肝巨大血管瘤外科治疗体会

EXPERIENCE OF RESECTING GIANT HEPATIC HAEMANGIOMAS

目的探讨肝巨大血管瘤手术指征及方法.方法回顾性分析1999年10月-2004年10月手术切除的28例肝巨大血管瘤的临床资料.全组肿瘤直径5～24cm,平均12cm,其中邻近第二肝门5例,与下腔静脉关系密切者7例,均采用肝血管瘤剥离术联合术中应用微波刀切除肿瘤.结果28例中12例出血量在400ml以下,未输血,5例出血量600～800ml,1例出血量为8000 ml.全组安全切除,均痊愈.病理检查为海绵状血管瘤.结论对于直径小于8 cm的肝血管瘤,可定期观察,但位于第二肝门的肝血管瘤,均应早期切除,肿瘤大于8 cm或合并有临床症状者,应手术切除.采用血管瘤剥离术联合术中应用微波刀切除肿瘤,出血量少,安全有效,并发症少,提高了手术切除率.

Objective to investigate surgical indications and techniques for recurrent giant hepatic haemangioma. Methods Clinical records of 28 cases of recurrent giant liver haemangiomas who underwent resection between October 1999 and October 2004 were analyzed retrospectively. The vascular diameter in the whole group ranged between 5cm and 24cm, average 12cm, Spatients were adjacent to secondary porta of liver. 7 patients were adjacent to the inferior vena cava. Haemangiomas were resected by hepatic haemangioma separating technique in combination with application of microwave knife. Result Postoperative hemorrhage in 12 cases of 28 patient was below 400ml without blood transfusion. Hemorrhage in 5 patients ranged between 600ml and 800ml ,and was 8000ml in 1 patient . Resection was safely done in all patients and all got cured. Pathologic examination revealed curernous haemangioma. Conclusion Hepatic haemangiomas which diameters are smaller than 8cm can be observed within a specific period,but rose located in secondary porta of liver should undergo early resection. Those which are larger than 8cm in diameter or have clinical symptoms should undergo surgical resection. The use of haemangioma separating technique in combination with intraoperative application of microwave knife is safe and efficient. It can not only reduce bleeding and complication, but also increase probability of surgical resection so that it is an ideal procedure