肝脏海绵状血管瘤剥离术及组织、解剖学基础

Enucleation and histologic and anatomical characteristics for cavernous hemangioma of the liver

目的探讨剥离术治疗肝海绵状血管瘤(CHL)手术方法及其相关组织学、解剖学基础。方法术中导管插至肝内Ⅱ级动脉,直接供血动脉造影;观察瘤体超微结构;肝叶切除,风干标本横切面观察及剥离新鲜标本观察瘤体㈦瘤床关系。临床治疗11例。结果瘤前均有约1mm的供血小动脉,可供方便结扎。瘤体内无肝小叶结构,证实CHL无门静脉供血及形成胆管的组织学基础。手术标本证实瘤体与瘤床间除供血小动脉外无任何粘连。结论手术剥离瘤体安全性高,无需切除肝组织,术中无大出血,术后无胆漏发生。可适用于肝脏各叶内血管瘤。安全性远高于肝叶切除治疗CHL。

Objective To explore enucleation and histologic and anatomical characteristics for cavernous hemangioma of the liver. Methods The clinical data of 11 patients with hepatic cavernous hemangioma were analyzed retrospectively. Serial selective hepatic arteriography was performed. Samples of hepatic cavernous hemangioma were prepared to examine using transmission electron microscopy. Results Blood supply of hepatic cavernous hemangioma might only originate from the hepatic artery. There were no hepatic lobules and biliary duct in hepatic cavernous hemangioma. Conclusions Cavernous hemangiomas of the liver can be removed more safely by enucleation than by hepatic resection. Enucleation is associated with fewer intra-abdominal complications such as bile leakage and massive bleeding.