紧邻肝门及大血管的肝血管瘤手术治疗

Hepatectomy for hepatic hemangiomas close adjoining the portal hepatis and vital blood vessels

目的探讨紧邻肝门及重要血管的肝血管瘤的手术方式及其安全性。方法总结自2005年6月至2010年6月解放军第一零一医院对17例患者紧邻肝门及肝内外重要血管的肝血管瘤施行肝切除手术的方法和效果。结果本组17例患者均手术成功，无手术死亡。规则性肝叶切除术6例，其中绕肝提拉法前人路右半肝切除术2例，肝右后叶切除术2例，左半肝切除术2例；外膜剥离术8例；肝实质劈开加外包膜剥离术3例。在绕肝提拉法前入路右半肝切除术患者中，采用选择性连续右半肝血流阻断法，其他患者采用常温下间歇性入肝血流阻断法。术后并发症：胸腔积液5例，伤口感染1例，肺部感染1例。本组患者均痊愈出院。结论根据患者肝血管瘤的不同部位、大小以及与肝门、肝内、外重要血管的关系，采用不同的手术切除方式，有助于提高手术安全性。

Objective To explore the surgical-modality and safety of hepateetomy for hepatic hemangiomas close adjoining the hepatic portal and vital blood vessels. Methods From June 2005 to June 2010 17patients of hepatic hemangiomas underwent hepateetomy. Data were retrospectively analyzed. Results All the 17 cases were operated on successfully. Six cases were treated with anatomic liver lobectomy including right hemibepatectomy through liver hanging maneuver by anterior approach in 2 cases, under right liver blood vessel blochade and anatomic right posterior hepatectomy in 2 cases, left hemihepateetomy in 2 cases. Eight cases were treated by hemangiomas enucleation, in 3 cases hemangioma was enuleated through liver parenchyma splitting under intermittent hepatic blood inflow exclusion. There was no postoperative mortality, postoperatively pleural effussion occured in 5 cases, wound infection occured in 1 case, and pulmonary infection occured in 1 case, all the cases were cured. Conclusions Different operation styles should be applied according to the position, size of hepatic hemangiomas close adjoining the hepatic portal and the important blood vessels.