肝血管瘤的诊断和治疗（附47例报告）

Diagnosis and treatment of hepatic hemangioma： a report of 47 cases

目的探讨肝血管瘤诊断和治疗方法的合理选择，评价肝血管瘤手术治疗的风险性。方法回顾性分析47例肝血管瘤患者的临床资料。36例患者具有各种不同程度的非特异性腹部症状或体征。B超、CT和磁共振成像（MRI）三种方法诊断准确率分别为44．7％、84．2％和100．0％。结果16例患者行肝血管瘤挖除术，27例行常规肝叶或肝段切除术，1例行肝右动脉结扎加碘油栓塞术，3例患者实施了右半肝联合左外叶切除术以及肝段切除联合血管瘤挖除术。术后并发症发生率为25．5％（12／47）。多变量Logistic回归分析示术中失血量和术中有无输红细胞（≥2U）是术后并发症发生的独立风险因素（P=0．0280，P=0．0013）。结论肝血管瘤是常见的肝脏良性肿瘤，临床表现缺乏特异性；B超、CT和MRI是诊断肝血管瘤的主要手段，MRI的诊断准确率最高，对本病的诊断具有特殊意义；手术切除是肝血管瘤最理想的治疗方法，手术指征应从严把握。术中出血量和术中有无输红细胞（≥2U）是影响肝血管瘤术后是否发生并发症的重要风险因素。

Objective To study the diagnosis and treatment of hepatic hemangioma,and evaluate the risk factors relative to postoperative complication. Methods Clinical data of 47 patients who underwent surgical removal of hepatic hemangioma were analyzed retrospectively. Thirty-six patients （76.6%） presented with symptoms such as abdominal pain,discomfort and other nonspecific gastrointestinal complaints. The accuracy of US, CT and MRI were 44.7% （21/47 ）, 84.2% （ 32/38 ） and 100.0% （6/6）. Results Hepatectomy was underwent in 30 patients （63.8%）, enucleation in 16 patients （34.0%） and transcatheter arterial embolization in patient 1 （2.1% ）. Postoperative complication rate was 25.5% （ 12/47 ）. Multiple stepwise regression analysis indicated that intraoperative bleeding amount and transfusion requirement were independent contributing factors for postoperative complication of hepatic hemangioma （P = 0.0280,P = 0.0013 ）. Conclusions Hepatic hemangioma is the most common benign tumors of the liver and with nonspecific symptom. US, CT and MRI are the main diagnostic methods for the diagnosis of hepatic hemangioma. The best effective treatment method is hepatectomy. Surgical risk factors for postoperative complication of hepatic hemangioma are intranperative bleeding amount and transfusion requirement.