Hepatic hemangioma

　　Liver hemangioma is the most common benign tumor in the liver, accounting for 84% of liver benign tumors, and is more common in elderly women. Most are cavernous hemangiomas, and very few are capillary hemangiomas and vascular endothelial tumors. Multiple pregnancies and oral contraceptives are common. Lesions can be solitary or multiple, and are more common in the posterior segment of the right lobe of the liver. At present, the exact etiology of liver hemangioma is not clear, and there are mainly the following theories:

　　(1) Congenital developmental abnormality theory: At present, most scholars believe that the occurrence of hemangioma is caused by congenital malformation of the terminal blood vessels of the liver. It is generally believed that during the process of embryonic development, due to abnormal development of liver blood vessels, abnormal proliferation of vascular endothelial cells leads to the formation of liver hemangioma;

　　(2) The hormone stimulation theory: some scholars have observed that during the female puberty, pregnancy, oral contraceptives, etc., the growth rate of hemangioma can be accelerated, and it is believed that female hormones may also be one of the pathogenic mechanisms of hemangioma;

　　(3) Other: such as deformation after capillary tissue infection, leading to capillary dilation; local liver tissue necrosis after the formation of empty bubbles due to vascular dilation; surrounding blood vessels are congested and dilated; regional blood circulation stasis in the liver causes the formation of cavernous dilatation of blood vessels.

　　The complications of liver hemangioma are as follows:

　　Liver hemangioma rupture

　　Liver hemangioma rupture causes massive intraperitoneal hemorrhage. At this time, the patient may suddenly develop acute abdominal pain, accompanied by shock. This is because the large sea-like hemangioma continuously produces fibrous thrombi within the sinus of the hemangioma, leading to the consumption of a large amount of fibrinogen in the circulation. In this case, bleeding is difficult to stop, and the mortality rate is high. Therefore, patients diagnosed with liver hemangioma who have symptoms such as liver area swelling and pain, abdominal distension, poor appetite, and other symptoms may be due to the progressive enlargement of the hemangioma. Surgical treatment can be considered to avoid the risk of bleeding due to hemangioma rupture.

　　Thrombocytopenia

　　Thrombocytopenia refers to a disease caused by a decrease in platelet count below the normal range. Thrombocytopenia may arise from insufficient platelet production, splenic retention of platelets, increased destruction or utilization of platelets, and dilution. Regardless of the cause, severe thrombocytopenia can lead to typical bleeding: multiple ecchymoses, most commonly on the lower legs; or small scattered ecchymoses at sites of minor trauma; mucosal bleeding such as nosebleeds, gastrointestinal bleeding, urinary and reproductive tract bleeding, and vaginal bleeding, as well as excessive bleeding after surgery, massive gastrointestinal bleeding, and intracranial hemorrhage, which can be life-threatening.

　　Hypofibrinogenemia

　　Hypofibrinogenemia, also known as decreased plasma fibrinogen, is an important coagulation factor. It plays an important role in the mechanism of hemostasis. Fibrinogen is produced by the liver and is a determinant of plasma viscosity. Elevated fibrinogen levels cause increased plasma viscosity and hypercoagulability, which are important mechanisms in the formation of intravascular thrombi. Low fibrinogen levels mainly manifest as coagulation abnormalities.

　　Hepatic enlargement

　　Hepatic enlargement The normal liver of a healthy adult usually has an upper limit at the 5th rib space of the right midclavicular line, and the lower limit is mostly not palpable. The normal size of the liver is 25 cm (long axis) × 15 cm (vertical diameter) × 16 cm (anterior-posterior diameter). However, if the upper limit of the liver is normal or slightly high, and the lower limit exceeds the costal margin by 1 cm, 3 cm below the xiphoid process, or exceeds the middle and upper one-third junction of the distance from the root of the xiphoid process to the umbilicus, it is called hepatic enlargement. In certain physiological conditions, such as children under 5 years old, adults with a slender body shape, or women with multiple pregnancies, the liver can be palpated under the ribs during deep inspiration, or transient hepatomegaly may occur after exercise; in certain pathological conditions, such as emphysema, ptosis of internal organs, or severe thoracic deformities, the liver can also be palpated under the ribs, but the upper limit of the liver also moves downward, and it cannot be called hepatomegaly. Hepatic enlargement can be classified into diffuse hepatomegaly, localized enlargement, infantile hepatomegaly, infectious hepatomegaly, toxic hepatomegaly, congestive hepatomegaly, cholestatic hepatomegaly, and metabolic disorder hepatomegaly.

　　Most hepatic hemangiomas have no obvious discomfort symptoms and are often discovered during routine health check-ups or abdominal surgery. Occasionally, they may be confused with other malignant tumors in the liver, leading to misdiagnosis. When hemangiomas grow to more than 5 cm in size, non-specific abdominal symptoms may occur, including:

　　(1) Abdominal mass: The mass has a cystic sensation, is non-tender, and has a smooth or rough surface. Sometimes, a conductive vascular murmur can be heard upon auscultation over the mass;

　　(2) Gastrointestinal symptoms: Right upper quadrant pain and discomfort, as well as loss of appetite, nausea, vomiting, belching, postprandial bloating, and dyspepsia may occur;

　　(3) Compression symptoms: Large vascular malformations can exert pressure on surrounding tissues and organs. Compression of the lower esophagus can cause difficulty in swallowing; compression of the extrahepatic bile duct can cause obstructive jaundice and cholecystasis; compression of the portal venous system can cause splenomegaly and ascites; compression of the lungs can cause dyspnea and atelectasis; compression of the stomach and duodenum can cause gastrointestinal symptoms, etc.;

　　(4) Rupture and bleeding of liver hemangioma can cause severe upper abdominal pain, as well as symptoms of bleeding and shock, which is one of the most serious complications. It is mostly caused by large liver hemangiomas located below the costal arch that rupture and bleed due to external force, which is extremely rare.

　　(5) Kasabach-Merritt syndrome: It is a coagulation abnormality caused by thrombocytopenia and excessive consumption of coagulation factors in hemangiomas. The pathogenesis is the retention of blood in large hemangiomas, which leads to the excessive consumption of red blood cells, platelets, coagulation factors II, V, VI, and fibrinogen, causing abnormal coagulation mechanism, which can further develop into DIC;

　　(6) Other: When a pedunculated hemangioma growing outside the liver twists, it can cause severe abdominal pain, fever, and fainting. Large hemangiomas with the formation of arteriovenous fistulas can increase the return blood volume and increase the heart burden, leading to heart failure and death.

　　Although liver hemangioma has a congenital factor, its growth is caused by acquired factors. Therefore, prevention involves avoiding factors that may cause tumor growth.

　　Firstly, to prevent liver hemangioma, it is essential to maintain a pleasant mood, avoid great anger or sudden outbursts, and relieve anxiety and tension. Avoiding emotional injuries is crucial for preventing the disease.

　　Secondly, to prevent the occurrence of liver hemangioma, it is also important to eat more vegetables and fruits, which are rich in dietary fiber, to maintain smooth defecation and prevent constipation.

　　Thirdly, to prevent liver hemangioma, it should also be noted that meals should not be overeating, and it is advisable to eat to about 70-80% of fullness. At the same time, reduce the intake of beef, mutton, pork, and dog meat, avoid greasy and spicy foods, and reduce the intake of strong alcohol and spicy fried foods. It is advisable to eat light and nutritious foods.

　　Fourthly, in daily work and domestic activities, prevent overexertion, do not carry heavy objects, and avoid strenuous exercise to prevent increased intra-abdominal pressure and potential rupture and bleeding of the tumor. When choosing physical exercise, long-distance walking and other low-intensity activities should be done.

　　Once a liver hemangioma is diagnosed, regular liver B-ultrasound should be performed for small hemangiomas, and attention should be paid to the size of the tumor, with timely treatment for larger ones. In terms of daily care, it is important to do the psychological work of patients, relieve anxiety and tension, keep patients in a cheerful mental state, and actively cooperate with treatment. Most patients with liver hemangioma have poor digestion and metabolism of the spleen and stomach, and it is advisable to eat fresh, light, and nutritious food. Pay attention to rest and avoid overexertion. Severe cases may require bed rest for treatment.

　　Common examinations for liver hemangioma include:

　　1. Liver color Doppler ultrasound:

　　Liver color Doppler ultrasound can show homogeneous, hyperechoic lesions within the liver, with most boundaries clear, or there may be hyperechoic areas with irregular hypoechoic areas within the lesion, where dilated sinusoids can be displayed.

　　Enhanced CT scan of the abdomen is an important method for diagnosing cavernous hemangioma of the liver, with characteristic manifestations, and the diagnostic accuracy can be over 90%.

　　(1) Plain scan: Low-density area within the liver, with clear contours and uniform density, or a lower density area within the lesion, representing thrombosis organization or fibrous septation, with calcification visible in a few cases.

　　(2) Enhanced scanning:

　　① Early lesions show significant enhancement in the form of nodules or 'island-like', with density similar to that of the adjacent abdominal aorta, significantly higher than the density of the surrounding liver parenchyma, and lasting for more than 2 minutes.

　　② As time elapses, the enhancement amplitude moves closer to the center of the lesion, while the relative low-density area of the lesion becomes smaller.

　　③ Delayed scanning shows isointensity or slightly higher density (the lower density within the lesion remains unchanged during the plain scan).

　　3. Isotope 99mTC liver blood pool scanning and liver angiography: These are helpful for the diagnosis of liver hemangioma, showing no tumor staining, clear and sharp edges, and a longer imaging time for the hemangioma.

　　4. MRI: T1 images show low signal intensity, with an extended T2 relaxation time, and appear as high signal intensity tissue.

　　Liver hemangioma lacks specific clinical manifestations, and imaging examinations (such as ultrasound, CT, MRI) are currently the main methods for diagnosing liver hemangioma.

　　Liver hemangioma is a common benign tumor of the liver, and patients should pay more attention to adjusting their diet and daily living. Dietary taboos include:

　　1. The diet for liver hemangioma should avoid high-calorie foods: High-calorie foods can accelerate the body's basic metabolic rate, thereby to some extent increasing the growth rate of the tumor, so the diet for liver hemangioma should avoid high-calorie foods such as chocolate and coffee.

　　2. The diet for liver hemangioma should avoid high-sugar foods: Sugar is easy to ferment and can easily induce symptoms of bloating, which is detrimental to the condition. In addition, liver hemangioma patients have relatively weak liver metabolic functions, and after consuming high-sugar foods, they cannot completely and effectively metabolize polysaccharides, leading to excess sugar being converted into fat and stored in the liver, thus increasing the liver burden and being detrimental to the condition, so the diet for liver hemangioma should avoid high-sugar foods.

　　3. The diet for liver hemangioma should avoid high-fat and high-cholesterol foods: During liver hemangioma, the liver's metabolic and detoxification functions are relatively weak, and high-fat and high-cholesterol foods are difficult to be digested and absorbed effectively, which can easily increase the liver burden and worsen the condition, so the diet for liver hemangioma should avoid high-fat and high-cholesterol foods such as animal brains, spinal cord, internal organs, yolks, shellfish (such as clams), and soft-bodied animals (such as squids, cuttlefish, fish eggs).

　　4. The diet for liver hemangioma should avoid spicy and刺激性 foods: Spicy and刺激性 foods are easy to stimulate the gastrointestinal mucosa, causing excessive secretion of gastric acid, which can easily trigger a series of gastrointestinal discomfort symptoms, which is extremely detrimental to the stability of the condition, so the diet for liver hemangioma should avoid spicy and刺激性 foods.

　　In addition, the diet for liver hemangioma should avoid excessive processed, salted, smoked, fermented, and moldy foods.

　　Liver hemangioma patients should consume foods with high caloric content and rich in nutrition, such as lean meat, chicken, fish, milk, and soy products. Fresh vegetables like celery, spinach, tomatoes, radishes, garlic, and fresh bamboo shoots. Sea products such as kelp, nori, jellyfish, algae, and those with habitual constipation should eat bananas, persimmons, watermelons, cantaloupes, water chestnuts, honey, bee milk, cornstarch, and others. Black fungus and silver ear, etc.

　　1、西医治疗方法

　　肝血管瘤发展缓慢，预后良好，是否需要治疗取决于肿瘤的生长速度及临床症状，而非肿瘤的绝对大小。大多数已确诊而无症状的病人，可门诊随访，无需特殊处理。肝血管瘤的干预方法众多，包括手术、介入治疗、硬化剂注射以及腹腔镜血管瘤切除术等。

　　虽然外科手术有一定风险，但是治疗肝血管瘤最直接和最彻底的手段。腹腔镜行肝血管瘤切除术，术后常有复发，不宜常规施行。对不能手术切除的有症状的巨大肝血管瘤，也可考虑采用原位肝移植术。肝血管瘤的非手术疗法包括：经导管肝动脉栓塞或腹腔镜下肝动脉结扎、局部放疗、口服类固醇药物及肌注α干扰素等。肝动脉栓塞治疗肝血管瘤可以导致严重的胆道并发症，应尽量避免。放疗可使少数病人症状缓解，肿瘤缩小。超声引导下硬化剂注射疗效，目前尚不肯定。

　　2、中医治疗方法

　　对肝血管瘤病治疗，多采用行气疏肝、活血化瘀、软坚散结为主，但在具体治疗中应分辨气滞、血瘀之偏重。如以血瘀为主，就采用以下药物：羚羊骨、水牛角、牛黄、赤芍清热凉血止痛；柴胡、黄皮核、素磬针等理气开郁；丹参红花活血化瘀；炒山甲、皂角刺、川足软坚散结、走窜经络。如以气滞为主，就采用以下药物：柴胡、郁金、黄皮核、素磬针等行气解郁；配丹参、红花、三棱、莪术、大黄活血化瘀；炒山甲、皂角刺、川足软坚散结、通络止痛。再配合口服“熊胆丸”和“丹火透热疗法”，疗效更佳。症瘕之症，与一般的气滞血瘀病症不同，其往往淤积日久，非单纯行气活血之法可以奏效。