中国实用外科杂志

中国实用外科杂志

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手术治疗直径≥10 cm肝海绵状血管瘤373例临床分析

董志涛，方鲲鹏，郭俊武，戴炳华，隋承军，耿    利，杨甲梅   

  1. 海军军医大学第三附属医院  东方肝胆外科医院特需诊疗科，上海 200438 
  • 出版日期:2022-04-01

  • Online:2022-04-01

摘要： 目的    分析直径≥10 cm肝海绵状血管瘤病例的临床特征和手术疗效，以及术中输血和术后并发症的相关危险因素。方法    回顾性分析2010年1月至2015年9月海军军医大学附属东方肝胆外科医院收治的行手术治疗的373例直径≥10 cm肝海绵状血管瘤病人的临床资料，术前根据最大瘤体直径将病人分为GH组（巨大肝血管瘤，直径10~<15 cm，241例）和EH组（特大肝血管瘤，直径≥15 cm，132例），对比两组病人的一般资料、手术治疗结果，分析输血及术后并发症的高危因素。结果    EH组血液学指标异常的发生率高于GH组。在EH组随访过程中，病人的临床症状及血液学指标异常的发生率随直径增加而增多（P<0.05）。EH组的肝门阻断时间、失血量、输血量和术后并发症发生率明显高于GH组（P<0.05），而两组的手术时间、切除病变数目、阻断方式、术后住院时间和病死率差异无统计学意义（P<0.05）。GH组病人多选用血管瘤摘除术，而EH组病人多选用肝切除术（P<0.05）。GH组中，行肝切除术者术后第1天丙氨酸氨基转移酶和总胆红素水平高于行肿瘤摘除术者（P<0.05），而二者并发症发生率和病死率差异无统计学意义（P>0.05）。Logistic回归分析显示，手术时间与血管瘤直径是术中输血的独立危险因素，血管瘤直径是术后并发症的独立危险因素（P<0.05）。结论    对于直径≥10 cm肝海绵状血管瘤病人，随着血管瘤直径的增加，病人的临床症状及血液学指标异常的发生率、术中出血量和术后并发症发生率均增高，故应根据直径重新划分血管瘤的亚组有助于区分临床治疗策略。

关键词: 肝海绵状血管瘤, 肝切除术, 摘除术, 输血, 并发症

Abstract: Analysis of surgical treatment of 373 cases of hepatic cavernous hemangioma with diameter≥10 cm        DONG Zhi-tao，FANG Kun-peng，GUO Jun-wu，et al. Department of Special Care， the Third Affiliated Hospital of Naval Medical University，East Hepatobiliary Surgery Hospital，Shanghai 200438，China
Corresponding author：GENG Li，E-mail：Dr_gengli@126.com
Abstract  Objective  To analyze the clinical features and surgical efficacy of hepatic cavernous hemangioma with diameter ≥ 10 cm，and to explore the risk factors of intraoperative blood transfusion and postoperative complications. Methods  The clinical data of 373 patients with hepatic cavernous hemangioma （diameter≥10cm）treated in Shanghai Eastern Hepatobiliary Surgery Hospital from January 2010 to September 2015 were retrospectively analyzed. According to the maximum diameter of hemangioma，the patients were divided into two groups, 241 patients with giant hepatic hemangioma （GH group） （15 cm > diameter ≥ 10 cm），132 patients with giant hepatic hemangioma （EH group） （diameter ≥ 15 cm）. The general data and the surgical treatment results of two groups were compared and analyzed，and the high-risk factors of blood transfusion and postoperative complications were analyzed. Results  The incidence of abnormal hematological indexes in EH group was higher than that in GH group. During the follow-up of patients in EH group, the incidence of abnormal clinical symptoms and hematological indexes increased with the increase of diameter (P < 0.05). The hilum blocking time，blood loss，blood transfusion and postoperative complications incidence in EH group were significantly higher than those in GH group （P<0.05），but there were no significant differences in operation time，number of resected lesions，blocking mode，postoperative hospital stay and mortality between the two groups （P<0.05）. Patients in GH group were more likely to be treated with hemangioma resection, while patients in EH group were more likely to be treated with hepatectomy (P < 0.05). The levels of ALT and TB in hepatectomy group were higher than those in liver resection group on the first day after operation （P<0.05），but there were no significant differences in complications rate and mortality between the two groups （P>0.05）. Logistic regression analysis showed that the operation time and the size of hemangioma were independent risk factors for blood transfusion，and the diameter of hemangioma was the independent risk factor for postoperative complications （P<0.05）. Conclusion    With the increase of the diameter of hepatic hemangioma, the incidence of abnormal clinical symptoms and hematological indexes increased significantly, and the amount of bleeding and the rate of postoperative complications also increased. Reclassification of hemangioma subgroups according to diameter is helpful to distinguish the clinical treatment strategies. The operation mode should be reasonably selected according to the characteristics of hemangioma before operation, and the operation time should be reasonably controlled by careful operation to reduce bleeding.

Key words: hepatectomy, hepatic cavernous hemangioma, enucleation, treatment