Treatment of hepatic hemangioma
At present, the treatment methods of hepatic hemangioma can be divided into three categories: drug treatment, surgical treatment and non-surgical treatment. When choosing the treatment method, generally according to the size of hepatic hemangioma, follow the following treatment principles:
If the tumor is less than 5 cm in diameter, surgery is not needed, and regular review and follow-up are needed.
Surgical treatment can be considered for tumors with a diameter of 5 cm to 10 cm.
Surgical treatment is generally recommended for tumors with a diameter greater than 10 cm.
1, drug therapy
(1) western medicine treatment. Western medicine generally does not use drugs, except for antibiotics in basic drugs used to prevent wound infection during surgical treatment.
(2) Chinese medicine treatment. Many ancient Chinese medicine books think that it is an internal injury of seven emotions, which leads to stagnation of liver qi, stagnation of qi and blood stasis, and blood accumulation for a long time, which becomes an abdominal mass. The treatment of this disease mainly adopts the methods of activating qi and soothing the liver, promoting blood circulation and removing blood stasis, softening and resolving hard mass, but the emphasis of qi stagnation and blood stasis should be distinguished in specific treatment.
If blood stasis is dominant, use the following drugs: antelope bone, buffalo horn, bezoar and red peony root to clear away heat and cool blood and relieve pain; Bupleurum, Huangpi nucleus, Su Qingzhen, etc. Regulate qi and relieve depression; Salvia miltiorrhiza and safflower promote blood circulation and remove blood stasis; Stir-fried turtle shell, spina gleditsiae, weak and hard foot, loose knot, dredging channels.
If qi stagnation is the main factor, the following drugs should be used: Bupleurum, Curcuma longa, Radix Astragali, Su Qingzhen, etc. Mixing with Saviae Miltiorrhizae Radix, Carthami Flos, Rhizoma Sparganii, Rhizoma Curcumae and Radix et Rhizoma Rhei to promote blood circulation and remove blood stasis; Stir-fried pangolin, Gleditsia sinensis, Chuanzu Ruan Jian San Jie, dredging collaterals and relieving pain. Combined with oral Xiong Dan pill and Danhuo diathermy therapy, the curative effect is better.
Epistaxis syndrome is different from the general symptoms of qi stagnation and blood stasis, which often accumulates over time, and the method of activating qi and activating blood circulation can be effective. Therefore, in the selection of drugs, the compatibility of activating qi and promoting blood circulation with fried pangolin, Gleditsia sinensis and Radix Aconiti can not only soften hard mass, but also dredge collaterals and relieve pain, with unique curative effect.
2, surgical methods
At present, there is great controversy about the surgical treatment of hepatic hemangioma. Surgical treatment methods mainly include hemangioma resection, hemangioma suture, hepatic artery ligation, microwave coagulation, radio frequency therapy, hepatic artery embolization and so on. Liver transplantation can also be performed for unresectable diffuse hepatic hemangioma or giant hemangioma, such as hepatic decompensation or Kassabah-Mei Lite syndrome.
3. Non-surgical treatment
(1) radiotherapy;
(2) Hepatic arteriography and tumor arterial embolization.
Patients can consult a doctor according to their specific condition, tumor size and family situation. And choose the most suitable treatment for them.
Symptoms of hepatic hemangioma
Hepatic hemangioma is a common benign tumor, which may occur at any age, but most of the symptoms appear after middle age, and there are more women than men. At the initial stage, there is no obvious discomfort, but when the hepatic hemangioma grows to more than 5 cm, the following symptoms may appear:
1, abdominal mass. There will be a lump in the abdomen of patients with hepatic hemangioma, which is cystic and sexy, but there is no tenderness. When auscultating a mass, you can occasionally hear conductive vascular murmurs.
2, gastrointestinal symptoms. Patients with hepatic hemangioma may have dull pain in the right upper abdomen, and sometimes they may have indigestion symptoms such as discomfort after eating, loss of appetite, nausea, vomiting, belching and fullness.
3. Symptoms of oppression. Huge hepatic hemangioma will push and oppress the surrounding tissues and organs, and the specific symptoms will vary according to the different parts of oppression:
(1) If hepatic hemangioma compresses the lower esophagus, it may affect the patient's normal swallowing and lead to dysphagia.
(2) If hepatic hemangioma compresses extrahepatic biliary tract, patients may have obstructive jaundice, gallbladder effusion and other symptoms;
(3) If hepatic hemangioma compresses portal vein system, patients may have splenomegaly and ascites;
(4) If hepatic hemangioma compresses the lung, the patient may have dyspnea and atelectasis;
(5) If hepatic hemangioma compresses the stomach and duodenum, the patient may have digestive tract symptoms.
4, severe pain in the upper abdomen. If the hepatic hemangioma ruptures and bleeds, the patient may have severe pain in the upper abdomen, as well as symptoms of bleeding and shock.
5. Others
When the pedicled hemangioma growing outside the liver is distorted, necrosis may occur, which may lead to abdominal pain, fever and collapse. Individual patients with huge hepatic hemangioma may be accompanied by arteriovenous fistula and increased blood return, leading to heart failure.
Etiology of hepatic hemangioma
At present, the exact cause of hepatic hemangioma is not clear, and there are mainly the following theories about the cause:
1, theory of congenital dysplasia. At present, most scholars believe that the occurrence of hepatic hemangioma is caused by congenital vascular malformation around the liver. It is generally believed that during embryonic development, abnormal development of hepatic blood vessels causes abnormal proliferation of vascular endothelial cells, thus forming hepatic hemangioma;
2. Hormone stimulation theory. Studies have shown that women can accelerate the growth of hepatic hemangioma after puberty, pregnancy and oral contraceptives, so considering that female hormones may also be one of the pathogenesis of hepatic hemangioma;
3. Other theories. Other theories about the pathogenesis of hepatic hemangioma include:
(1) After infection, the capillary tissue is deformed, which makes the capillaries dilate, leading to local necrosis of the liver tissue, blood vessels dilate to form vacuoles, and the surrounding blood vessels are congested and dilated.
(2) The local blood circulation of the liver stagnates, leading to cavernous expansion of blood vessels.
What is good for hepatic hemangioma?
1, dietary precautions
Patients with hepatic hemangioma have the following precautions in diet:
(1) Patients with hepatic hemangioma should have a light diet. It is suggested that foods rich in vitamins and magnesium should be used as ingredients to avoid greasy, thick-flavored, spicy and irritating foods, including peppers, seafood, barbecues, spirits and spicy fried foods. In addition, patients should pay attention to eating less febrile foods such as cattle, sheep, pigs and dog meat, and it is best to choose meat.
(2) Patients with hepatic hemangioma should eat more vegetables and fruits, such as celery, spinach, tomatoes and bananas. In order to keep the ambassador unobstructed and prevent constipation, because frequent constipation may aggravate symptoms such as abdominal distension and belching. In severe constipation, huge tumors may be in danger of rupture.
(3) Patients with hepatic hemangioma should develop good eating habits. Don't eat too full, seven or eight points full is appropriate, don't smoke and drink less.
2. Diet prescription
Patients with hepatic hemangioma can drink hawthorn malt and eat stewed lean meat from Tianqi turtle shell, which has a certain therapeutic effect and is beneficial to the health of patients.
(1) Hawthorn malt beverage
Ingredients: raw hawthorn 20g, raw malt 10g.
Practice: First chop raw hawthorn, wash it, then put it into a teacup with a lid, brew it with boiling water, and stew it for 2~3 minutes before drinking. Drink fruit juice as tea every day and often.
(2) Stewed lean meat with Tianqi turtle shell
Ingredients: lean meat120g, Tianqi10g, turtle shell 30g, and 4 red dates.
Practice: After cleaning Notoginseng Radix, Carapax Trionycis and Jujube, clean lean pork and cut it into pieces, then put all the ingredients together in a stew, add appropriate amount of boiling water, stew for 2-3 hours with low fire, and season to serve. You can always eat soup and meat.
Examination of hepatic hemangioma
Because of the lack of specific clinical manifestations of hepatic hemangioma, imaging methods such as B-ultrasound, CT and MRI are the main methods to diagnose hepatic hemangioma at present.
1, B-ultrasound examination. The ultrasonic manifestations of hepatic hemangioma are hyperechoic, and those with hypoechoic are mostly reticular structures with uniform density, regular shape and clear boundaries. The larger hemangioma section can be divided into leaves, and the internal echo is still mainly enhanced. It can be tubular, reticular or irregular nodular or strip-shaped hypoechoic area, and sometimes there may be calcified strong echo and aftersound shadow, which is caused by thrombosis, organization or calcification in vascular lumen.
2. Contrast-enhanced ultrasound. If the imaging manifestations of hepatic hemangioma are not typical, selective contrast-enhanced ultrasound examination of liver can be considered. The typical contrast-enhanced ultrasound manifestations of hemangioma are nodular or annular enhancement around the arterial phase, which gradually expands to the center with time. The dilation process is slow, and the lesions in portal phase and delayed phase are still in enhanced state, and the echo is equal to or higher than the surrounding liver tissue.
3. Spiral enhanced CT. CT plain scan showed round or quasi-round low-density lesions with clear inner boundary of liver parenchyma, and a few of them could be irregular.
4. Nuclear magnetic resonance examination. MRI showed low signal on T 1 weighted image and high signal on T2-weighted image, with uniform intensity and clear edge, which was described as "light bulb sign" and was a specific manifestation of hepatic hemangioma on MRI.
5. others. You can also choose liver biopsy, hepatic arteriography, whole body positron emission computed tomography, laparoscopy, X-ray examination, ECT and other inspection methods. The accuracy of liver biopsy is low, which can lead to bleeding; Hepatic arteriography is an invasive examination, which is mostly unnecessary; Whole-body positron emission computed tomography (PET/CT) is valuable for excluding malignant tumors with active metabolism. Laparoscopic examination can help doctors observe the color and shape of tumor surface, and doctors can choose examination methods and auxiliary diagnosis according to patients' physical condition and symptoms.
Prevention of hepatic hemangioma
Because the exact cause of hepatic hemangioma is not clear at present, although there are congenital factors, the growth of hepatic hemangioma is not unrelated to acquired factors, so contact with possible pathogenic factors should be avoided as far as possible in the prevention of hepatic hemangioma.
1, reasonable diet. If the diet is unreasonable, it may touch the potential disease factors in the body, so the daily diet should be kept reasonable as far as possible, and good eating habits should be developed: avoid smoking and alcohol; Avoid overeating and greasy food, salty, smoked, roasted and fried food, especially roasted and burnt food; Avoid spicy and irritating foods, such as onions, garlic, peppers, peppers, cinnamon, etc. Do not eat moldy and pickled foods, such as moldy peanuts, moldy soybeans, salted fish and pickles. Avoid foods that are bony, rough and hard, sticky and indigestible, and contain crude fiber; Avoid foods that are too heavy, too sour, too sweet, too salty and too cold.
2, active exercise, regular physical examination. Exercise can help us improve our physical fitness and resist diseases; Regular physical examination can help us find out the potential disease factors in time, especially once we find abdominal mass, emaciation and fatigue, we should check it as soon as possible and treat it in time so as not to delay the best treatment period.
3. Relieve your emotions appropriately. If the mental stress is too great, it may also induce the growth of hepatic hemangioma. Therefore, we should actively adjust our emotions in our daily life. If we feel stressed, depressed and anxious, we can adjust our mental state by listening to music, distracting ourselves, walking and doing exercise, and don't let ourselves be under great mental pressure for a long time.