of its high cost limiting its universal use,a selective use in at-risk patients for the intavenous examinations is proposed by us.Excluding the usual high risk factors describ- ed in literature,we suggested that if the patients with the following factors,NICM should be the preferred choice for the angiography and CTE:(1)the post-operative patients of biain disease;(2)the patients with coma or shock;(3)the patients with peripheral aterial of ve- nous thrombosis and(4)the patients for interventional procedures of cardioascutlar system (CVIR). In addition to,the authors pointed out that some new problems concerning with the con- trast media(CM)must be noticed in the procedures of CVIR:the overdose of CM,he ad- verse effects resulted from the mixing of CM with other pharmaceutical products injected and the evaporated hyperc oncentatian decomposition,or carbonization of the CM resulted from the interaction within high energy equipment or under high temperature.