肝脏良性病变切除术手术适应证的选择

The indication of resection of benign lesions of the liver

目的:探讨肝切除术在肝良性病变治疗中的价值。方法:回顾性研究和分析空军总医院与解放军总医院1986-2010年955例连续性肝切除手术病例临床资料。结果:本组病例数最多的疾病是肝血管瘤和肝内胆管结石,分别占所有良性疾病的44.3%(423例)和27.7%(265例)。术中失血≤200 ml者596例(62.4%),200～400 ml者122例(12.8%),400～1 000 ml者164例(17.2%),>1 000 ml者73例(7.9%)。术中输异体血者359例(37.6%),自体血回输者81例(8.5%)。手术时间平均(240.60土98.31)min。术后住院时间平均(14.01±8.23)d。术后并发症发生率为13.7%,围手术期病死率为0.2%。经多因素Logistic回归分析,与并发症相关的独立影响因素是手术时间(P=0.004,OR=1.003)和白蛋白(ALB)值(P=0.040,OR=0.938),其中手术时间的延长为危险因素,ALB值的升高为保护因素。结论:肝切除术是治疗肝脏良性占位性病变的安全、有效方法,但手术适应证需严格评价。

Objective：To discuss the value and indication of hepatectomy for benign lesions of the liver. Methods： The clinical date of 955 hepatic benign lesions undergoing hepatectomy consecutively from January 1986 to December 2010 at Airforce General Hospital of PLA and PLA General Hospital were analyzed retrospectively. Results： Hemangioma and hepatolithiasis were the first two in the list of our group, and they accounted for 44.3% （423 cases） and 27.7 % （265 cases） respectively. Among them, those with blood loss less than 200 ml accounted for 62.4% （596 cases）, 200-400 ml accounted for 12.8% （122 cases）, 400-1 000 ml accounted for 17.2% （164 cases）, whereas those with more than 1000 ml of blood loss accounted for 7. 9%（73 cases）. Three hundred and fifty-nine （37.6%） patients required transfusion of blood products during operation, in 81 cases autologous blood was transfused （8.5 % ）. The average operation time was （240.60±98. 31） minutes, the mean time of hospital stay after operation was （14. 01 ± 8.23） days. The postoperative complication rate was 13. 7%, perioperative mortality was 0. 2%. On multivariate analysis, the operating time（P= 0. 004 ,OR= 1. 003） and the value of albumin（P= 0. 040, OR=0.938） were independent predictors of morbidity. Conclusions： Liver resections for the treatment of a wide range of benign hepatobiliary lesions are associated with low morbidity. However, the indications must be assessed with care.