Treatment and clinical grading system of liver hemangioma among 514 patients

Objective To investigate the clinical efficacies of different treatment methods and evaluate the application value of clinical grading system for liver hemangioma. Methods The clinical data of 514 patients with liver hemangioma who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to December 2013 were retrospectively analyzed. The surgical resection, transcatheter arterial embolization (TAE) , radiofrequency ablation (RFA) and follow-up observation were selectively applied to patients. The treatment, operation time, level of ALT at postoperative week 1, duration of postoperative hospital stay and incidence of complications in all patients were observed. The clinical grading system for liver hemangioma was proposed based on the clinical effects and symptoms of patients, diameter, location, diametral growth rate of tumor and related factors. The surgical treatment method was selected for the patients with score≥4, and TAE or follow-up observation was selected for the inoperable patients. The follow-up observation was selected for the patients with score <4 and without other risk factors. The patients with score <4 and other risk factors received the individual follow-up based on conditions of patients, and then underwent surgical resection or TAE or RFA after reevaluation. All the patients were followed up via outpatient examination and telephone interview up to June 2014. Results (1) The results of treatment showed as follows: ①Of 380 patients undergoing complete resection, 195 had symptoms remission and 17 had no obvious symptoms remission. The operation time, level of ALT at postoperative week 1 and duration of postoperative hospital stay were (175 ± 15) minutes, (139 ± 14) U/ L and (11. 5 ± 1. 4) days, respectively. Fifty-eight patients had complications. ②Of 37 patients undergoing TAE, the results of postoperative CT showed that no enhancement was detected in 1 patient and partial enhancement in 36 patients, with the loss of volume of 25% -90%. Thirteen patients had symptoms remission and 10 had no obvious symptoms remission. The operation time, level of ALT at postoperative week 1 and duration of postoperative hospital stay were (67 ± 13) minutes, (64 ± 13) U/ L and (6. 8 ± 0. 7) days, respectively. Two patients had complications. ③Of 16 patients undergoing RFA, the results of postoperative CT showed that no enhancement was detected in 2 patients and partial enhancement in 14 patients, with the loss of volume of 29% -72%. Three patients had symptoms remission and 1 had no symptoms remission. The operation time, level of ALT at postoperative week 1 and duration of postoperative hospital stay were (75 ± 26) minutes, (41 ± 18) U/ L and (5. 3 ± 2. 7) days, respectively. ④Of 81 patients undergoing follow-up observation, 24 had symptoms remission, 8 had no symptoms remission and 49 had no symptoms. Twenty had slow enlarging tumor and 3 received surgical resection of rapid enlarging tumor without complications. (2) The results of clinical grading system showed as follows: of 176 patients with score≥4, 159 patients received surgical resection, 8 received TAE and 9 received follow-up observation. Of 338 patients with score <4, 221 patients received surgical resection, 29 received TAE, 16 received RFA and 72 received follow-up observation. (3) All the patients were followed up for 6-150 months (mean, 89 months) with full recovery. Conclusions Surgical resection is an effective method for the treatment of liver hemangioma. TAE and RFA have an advantage of minimal surgery wounds with poor efficacy, and follow-up observation could be applied to patients without surgical indications. The selection of treatment may depend on the clinical grading system for liver hemangioma, and combining with the individual conditions. Key words: Liver hemangioma; Hepatectomy; Transcatheter arterial embolization; Radiofrequency ablation