改良式全肝血流阻断包膜外切除肝巨大血管瘤

Modified total hepatic vascular exclusion for liver extracapsular resection of giant hepatic cavernous hemangioma

目的评估自体回输血配合常温下全肝血流阻断治疗紧贴重要血管的肝巨大血管瘤包膜外切除的可行性。方法从2001年2月至2006年12月采用全自动自体血液回输机,32例紧贴重要血管的肝巨大血管瘤,瘤体大小12cm×15cm～18cm×40cm。常规在肝上下腔静脉、肝下下腔静脉、第一肝门放置阻断带,根据术中需要行不同时间的全肝血流阻断使手术顺利完成。结果全组32例均完整切除瘤体并痊愈出院,其中1例游离肝脏时瘤体破裂未能及时行全肝血流阻断致大出血,术中输血6000ml;4例术中输外源性同型血400～800ml;其余27例术中未输外源性同型血。术中有8例仅采用Pringle法切肝,其余24例用全肝血流阻断法,阻断时间5～30min,平均16min。结论采用自体回输血常温下全肝血流阻断技术对紧贴重要血管的肝巨大血管瘤包膜外切除是安全可行的。

Objective To explore the feasibility of intraoperative autologous transfusion in modified total hepatic vascular exclusion under normal temperature for extracapsular resection of giant hepatic hemangioma. Methods The clinical data of 32 patients undergoing hepatic resection with total hepatic vascular exclusion requiring intraoperative autologous transfusion were analyzed retrospectively. The tumors in these cases involved the proximal hepatic veins and inferior vena cava, with hemangioma volume ranging from 12 cm×15 cm to 18 cm×40 cm. Results The hemangioma were completely resected in all patients, who all recovered smoothly. In one case, hemangioma rupture occurred during dissociation of the liver, resulting in massive hemorrhage which required blood transfusion of 6000 ml. Four patients received blood transfusion of 400-800 ml, and the other 27 had no blood transfusion. Only 8 patients underwent pringle maneuver with resection, whereas the other 27 underwent total hepatic vascular exclusion during liver resection for 5-30 min （mean 16 min）. Conclusion Intraoperative autologous transfusion in modified total hepatic vascular exclusion under normal temperature is feasible and safe for extmcapsular resection of huge hepatic hemangioma adjacent to the major arteries.