Criteria for Selecting the Optimal Method of Treating Hepatic Hemangiomas
The aim of the study was to develop criteria for optimal tactics of treating hepatic hemangiomas of various sizes and localization including endovascular, percutaneous puncture ablative, and open resection interventions.
Materials and Methods. The results of treating 95 patients (65 women and 30 men aged 26–65 years) with hepatic hemangiomas have been analyzed. Tumor diagnosis was based on the data of echosonoscopy, MRI, multispiral computed tomography with intravenously injected contrasting medium, US dopplerography, and puncture biopsy. 78 patients were operated on, 63 of them underwent isolated surgery, whereas 15 patients were treated with a combination of methods. In 17 cases, the decision was made not to use operative treatment.
Results. After open resection operations (n=34), complications in the form of bilomas were observed in 3 patients in the postoperative period, in 1 patient the tumor growth continued two months after the resection of liver segment IV. Sclerotherapy of hepatic hemangiomas with ethanol (n=13) resulted in the recovery of 10 patients, massive intravascular hemolysis has developed in one patient, two patients died. After radiofrequency thermoablation of hepatic hemangiomas less than 5 cm in diameter (n=4), recovery was achieved. Echosonoscopy showed the reduction of blood flow and absence of tumor growth in 12 patients after isolated endovascular embolization of the vessel nourishing hepatic hemangioma. The combined treatment according to the method developed by us resulted in clinical recovery of all 15 patients.
Conclusion. Sclerotherapy of hepatic hemangiomas with ethanol, especially those being large in size, may cause unpredictable complications and individual pathological reactions with severe outcomes. Surgical treatment is not required if morphologically verified hepatic hemangiomas are less than 3 cm in diameter without evident clinical manifestations and growth. When the diameter of hepatic hemangiomas is in the range of 3‒5 cm with a tendency to growth, radiofrequency thermoablation is preferred. Hemangiomas of the left liver lobe more than 5 cm in size should be treated by resection methods. Our combined method is designed to treat hemangiomas of the right liver lobe exceeding the size of 5 cm. If the right lobe tumor is more than 10 cm, it is advisable to make a decision in favor of open operation.
- Goncharova Ya.A. Hemangiomas and vascular malformations. Current theories and therapeutic management. Zdorov’e rebenka 2013; 6(49): 148–152.
- Kyzhyrov Zh.N., Baimakhanov B.B., Sahipov M.M., Chormanov A.T., Birzhanbekov N.N., Serikuly E. Surgical treatment of focal liver disease. Vestnik Kazakhskogo Natsional’nogo meditsinskogo universiteta 2016; 1: 385–390.
- Koszka A.J., Ferreira F.G., de Aquino C.G., Ribeiro M.A., Gallo A.S., Aranzana E.M., Szutan L.A. Resection of a rapid-growing 40-cm giant liver hemangioma. World J Hepatol 2010; 2(7): 292–294, https://doi.org/10.4254/wjh.v2.i7.292.
- Polysalov V.N. Gemangiomy pecheni [Hemangiomas of the liver]. Saint Petersburg; 1999.
- Kamalov Yu.R., Sinitsyn V.E., Skipenko O.G., Ratnikova N.P., Bagmet N.N., Zavenyan Z.S. Hemangiomas of the liver: clinic, diagnosis, tactical approaches to treatment. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii 2004; 14(5): 14–20.
- Akhmadzoda S.M., Safarov B.Dzh., Tabarov Z.V., Rakhimov S.S., Ibrokhimov N.K., Navruzov O.F. Surgical treatment of liver hemangiomas. Zdravookhranenie Tadzhikistana 2017; 4: 10–19.
- Polysalov V.N., Granov D.A. Treatment of liver hemangiomas: the dependence of surgical tactics on the form of the disease. Voprosy onkologii 2003; 49(5): 630–635.
- Chardarov N.K., Ganiev F.A., Bagmet N.N., Skipenko O.G. Liver hemangiomas: the surgical point of view. Annaly hirurgiceskoj gepatologii 2012; 17(1): 86–93.
- Chernousov A.F., Musaev G.H., Zhemerikin G.A., Yurichenko Yu.Yu., Nekrasova T.P. Microwave ablation as a method of surgical treatment of the liver hemangiomas. Vestnik khirurgicheskoy gastroenterologii 2016; 1–2: 15–22.
- Skipenko O.G., Chardarov N.K., Ganiev F.A., Shatverian G.A., Bagmet N.N., Bedzhanian A.L. The liver hemangioms: operation or observation. Khirurgiya. Zhurnal im. N.I. Pirogova 2012; 9: 13–20.
- Alimpiev S.V. Current trends in surgical policy in hepatic haemangiomas. Annaly hirurgiceskoj gepatologii 1999; 4(1): 97–103.
- Durleshter V.M., Bukhtoyarov A.Yu., Nikitin S.P., Madaminov I.Ya., Vittek M.M. Hepatic hemangiomas as a niche of endovascular surgery. Nauchnyy vestnik zdravookhraneniya Kubani 2015; 37(1): 1–8.
- Aksenov I.V., Fedorchenko A.N. Hepatic hemangioma: the choice of treatment. Khirurgiya. Zhurnal im. N.I. Pirogova 2010; 6: 40–42.
- Anisimov A.Yu., Galimzyanov A.F., Malinovsky M.N., Sangadzhiev S.B., Yakupov A.F., Baytimirov A.M., Kuznetsov M.V., Zimagulov R.T., Podshivalov A.G., Mrasov N.M. Endovascular embolization of liver multiple cavernous hemangioma. Kazanskij medicinskij zurnal 2008; 89(4): 510–512.
- Gritsaenko A.I., Nartailakov M.A., Rakhimov R.R., Mustafin A.Kh., Garaev M.R. Treatment techniques of hepatic hemangiomas. Permskiy meditsinskiy zhurnal 2012; 29(5): 13–18.
- Alperovich B.I., Merzlikin N.V., Salo V.N., Paramonova L.M., Maksimov M.A., Saipov M.B., Yeskov I.M. Cryosurgery of focal liver diseases. Bulletenʹ sibirskoj mediciny 2011; 10(1): 143–149.
- Cui Y., Zhou L.Y., Dong M.K., Wang P., Ji M., Li X.O., Chen C.W., Liu Z.P., Xu Y.J., Zhang H.W. Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma. World J Gastroenterol 2003; 9(9): 2132–2134, https://doi.org/10.3748/wjg.v9.i9.2132.
- Zagainov V.E., Kostrov A.V., Strikovsky A.V., Yanin D.V., Vasenin S.A., Zarechnova N.V., Shkalova L.V., Plotnickov A.F., Bugrova M.L., Snopova L.B. New method of the liver tumor thermal destruction with a local effect of the SHF energy. Sovremennye tehnologii v medicine 2010; 3: 6–13.
