复杂肝脏血管瘤的手术治疗

Surgical treatment for liver hemangioma

肝脏血管瘤是肝脏良性实性肿瘤中最为常见的一类病变,正常人群中的发病率为8%左右。目前对其外科切除的指征尚有争论,国外多以有无临床症状作为标准,国内学者认为对直径>5cm或生长速度较快者应予以切除。手术方式包括血管瘤剜除术,肝脏规则性切除和不规则性切除,其中以血管瘤剜除术最为常用。对边缘性病灶手术常常简单易行,对于中央型血管瘤,因肿瘤与正常的肝组织往往有明显的边界,故准确找出这一边界采用钝性分离的方式常使切除简单,但要仔细注意保护边界上正常肝组织的血管胆管系统,以使保留的肝脏组织的入肝出肝血流及胆管引流通畅,手术中往往需要修补肝静脉门静脉上的小的开口。术后的主要并发症是出血和胆瘘。

Liver hemangioma is the most common primary benign tumor of the liver with the incidence of 8% or so. For the operation indications, there are some controversies. Foreign surgeons depend on symptoms but domestic surgeons depend on the tumor size. The diameter more than 5 cm or quick growth is the indication of resection. The surgical methods include enucleation, regular or unregular liver lobes resection. Enucleation is a popular technique in the treatment of large liver hemangiomas because of a plane between lesion and liver exist. Blunt dissection along the plane makes it easy to remove the lesion safely and quickly. Main branches of portal veins and hepatic veins must be preserved in order to keep the inflow and outflow of remnant liver lobes patent. Bile leakage and transaction area bleeding are two common complications.