RESUMEN
OBJECTIVE: The aim: To revise the case-series of hepatic vascular tumors (HVT), particularly to identify optimal visualization, management and role of surgical intervention. PATIENTS AND METHODS: Materials and methods: Out of 96 children with hepatic tumors who hospitalized in a single center from 2011 to 2020, 20 (20,8%) were diagnosed HVT. Hepatic Hemangiomas (HHs) were presented in 19 patients and Kaposiform hemangioendotelioma (KHE) in one case. To determine the type of HH we used radiological classification. For visualisation contrast-enhanced MRI (n=7, 30%) and cCT (n=15,70%) were used. Follow-up period was 14-77 months. RESULTS: Results: All HVT were revealed by sonogram at the age of 0-5 m, with 4 (20%) diagnosed prenatally. Male to female ratio was 3:2. Beta-blockers were prescribed to 12 patients with HHs. Treatment duration was from 6 to 24 month. Steroid therapy was initial in cases when it was impossible to prescribe the curative dose of beta-blockers. Complications of propranolol treatment were transitory bradycardia (n=7) and transitory hypoglycemia (n=2). After vincristine chemotherapy decreases the tumor size by 54%, that allowed a safe liver resection. 4 (20%) patients - two multifocal HHs, one diffuse HH and in patient with KHE manifested congestive heart failure and pulmonary hypertension Mortality rate is 5% (n=1), this patient died against progressive cardiovascular failure. CONCLUSION: Conclusions: life-threatening complication of HVT was congestive heart failure. Early treatment is beneficial for complications prevention. Surgical treatment is optional for KHE when can be removed safely.
Asunto(s)
Insuficiencia Cardíaca , Hemangioma , Neoplasias Hepáticas , Neoplasias Vasculares , Niño , Femenino , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Masculino , Estudios Retrospectivos , Neoplasias Vasculares/complicacionesRESUMEN
OBJECTIVE: The aim: To evaluate the efficacy of endoscopic variceal band ligation (EVL) after the first esophageal EVL session in children with PH according to endoscopic data. PATIENTS AND METHODS: Materials and methods: EVL was performed to 39 patients with PH for the purpose of variceal bleeding primary and secondary prophylaxis. RESULTS: Results: Esophageal varices grade decrease was observed in 22 (56.41%) children. Cases of early rebleeding (within 14 days after EVL) were not registered. Eradication of varices was successful in 11 (28.2%) of patients. In 1 (2.56%) case the complication (bleeding) occurred while banding procedure. 1 (2.56%) patients had bleeding from gastric varices prior to a control endoscopy. Portal gastropathy grade changes were observed in 17 (43.59%) patients. CONCLUSION: Conclusions: EVL is a safe and effective method of esophageal varices bleeding prophylaxis. This method allows control the esophageal varices grade at different phases of PH treatment in children. Even one EVL session can decrease the grade of esophageal varices (Ñ<0.001). The EVL effect on the severity of portal gastropathy (p=0.02) and on the red marks presence (p=0.005) was also determined. EVL reduced the risk of variceal rebleeding (Ñ=0.05, RR=0.05 (95%CI 0.01-0.32)).