Hemangioma in the right lobe against the background of steatosis. Treatment of hemangioma of the liver

The liver is its most common benign tumor of mesenchymal origin.

Small capillary hemangiomas occur more often large cavernous and associated with multiple defeat. Small neoplasms are usually clinically not manifested (they are randomly found), but they can significantly complicate the diagnosis in any other liver pathology. Accurate diagnosis allows you to avoid unnecessary treatment. The frequency of detection of cavernous hemangioms at autopsy is an average of 8%. In the US, these formations consider the most common liver tumors after a metastatic lesion. Due to the wide use of sensitive visualization methods during the survey of the upper floor abdominal cavity The frequency of accidental detection of cavernous hemangiom will undoubtedly increase. The tumors of this species can reach large sizes - a case is recorded when the weight of the hemangioma exceeded 6 kg. Giant hemangiomas are considered at 4 cm diameter and more. They have, as a rule, dense consistency; In 10% of cases there are multiple foci. Perhaps simultaneous damage to the skin and other organs. Typically, cavernous hemangiomas are evenly distributed throughout the volume of the liver, but at large sizes can be located on the periphery of the organ and even have a leg.

Causes of hemangiomas of the liver

They believe that hemangiomas have congenital origins, and do not arise as a result of the neoplastic process, and therefore are not subjected to malignant transformation. Cavernous hemangiomas are found in all age groupsbut most often aged 30-50 years. As a rule, the disease manifests in women in young age, especially with the onset of pregnancy and motherhood. The progression of the disease is associated with an increase in the concentration of genital hormones, although the influence of hormonal contraceptives is not detected. Etiology remains unknown, but the tumor belongs to benign innate Gamartoms. It is likely that the neoplasm increases in size due to the existence, and not hyperplasia or hypertrophy.

Pathology

On hemangiomas look like clearly limited structures of purple-red color. There is a border of the section between the tumor and the parenchy liver. When it disseminated, due to the massive blood flow, the collapse of the walls occurs, after which the cellular structure of hemangioma becomes visible. It is possible to detect explicit signs of thrombosis, fibrosis or calcification. Microscopically liver hemangioma is a complex of cystic extended vascular spaces lined with endothelium and separated by fibrous jumpers of various thicknesses. Usually hemangioma is covered with a capsule from fibrous tissue and is easily separated from the thickness of the liver parenchyma.

Symptoms of the hemangioma of the liver

Most hemangiomes are not clinically manifested until 10 cm in diameter is achieved. Symptoms of disease are nonspecific: uncertain and gravity in the abdomen, early saturation, nausea, vomiting and fever. Less often arise, violation of the gastric emptying, liver colic, spontaneous perforation. Although abdominal pain or abdominal discomfort are the most frequent signs The hemangiomas of the liver, they can be due to the concomitant pathology. O. Farges indicates that in their study, 42% of patients were detected by concomitant diseases - lesions gallbladder, liver cysts, gastroduodenal ulcers and hernia of the esophageal hole of the diaphragm. The difficulty of diagnosing hemangioma liver is that sometimes symptoms of the disease are preserved and after surgery.

The pain in the hemangiome liver is most likely tensile or inflammation of the glisson capsule. Sometimes a large tumor located in the left lodge of the liver squeezes the lying part of the structure, determining the corresponding symptoms. In some patients, suddenly emerged pains are explained by infarction or hemangioma necrosis. A very rare complication is intraperous bleeding due to a traumatic or spontaneous tumor break. Since 1991, he was reported, taking into account the widespread spread of this pathology, only about 28 cases of the spontaneous or traumatic leaving of the hemangioma of the liver with the development of dangerous intra-abdominal bleeding. In some cases, the cavernous hemangioma of the liver is accompanied by thrombocytopenia and a decrease in fibrinogen concentration (Kazabach-Merritt syndrome), which may be caused by coagulopathy consumption.

Diagnostics

With the large size of the hemangioma, the liver on the breath can be placed the edge of the liver or painless education. When palpation through the front abdominal wall It is difficult to distinguish hemangioma from unchanged liver parenchyma while the tumor does not undergo calcification, thrombosis or fibrosis. In some cases, noise can be heard over the tumor area, but this feature is nonspecific. Functional liver tests in the absence of complications do not go beyond the rules.

On angiomas look like hyperheogenic structures. O. Farges found that patients with hemangiomas less than 6 cm in diameter diagnosis can be supplied with an ultrasound in 80% of cases. However, the use of only this method of research does not allow differential diagnosis Between angioma, liver cell cancer, hepatocellular adenoma, focal nodular hyperplasia or solitary metastases. CT is the most informative study in the diagnosis of the liver aneg. Before the introduction of a contrast preparation of hemangioma on CT looks like a plot of reduced density with tight borders. After the addition of contrast on a series of tomographic sections, it is visualized as a gradually increasing the plot in the periphery, heterogeneous in density, often with uneven edges. The density of the hemangioma center remains reduced, and the volume of the neoplasm does not change. With the selective angiography of the liver, they detect a characteristic picture: liver arteries normal sizes, signs of non-typialization or formation of "spirals" are absent. Typically rapid filling of volumetric hemangioma vascular spaces with a contrasting substance. As a result, a "cotton-wool image" arises around the liver of the arteries.

Due to the widespread implementation of the CT, the role of angiography is gradually decreasing. In the last decade, the main method of diagnosing hemangiom liver is MRI. The sensitivity of the method is 90%, specificity - 95%, accuracy - 93%. When conducting an MRI on T2-suspended photographs of hemangiomas look extremely bright (the phenomenon of "light bulbs"), on T1-suspended images when using the gadoline as a contrast preparation, the enhancement of peripheral nodes is characterized. Similar emission computed tomography with the use of labeled technetium-99 red blood cells has a high resolution and sensitivity and accuracy comparable to MRI. In clinical practice, it is preferable to combine the specified research methods. Laparoscopy is also valuable enough in the diagnosis, especially with the surface location of the neoplasm, when it can be detected during a survey or neatly placing with characteristic compressions. The method can be successfully used in combination with laparoscopic ultrasound, which increases its diagnostic capabilities.

neoplasms puncture contraindicated. The diagnosis of cavernous hemangiomes is not common. Problems may occur only with small tumors, when it is difficult to establish the cavernous nature of education. In this case, it may be necessary to carry out additional research methods.

Treatment of hemangioma of the liver

The strategy of conducting such patients is different - from dynamic observation to resection of a part of the liver. A variable success uses such treatments such as leaging the arteries of the liver, radiation and glucocorticoid therapy can. For a patient with randomly detected hemangic small sizes (less than 4 cm), quite simple observation. With large cavernous hemangiomes, it is necessary to carefully weigh the degree of operational risk and risk with the natural course of the disease. V.F. Trastek traced the fate of 34 patients who did not receive any treatment for 15 years. No patient had bleeding or abdominal symptoms, none of the patients reported a deterioration in the quality of life. At the 21st year of observation (the duration of which was an average of 12.5 years) in two patients with large, clinically manifested hemangiomas of dubious operations, the growth of formations was insignificant, and the symptoms remained the same. Hemangioma rupture cases. Two recent long-term studies confirmed the generally accepted point of view that large hemangiomas of the liver flowing asymptomatic can be observed in dynamics.

Weimann analyzed the history of the disease of 69 patients who were conducted by surgical treatment. There were no postoperative deaths, the soreness was noted in 19% of patients. The study also included patients with a hemangic installed (n \u003d 104) and a focal nodular hyperplasia (n \u003d 53). Patients were observed on average for 32 months (from 7 to 132 months). None of the patient had a malignancy of the neoplasm or its rupture. Based on the results, it can be argued that safe resection of the cavernous hemangioma of the liver is quite possible. However, there are no convincing data proving that patients with asymptomatic occurrence should be subject to operational interventionSince the risk of tumor break is minimal.

The testimony for resection of angioma is a manifest course of the disease with moderate surgical risks, as well as the under-clear nature of the neoplasm, despite the preoperative examination.

If treatment is necessary, provide good result capable only surgical intervention. Messages about the effectiveness of liver arteries are not reliable. The question of the ligation of the arteries and their embolization in order to stop bleeding can be considered in special cases when it is necessary to win the time to have time to deliver the patient to a specialized center. The successes of the treatment of capillary hemangioma liver using radiation and glucocorticoid therapy are dubious. The success attributed to the ligation of arteries, radiation and steroid therapy can be explained by the spontaneous involution of the neoplasm.

Choosing surgical methodIt is necessary to take into account the size of the hemangioma of the liver and its localization. Frequently, the tumor can be pulled out, which avoids the violation of the liver parenchyma functions, minimize blood loss and postoperative loss of yellow. In some cases, standard anatomical resection of the liver is very reasonable and safe. When deserted, the border of the section between the hemangioma and parenchy liver is clearly visible, so it is possible to interfere with the rude way. It facilitates the procedure to use the Ultrasonic Surgical Aspiration System "Cavitron" (CUSATM) with simultaneous control of the supply vessels. There are reports of laparoscopic resection of hemangioma. Orthotopic liver transplantation is possible with gigantic inoperable tumors.

The hemangioma of the liver rarely gives any complications, so the surgical removal of the tumor should be carried out only with pronounced symptoms.

The article has prepared and edited: a surgeon doctor

The hemangiome of the liver is a mysterious neoplasm, the causes of the appearance and growth of which still remain the mystery for doctors. Hemangioma affects approximately 2% of the population, and men have less frequently than in women: one man with hemangioma accounts for 4-6 women. The hemangioma of the liver may occur at any age, but in most cases it is registered in people from 30 to 50 years. In women, the age border is shifted to the bottom - they are more often encountered by Hemangioma in young age, and the tumor is usually larger. The hemangiomas of the liver can also be found in infants, in some cases they were even prenatally detected by the growing fetus! Fortunately, the hemangiomas of the liver are always benign; No cases of rebirth in malignant tumor was noted.

What is hemangioma liver and the causes of her occurrence

Strictly speaking, hemangioma is the accumulation of vessels, which are flattened endoterial tubes separated by fibrous partitions. Usually on the liver hemangioma is only one; Cases when there are several, quite rare. Gemehangi size can vary from small liver formations of 2 mm in size to giants more than 20 cm. With surface inspection, the surface of the hemangioma of the liver can be both flat and buggy due to subcapsular damage (hematoma). One of the main signs of hemangioma - color; He has a reddish-blue and well distinguish against the background of the liver's surrounding tissues. Large tumors can be on the leg. The right lobe of the liver is more susceptible to the formation of hemangiomes than the left.

The hemangiomas of the liver can be both cavernous (several large cavities with inner walls from fibrous tissue), and in much more rare cases - capillary (many small cavities, each of which contains according to the vessel). The latter is very difficult to diagnose - they are so small that they are not visible during the examination.

The reasons for the occurrence of the hemangioma of the liver remain mystery for doctors, although it is assumed that hormonal contraceptives and steroids can accelerate its growth (it is unclear, however, whether these drugs are able to contribute to its formation). It is also unknown, there is a hereditary predisposition to the emergence of hemangioma of the liver; There are evidence, however, rare that several women of different generations in one family had hemangiomas. Some scientists believe that the hemangioma of the liver is a benign congenital gamartom (tissue developmental anomaly). Hemangiomas can be laid in childhood, as well as occur under the influence of unknown factors.

Much more often, hemangiomas are encountered; True, it is unclear whether they affect in any way to the existence of their "sisters" in the liver.

Symptoms of the hemangioma of the liver

As a rule, a person with hemangioma liver does not experience any inconvenience and, especially since it does not require treatment. The presence of hemangioma is most often detected by randomly - during preventive inspections, with suspected of other diseases or after death during the opening. True, after the diagnosis of hemangioma, the discomfort of the psychological plan is possible - a person may be unpleasant at the thought that there is a tumor in his liver. However, it is not necessary to fear, hemangioma liver - a benign tumor and rarely delivers the inconvenience to its owner.

If the symptoms are still present, most often the patients complain about the painful sensations in the right upper part of the abdomen. In some cases, the occurrence of pain is due to thrombosis, blood zero due to a gap or mechanical squeezing of organs adjacent to hemangioma. In other cases, the reason for the appearance of pain cannot be established. Sometimes the patient's liver increases, however, during hemangioma it rarely happens. Patients may complain about the feeling of the overcrowding of the stomach after receiving a small amount of food, nausea, vomiting. As a rule, the greater the hemangioma of the liver, the clearer expressed symptoms - from 40% of people with hemangioma of 4 cm to 90% of people with a hemangic value of 10 cm.

However, these signs are not specific to the hemangioma of the liver and may be caused by other diseases. In any case, with a constant sensation of discomfort and abdominal pain, you should consult a doctor.

The factors causing the hemangioma of the liver

According to existing research, hemangioma affects the growth of steroids and stimulation of bunks by a chorionic gonadotropin of a person. Women who have passed replacement hormone therapy, liver hemangiomas found more often. Another risk factor is pregnancy - pregnant hemangioma detects more often than ever pregnant. It is believed that estrogen plays the role here, the content of which in the body of a woman increases during pregnancy.

In 40% of cases, the hemangiomas of the liver increase in size at low speed - up to 2 mm per year. Faster than the tumor grows in young, not older than 30 years, and more slower - in people who oversail the half-century border. The more liver hemangioma, the slower it grows.

Hemangioma liver in children

One of the most common types of tumors when infant - hemangioma. Approximately 5-10% of children at the age of one year, hemangiomas are observed, which in most cases (80%) did not require treatment and passed well in themselves. Moreover, however, hemangiomas appear on the skin and subcutaneous tissue, but sometimes the liver is affected.

Hemangioma liver in pregnant women

If a woman was diagnosed with hemangioma and then she became pregnant, the risk of complications associated with this neoplasm increases. As it should be assumed, the increased amount of estrogen causes an increase in the hemangioma of the liver.

In rare cases, the growing hemangiome of the liver may require treatment. A woman can observe such signs as pain in the right upper part of the abdominal area, bloating, nausea. However, the presence of hemangioma does not mean that a woman can not be pregnant; It is best to discuss this issue with your doctor.

Medicinal preparations affecting the level of hormones in the body (for example, contraceptive pills) can cause complications with a diagnosed hemangiome of the liver. Again, this question is better to discuss with your doctor.

Complications for hemangiome liver

In general, the prognosis of the disease in a person with a hemangioma liver is very good. Until there were cases when hemangioma liver would be reborn in malignant cancer tumor. However, in some cases complications are possible, more dependent on the size and location of the tumor. It is worth noting that cases are very rare.

Tumor break. In rare cases, large cavernous hemangiomas liver can break themselves by themselves or as a result of injury, which can lead to vascular shock or hemoperitoneum (when blood is poured into the abdominal cavity). The man is pale, he has a heart rhythm, blood pressure is reduced, the skin stands on the skin cold sweat. When such signs appear, immediately apply for an emergency medical help - This condition threatens the life of the patient and requires immediate treatment.

Outdoor bleeding. It can be diagnosed by the presence of feces in the blood, which was there as a result of entering the liver to the intestine on the bile dots.

Squeezing bile ductslocated next to the tumor of arteries and veins. In isolated cases, the tumor may take a blood vessel located nearby, causing a circulatory disorder (for example, when hemangioma is overlapped with a lower hollow vein, legs are observed).

Stomach compression. In very rare cases, the hemangioma of the liver can grasp the stomach, preventing the output of its contents. The following symptoms are developing: rapid saturation when receiving even a small amount of food, nausea, vomiting, discomfort in the stomach

Hemobilia. Another rare pathology in which blood through gallways Enters the intestines. A person may have a jaundice skin Pokrov and mucous membranes, darkening of urine, discoloration of feces.

In rare cases, multiple hemangiomas liver big size may require surgical treatment.

Diagnosis during the hemangiome of the liver

Gemangioma is one large diagnostic problem. The diagnosis is complicated by the fact that next to hemangioma can be (and sometimes imitate it) other liver damage, both benign and malignant. Therefore, it is necessary to differentiate hemangioma from benign (cyst, adenoma, focal hyperplasia of nodes, abscesses) and malignant tumors (carcinomas, hepatic angiosarcoma, metastasis in the liver).

In some cases, the hemangiomas of the liver is a consequence of the development of other diseases, for example, with a clippel-trenon-webker syndrome or Kazakh-Merritt syndrome. Multiple liver hemangiomas have been reported in patients with a systemic red lupus.

Surveys in the hemangiome liver

In physical examination, forgive the hemangioma of the liver is impossible due to its little size. Blood tests, urine and feces in the hemangiom of the liver are completely normal (although thrombocytopenia may be observed at large tumors). Therefore, several laboratory and instrumental methods are usually used to form a diagnosis, for example, ultrasound, computed tomography, magnetic resonance imaging and hepatic arteriality.

Ultrasound. Larger available, non-immature and cheap way Surveys. The liver hemangiomas are usually echogenic, but the best results gives the color Doppler mapping. If the effectiveness of the usual ultrasound to determine the hemangiom of the liver is 46%, then it increases to 69% at the CDC.

CT scan. For examination, hemangiomes are preferable to conduct a study with a contrast agent; Hemangioma liver is able to properly define in 66% of cases.

Magnetic resonance imaging. As well as computer tomographyBest of all the hemangiomas of the liver are determined when entering the patient's body contrast substance. True, small hemangiomas (less than 2 cm in diameter) look like carcinomas or metastases in the liver similar to carcinomas or metastases, but in general, the survey performance is very high - above 90%. However, when MRI is ordinary benign Gemangioma The liver is easy to take for a much more dangerous hepatic angiosarcoma. One of the main differences of it from the usual hemangioma of the liver is rapid growth, so the doctor can offer a patient to pass MRI once again in a few months to determine the growth rate of the tumor.

Similar emission computed tomography (Spect or OECT) is a relatively recent invention. In contrast to previous surveys, this technique allows you to create three-dimensional images. With its help, you can diagnose hemangioma liver more efficiently; Unfortunately, emission computed tomography is not available everywhere. When diagnosing the hemangiom of the liver size up to 2 cm OEKT gives the best results.

Arteriography. Although the diagnostic accuracy of the non-invasive surveys described above is high enough, arteriography may be useful in the diagnosis of some hemangioms. It is possible to determine their presence on the displacement of the branches of the hepatic artery, their stretching and the degree of fullness.

Biopsy. This method is not recommended to be applied due to increased risk of bleeding during material fence. If it is unclear, hemangioma is or carcinoma, it is recommended to use a combination of computed tomography and magnetic resonance tomography instead of biopsy. And only if the results of the surveys will be unsatisfactory, you can resort to biopsy.

Treatment of hemangioma of the liver

The overwhelming majority of the hemangioma liver of a small size, do not cause unpleasant symptoms, do not require treatment and are as follows throughout the life of the patient. Studies have shown that only one of 47 patients with re-scanning after a few years hemangioma liver has grown in size. In addition, there was no cases when hemangioma would be reborn into a malignant tumor. Therefore, doctors usually suggest a re-examination after 6-12 months after detecting the hemangioma of the liver to check whether it has increased in size. If this did not happen, as a rule, the doctor recommends keeping everything as it is. There is no need to treat, and even in further surveys there is no need.

The exception is patients who suffer from liver diseases, pass hormonal therapy or become pregnant. Also behind the condition of patients whose hemangioma is exceeded 10 cm, it should be followed more carefully; As a rule, they are recommended to check the condition of their liver every year due to the likely risk of developing complications.

Drug therapy with hemangiome liver

Until recently, the method did not exist, with which it would be possible to reduce the size of the hemangioma of the liver drugs. And only a few years ago, the doctors found that hemangioma can be reduced using a co-pinpiece (antitumor drug, inhibitor of the multi-channel). Now the preparations based on seraplenb are actively used in the treatment of renal cellular and hepatic cancer.

Surgical treatment with hemangiome liver

As a rule, the operation is prescribed if hemangioma serves as the appearance of adverse symptoms. Unfortunately, it is difficult to determine whether hemangioma liver is to blame or any other disease (for example, irritable bowel syndrome). It happens that after the operation, a person continues to feel pain in the stomach; So, the cause of it was not hemangioma liver, but something else.

Also, surgical treatment is shown if hemangioma grows rapidly or if it is impossible to differentiate it from malignant liver tumors. And, of course, if hemangioma is torn - the cavernous hemangiomas of the liver when the break is strongly bleeding, which can even lead to the death of the patient. Fortunately, it happens rarely - the risk of breaking the large hemangioma of the liver is only 3.2%.

The first thing to the patient with a torn hemangioma of the liver stop bleeding by ligation or embolization of hepatic arteries. As soon as the patient is stabilized, an operation to remove hemangioma is carried out. Preference is given to minimally invasive techniques, for example, arterial embolization and sclerosis (as best to get rid of the many small hemangioms; although they do not disappear, but in the future their growth is excluded). Radio frequency destruction also contributes to the growth of the growth of hemangioma of the liver.

Doctors cannot come together in opinion, whether it is necessary to preventively remove large hemangiomas of the liver. On the one hand, the gap of hemangioma threatens the life of the patient. On the other hand, the gap of the hemangioma of the liver does not happen more than 3.2% of cases, but the percentage of complications after the hemangioma removal operation is higher than twice. After surgery, 7% of patients have developed complications, including threatening life. As a result, doctors tend to believe that surgical treatment should be prescribed only to patients with severe symptoms or serious complications of the disease.

Life with hemangioma liver

People who have been diagnosed with uncomplicated hemangioma liver, does not require a special power mode, there are no restrictions in physical activity - they can continue to keep the lifestyle to which they are accustomed to, without the slightest damage for themselves. True, if hemangioma is large, the doctor will advise the patient to avoid activity contributing to the injuries of the right-top square of the abdomen, where the liver is located.

Hemangioma liver is a benign vascular neoplasm of embryonic origin. According to statistics, hemangiomas in one or two liver shares are present in 7% of the population, occupying the first place in the prevalence among all benign neoplasms of the hepatobiliary system.

So looks like hemangioma liver

Causes of hemangiomas of the liver

The reason for the occurrence of hemangioms in the liver is the violation of the processes of bookmarking vessels of the venous bed in the first trimester of pregnancy, due to the impact of damaging factors on the maternal organism. The direct correlation between the frequency of the hemangiom and blood group A (II) gives the basis to assume the presence of the genetic component in the pathogenesis and the possibility of inheritance of the tendency to the formation of hemangiom.

The hemangiomas of the liver diagnosed in babies, about 80% of cases are allowed by themselves. In adulthood, large hemanhythomatous nodes are more often found in women. According to one of the hypotheses, estrogens (female sex hormones) increase the growth rate of vascular neoplasms. In many patients, the first signs of hemangioma appeared during pregnancy or when taking estrogen-containing drugs.

According to another version, the causes of the hemangiomas of the liver are not associated with tumor growth and lie in congenital vices for the development of vessels, which lead to telangiectasia - resistant expansion of capillaries. With respect to the cavernous form, the assumption is partly confirmed by cases of identifying multiple hemangiomes or total hemangiomatosis, which is uncharacteristic for tumors. The results of pattomorphological studies of the substrate nodes put the hemangiomas of the liver to the intermediate place between the embryonic tumor and congenital vice Development of hepatic veins.

Forms

In the gastroenterological practice there is a tendency to a wide interpretation of the concept of "hemangioma": so-called almost all benign vessels of the liver vessels, including venous, cavernous, grinding and capillary angioma, as well as benign hemangioendothelioma.

Actually hemangioma, depending on the structure, classified on capillary and cavernous. The capillary hemangioma consists of several blood-filled sinusoid cavities separated by connecting partitions. Each sinusoid contains a vessel.

The greatest threat is the gap of hemangioma with extensive intraperitoneal hemorrhage and large blood loss, which can be provoked by sharp movements, redundant exercise or injury abdominal area.

Cavernous hemangioma liver, or a cavering, is formed as a result of a merger of several cavities in one. The cavernous nodes can reach large sizes - 10 cm and more, and in 10-15% of cases in the hepatic parenchyma are at the same time there are two or three formations or multiple minor caverners in size up to 2 cm.

Symptoms of the hemangioma of the liver

In most cases, the hemangioma of the liver does not exceed 3-4 cm and does not exhibit itself. Clinical manifestations It is noted only with an increase in the node to 5-6 cm and more when the tumor begins to squeeze the adjacent organs and blood vessels and injures the fabrics, causing internal bleeding, but the share of giant hemangi has no more than 8-10% of cases. Since tumor nodes are different slow growthThe manifestation of hemangioma usually falls on mature age - from 40 to 50 years.

Early symptoms of liver hemangioma are non-specific and characteristic of many diseases of the hepatobiliary system:

• frequent attacks of nausea;
• belching and feeling of bitterness in the mouth;
• increase liver;
• feeling of squeezing in the area of \u200b\u200bthe stomach;

Diagnostics

When localizing the neoplasm in the right lobe of the liver is also required to undergo the angiography of the ventilation trunk for estimating the condition of blood flow and the presence of thrombus in the arterial, venous and capillary phase. To assess the general state of the hepatobiliary system, clinical blood tests and liver samples can be assigned.

According to statistics, hemangiomas in one or two liver shares are present in 7% of the population, occupying the first place in the prevalence among all benign neoplasms of the hepatobiliary system.

Treatment of hemangioma of the liver

With small laggings, treatment is usually not required. To control the dynamics of the process, the patient recommended systematic observation from the gastroenterologist. Three months after the diagnosis, the control ultrasound or MRI liver and biliary tract is appointed. If the tumor does not increase, subsequent examinations the patient passes once or twice a year.

To maintain the functions of the hepatobiliary system, it is important to adhere to the gentle power mode and avoid self-medication with a hepatotoxic effect. The recommended diet with the hemangiome of the liver was developed by M. Pevzner and is known in gastroenterological practice as table number 5. Limit consumption of fats, purines, oxalic acid, salt, coarse tissue and products rich in extractive substances that stimulate the production of digestive enzymes. Vegetables and fruits rich in fiber, it is required to peer, white bread - dry in the oven, and the fat meat is finely chopped. Dishes and drinks are best to use warm. The basis of the menu with hemangioma of the liver should be dairy and vegetarian soups that do not contain sorrel and tomato paste, boiled and baked dishes; Occasionally you can add stewed products. Fried dishes from the diet preferably completely exclude. Also under the ban fall:

• radish broths;
• red meat and sub-products;
• smoked and sausage products;
• fatty cheeses and dairy products;
• fat fish and canned fish, grainy caviar;
• mushrooms;
• legumes;
• corn, raw white cabbage, eggplant, radishes, radish, turnip, ginger, rhubarb, sorrel, spinach;
• pearl, bishic and corn cereals;
• coarse bread;
• chocolate;
• ice cream;
• baking and puff pastry;
• all types of marinades.

From drinks unwanted fresh and concentrated juices, coffee, cocoa, green tea, carcade, sweet sodes and alcohol. To improve the protein and lipid metabolism, the exchange rate reception of vitamin B 12 is shown; If necessary, a course of hepatoprotectors is appointed.

In the event of the growth of the hemanhythomatous node and the emergence of alarming symptoms, the question of radical removal of the neoplasm is considered. In favor of the operation testify:

• the size of the node is more than 5 cm;
• rapid growth of neoplasms (more than 50% per year);
• squeezing blood vessels and neighboring bodies;
• tumor infection;
• vessel thrombosis and necrotization of hemangioma;
• breaking tumor tissues with intraperitoneal hemorrhage;
• suspicion of malignation.

The hemangiomas of the liver diagnosed in babies, about 80% of cases are allowed by themselves.

For the removal of hemangioms of different sizes and localization, various surgical techniques are applied:

• segmental resection of the liver - removal of one or more segments affected by hemangioma. The boundaries of the segments are determined taking into account the bilio-vascular structure;
• lobectomy - removal of the affected liver lobe by anatomical border;
• hemigepatectomy - Removal V, VI, VII and VIII-th segments of the right lobe of the liver with the drainage of bile ducts. If necessary, the IV segment of the left lobe is also removed.

To reduce the volume of operation and prevention postoperative complications The patient before the operation is prescribed a course of hormone therapy, aimed at reducing the vascular node.

Contraindications to radical surgical treatment are:

• germination of tumor into large veins,
• the location of hemangiom in both liver shares;
• multiple hemangiomatosis.

Alternative operational treatment Non-invasive techniques can be served - sclerosis and embolization by hemangi methods of radiolochy therapy, microwave and laser and therapy. One of promising directions lies in the introduction of a tumor tumor of ferromagnetic particles in order to generate high-frequency electromagnetic field, causing a significant increase in temperature in the region of the hemanhythomatous node and the mass death of tumor cells.

Possible complications and consequences

The greatest threat is the breaking of a tumor with extensive intraperitoneal hemorrhage and large blood loss, which can be triggered by sharp movements, excessive physical exertion or injury of the abdominal area. Therefore, when acute pain In the stomach, which is ongoing more than two hours, it is urgent to seek medical attention.

Against resistant increase in pressure in the gastrointestinal leaf system, gastrointestinal bleeding may occur; There is also the likelihood of sepsis due to the infection of hemangioma or necrotization of the hemanhythomatous node tissue due to thrombosis of vessels that feed the tumor. With total hemangiomatosis with the defeat of a significant part of the parenchyma, it is possible liver failure and liver cirrhosis.

Forecast

In the hemangiome of small sizes, the forecast is favorable: as a rule, the neoplasm size up to 4-5 cm does not cause serious deterioration of well-being and does not limit the physical possibilities of the patient. After removal of large hemangi, the possibility of relapse is not excluded. Malignant rebirth of hemangioms is extremely rare. One of the signs of malignancy may be a rapid growth of the neoplasm.

Prevention

By virtue of the congenital nature of the pathology, a pregnant woman is responsible for the prevention of hemangiom, especially if there were already cases of vascular liver neoplasms in the family history. On the early timing Pregnancy It is important to avoid viral infections, contact with eradicate and taking potent drugs with teratogenic effect.

On the patient's behavior only depends on the prevention of the complications of the hemangioma of the liver. To track the dynamics of the process, it is important to take planned surveys in a timely manner and at the first signs of unfavorable take action. In order to prevent internal bleeding It is worth avoiding traumatic sports or apply reliable means of protecting the abdominal area, and women during the selection of oral contraceptives or before passing hormone therapy Gynecologist should be prevented about the presence of hemangioma liver.

Video from YouTube on the subject of Articles:

A vascular tumor of benign origin, located in one or both fractions of the liver, is hemangioma. Often, its diameter is not more than 50 millimeters, and clinical signs may not be absent. Hemangioma liverIn most cases, diagnosed with a personal or examination for other disease.

The frequency of malignant rebirth of this formation is extremely small, but there is still a risk. Most scientists tend to the option of congenital origin of hemangioma. It is registered in 7% of the population and, despite the general opinion about the rarity of the ailment, vascular neoplasms in second place among the entire hepatic oncological pathology.

Causes of the appearance of the hemangioma liver

The cause of the formation of hemangioma is the anomaly of the bookmark of the vascular bed during intrauterine development. Onbox is more often located in the liver than in other internal organs. Perhaps their increase to 5 or more centimeters.

It has not yet been established, hemangioma is a tumor or development defect. The cavernous type grows much faster than the capillary.

Education data can be spontaneously disappearing (in 80% of cases), subject to the identification of the newborn to 3 months of age. The disease is mainly registered with the female population. This is due to the effects of estrogen stimulating tumor growth.

Signs and manifestation

The clinical manifestations of the vascular tumor are diverse and depend on its size, location, severity of the lesions of the surrounding tissues and the availability of complications.

It is symptomatic to suspect the hemangioma of the liver according to the following signs:

• pain syndrome, due to an increase in onco-formation;
• swelling;
• yellow scool and skin.

Sharp pain in the right hypochondrium, reduced pressure, dark feces, vomiting and deterioration of the general condition indicate the development of complications.

Mature symptoms

In most cases clinical symptoms There is no, since the neoplasm does not exceed 5 centimeters in diameter. Laboratory methods also fail to identify neoplasm with such sizes.

If the tumor reaches 10 centimeters, the patient can feel the pain to the right under the ribs, nausea and adversely undergraduate with an enlarged liver. At this stage, there is squeezing of vessels and the surrounding organs an increased tumor.

The growth of education is associated with hemorrhages, thrombosis, cellular reproduction and vascular expansion. The average mass is approximately 500 -1500 grams, but the maximum weight of such a hepatic tumor can be more than 5 kilograms.

What to do and when to contact the doctor?

With the appearance of gravity and feeling of cutting in the right hypochondrium, you must consult with a specialist. However, it is recommended to regularly attend the doctor for timely detection of onco-formation.

Analyzes and examinations

In view of the fact that complaints under this disease may be absent, to the first plan in the diagnosis there is an instrumental examination. Ultrasound and tomography of the abdominal cavity are prescribed to detect the tumor. Visually, the hemangioma of the liver seems to be clearly defined formation and inhomogeneous filling.

Also. Current trunk and liver scintigraphy. As for laboratory techniques, they are not so informative. Penal biopsy is not performed due to the high risk of bleeding.

What complications and consequences are dangerous hemangioma liver?

Vascular liver tumors can lead to the development of complications:

• breaking the neoplasm, as a result of which there is intraperous, intestinal bleeding;
• hepatic, heart failure;
• jaundice;
• ascitis;
• compression and displacement of the surrounding structures;
• malignancy;
• thrombosis;
• hepatitis.

In addition, it is worth emphasizing that massive bleeding with a decrease in pressure, weakness and loss of consciousness may become the first manifestation of hemangioma.

Modern treatment of hemangioma liver

Therapeutic tactics depends on the size of the tumor focus. With its diameter up to 50 millimeters, surgical intervention is considered irrational. In this case, observation is carried out and 3 months after the initial detection of the tumor, the re-ultrasound is carried out. Then the survey is performed every year.

Indications for operation are:

• size more than 50 millimeters;
• rapid growth (50% each year);
• breaking a neoplasm with bleeding;
• complications caused by compression of vessels or other organs;
• suspicion of cancer transformation.

In addition, it is necessary to take into account the presence of concomitant pathology and general state patient.

Among the contraindications it is worth highlighting:

• germination of the tumor into hepatic vessels;
• cirrotic liver damage;
• multiple hemangiomas.

The volume of surgical intervention can be:

1. Removal of the segment.
2. Removal of the liver lobe.

Also, the efficient method is considered sclerosis and embolization.

Now is being developed new approach In treatment, based on the introduction of specific particles in a tumor and creating an electromagnetic field. Thus, the temperature in the pathological focus increases and the ignition of the tissues is observed followed by lysis (splitting).

Treatment with folk remedies

Folk Medicine In the fight in the hemangic liver uses the following recipes:

1. Crumpled dry leaves Bitter wormwood poured 70% alcohol in a dark bottle (1:10) and insist 20 days. Then, profiling, the tincture is stored in the refrigerator. Drink 45 days 12 drops three times a day 20 minutes before meals. A month later, the course is repeated.
2. A glass of oats seeds poured in a saucepan of a liter of water, it insists for 10 hours, then boiled during half an hour. After that, the decoction is left overnight, then filtered and filt with a liter of water. Drink 45 days three times in half a cup before meals. The course is repeated after a monthly break.

Daily in the morning (2 months) you can drink lime tea. Such a course must be carried out once a year.

Forecast and survival

When small is diagnosed hemangioma liver, Forecast is favorable. For large types of neoplasms, the forecast depends on the availability of complications and timely treatment.

The hemangioma liver is called a benign tumor, the formation of which is somewhat unusual and in essence, is a glomerus of the blood vessels, incorrectly developed and formed in the germinal period. In this regard, the disease is considered congenital.

Usually, as a result of the examination, the formation of one such tumor is revealed and mainly its size does not exceed 3-4 cm. Most patients have any symptoms, so they can not suggest its presence for a long time. Extremely rarely arise situations that can provoke an increase in hemangioma to 10 cm in the amount of which will be pronounced characteristic symptoms. Such patients need mandatory treatment.

What it is?

Hemangioma liver is a benign tumor having enough unusual nature. In many cases, this name implies a number of different vascular neoplasms of blastomatous and disymbraidastic types.

Causes of occurrence

The vascular tumor, localized in the liver, is called mysterious disease, since the causes of the occurrence, its behavior and growth rates cannot be calculated in advance and predict. But, without looking at her "mystery and secrecy", the hemangioma is not very well known:

1. Gives preference to women's liver (in female people, these tumors occur 5-6 times more often);
2. Of the two liver lines, it advantageously chooses the right share;
3. She has a "favorite" age (20-30 years);
4. As a substrate "tries" to use venous elements;
5. The found vascular tumor in the liver of adults definitely belongs to the period of the intrauterine development of its "hosts";
6. According to the unknown reason, Gemangioma is able to go into growth, fortunately, non-indemnatory.

It is extremely difficult to determine the exact cause of the formation of such a tumor. Among the main probable factors of the occurrence of the hemangioma of the liver are allocated:

1. Genetic predisposition. In this case, Gemangioma "does not cause himself long to wait" and is found in children of infant age.
2. Influence of genital hormones. It is about the female sex hormones here (in particular, about estrogen), which, according to scientists, are able to provoke the development of a benign liver tumor.
3. Mechanical liver injuries (bruises and other).

In most cases, hemangioma is single and small in size, there are less often multiple and large tumors.

Classification

Depending on the histological structure, 2 types of vascular tumors are distinguished:

Capillary

the vascular tumor of small sizes is the cavity and protrusion of postcases (small vessels, which then form a venous network of the microcirculatory bed). Dimensions rarely exceed multiple centimeters in diameter. It is more often detected in women during or after pregnancy, with its hormonal imbalance, which is associated with the provoking effect of estrogen and progesterone.

Cavernous

a larger vascular tumor, which is formed from venous vessels, is a few small cavities filled with blood and enclosed in one capsule. The dimensions of the cavernous vascular formation can reach up to 20 cm in diameter, as a result of which such a tumor can give the appearance of symptoms of the functional impairment of the liver. The hemangioma surface is uneven with a large number of vascular convexities. Frequent complications The cavernous hemangioma is the development of pronounced intrahepatic bleeding during damage to the walls of the vascular tumor.

By the nature of clinical severity, such hemangiosis varieties can be distinguished as:

1. Asymptomatic form;
2. Uncomplicated tumor process, but there is a typical clinical picture;
3. Complicated hemangioma;
4. Atypical hamgeal forms developed by concomitant pathological processes.

Such tumor formations are usually solid, although there are multiple renal tumors growing to very large sizes and often pulling nearby tissues in the oncoprocesses.

Symptoms

The preliminary diagnosis is based on patient complaints, which are simultaneously indirect signs of vascular tumor localized in the liver:

1. Feeling of the stomach, 12-rosewood and all adjacent structures located in the hepatoduodenal zone;
2. Stupid, buty painfulness in the right hypochondrium;
3. The appearance of jaundice;
4. Dyspeptic disorders (unstable stool, flatulence, nausea, gravity in the stomach after meal);
5. Rarely - intense, suddenly arising pain, which usually indicates that certain events occur in hemangiom: infarction or necrosis of its fabric, hemorrhage into the tumor.

With hemangiomas of the liver who has reached dangerous sizes, the development of symptoms of portal hypertension and heart failure is not excluded.

Features of development in children

The reasons for the occurrence of hemangioms in the child are definitely unknown. It is believed that the vascular tumor is formed during the period of tooling the fetus when pregnant sick infections during the bookmark period of cardio-vascular system crumbs. Almost always the pathology is diagnosed immediately after birth, only sometimes such benign tumors Manifest themselves in the first month of the life of a newborn. The hemangioma dimensions are actively incremented by half a year, after which growth slows down. Sometimes it is capable of resolving themselves with age, especially if the tumors are small, so it does not always need to be removed.

When the hemangiomas on the liver in the newborn grow along with the crumb, accompanied by symptoms, it is necessary to undergo a course of treatment, since sometimes a disease is dangerous.

Diagnostics

Gemangioma proceeds asymptomatic, and the patient begins to contact the doctors only when complaints. Diagnosis of the disease includes:

• for delivery general analysis blood;
• CT, if necessary, clarify the diagnosis;
• angiography to determine the state of blood vessels in suspected the development of the neoplasm in the right robbery;
• puncture biopsy, if necessary, confirmation of the diagnosis (but the diagnosis of tumor is rarely carried out, can lead to massive bleeding and complications).

Possible complications

Hemangioma although not prone to malignancy, but may lead a lot hazardous consequences For patient:

1. Casabach-Merrita syndrome is a dangerous complication that causes the fatal outcome of a third of patients. It is characterized by thrombocytopenia and gigantic sizes of hemangioma, inside of which the bloodstream, causing a circulating disorder;
2. The gap - can lead to abundant bleeding. The cause of the break is usually bruised, injury, etc.;
3. The lack of liver arising from the development of multiple tumors or a giant hemangioma, which indispensable renal parenchyma.
4. Tumor thrombosis, accompanied by purulent and septic processes and leaning fabrics.

Treatment of hemangioma of the liver

People who have been identified benignant neoplasmIt is recommended to re-examine after 3 months to assess the growth of the tumor. If hemangioma growth is not detected, the patient is still necessary every six months or, at least 1 time per year, to undergo a survey, in order to dynamically observe the tumor.

If the tendency to the growth of the hemangioma of the liver is not noted, and its size does not exceed 5 cm in diameter, then treatment is not required. No patients appointed medications, and even there is no need to comply with a special diet.

But the situations in which surgery may need, still happen. These include:

• tumor break;
• permanent discomfort in the stomach, worsening the quality of life of the patient;
• rapid tumor growth (more than 50% per year);
• hemangioma size exceeds 5 cm;
• great hemangioma and squeezes neighboring authorities, breaking their work;
• if the results of the survey could not be installed malignant tumor or not.

Contraindications for the operation is considered:

• pregnancy;
• hepatic hematoma;
• cirrhosis of the liver;
• lesion of large vessels;
• hormonosophic therapy in the treatment of tumor.

Also inexpensively biopsy during hemangiom hematic. High risk of strong bleeding capable of leading to death.

Hormonal therapy requires a gentle conduct, can only provoke a tumor growth, a rapid increase in size. Appointed only by a doctor, taking into account many factors: the age of the patient, the degree and stage of development of the neoplasm, available other internal pathologies.

ethnoscience

Treatment of hemangioma folk remedies (like other diseases) can be used only for adults after consulting a doctor. Effective are considered:

• ginseng root;
• linden;
• termino;
• potatoes;
• oats;
• wormwood, etc.

The ramisture is used in herbal collection (cat's cat, Chernykorn, Pijm, Yarrow, St. John's wort, Cherry (fruits), Calendula, Celebrel 3 tbsp. L.; Mcomstly and-stepmother - 4.5 art. L.; Plantain - 6 st l.). Ingredients are mixed. To prepare a decoction, 1 tablespoon of the mixture is needed, it is sealed with 1.5 glasses of boiling water and boiled a few minutes. You need to drink everything 4 times in one day. Repeat the procedure for 3 weeks, after which 2 weeks drink the powder from the millenno seed 3 times a day. Course for 5 years.

Diet

One of the methods of maintaining the neoplasm in a stable state - organization proper nutrition With the hemangiom of the liver. This includes traditional contraindications for diseases of this organ - fried, greasy, salty. It is also advisable to exclude:

• alcohol;
• sharp seasonings;
• yolks;
• mushrooms;
• pears;
• chocolate;
• fresh bread;
• carbonated drinks.

Hemangioma liver requires a diet. With small tumor sizes, it is possible to stop its growing, pickup menu with suitable products. Nutritionists offer to use in a daily diet:

• bread in the form of crackers;
• vegetables, greens;
• porridge;
• citrus;
• fruit except pears;
• vegetable oil - sunflower, olive;
• dried fruits compote.

Such a disease does not require adhere to strict diet nutrition. It is enough to exclude from the daily dietary dietary "heavy products" from the daily diet, and also try more often to eat fried and oily food. It is also not recommended to eat canned and salty products.