423例肝血管瘤切除术围术期因素回顾性分析

Perioperative analysis of 423 consecutive hepatectomies of hepatic hemangioma

目的回顾性分析肝血管瘤切除术相关围术期因素,探讨肝血管瘤的手术适应证及治疗方法。方法回顾性研究和分析了空军总医院1991~2011年423例肝血管瘤切除术围术期病例资料。结果本组病例中伴上腹部不适症状的肝血管瘤患者占91.3%（386/423）。术中失血≤200 mL者276例（65.25%）,200~400 mL者86例（20.33%）,400~1 000 mL者42例（9.93%）,〉1 000 mL者19例（4.49%）。手术时间平均（170.60±78.23）min。术后住院天数平均（12.67±10.51）d。总的术后并发症发生率为7.80%,围手术期死亡率为0。经多因素Logistic回归分析,手术时间的延长为危险因素（P=0.004,or=1.015）,ALB值的升高为保护因素（P=0.021,or=0.852）。结论肝血管瘤切除手术适应证应从严掌握,在重视优化围术期处理和创新手术技术的前提下,肝切除术是治疗肝血管瘤安全有效的方法,并可保持低并发症发生率。

Objective To study the surgical indication and therapeutic method of hepatic hemangioma according to analyze perioperative factors associated with hepatectomy retrospectively.Methods 423 consecutive hepatic hemangiomas undergoing hepatectomy were investigated retrospectively from January 1991 to November 2011 at Airforce General Hospital of PLA according to their clinical perioperative documentation.Results Hemangiomas with epigastric discomfort in the group accounted for 91.3%（386/423）.Patients with blood loss less than 200 mL was 276（accounted for 65.25%）,200-400 mL was 86（20.33%）,400-1 000 mL was 42（9.93%）,and those with more than 1 000 mL was 19（4.49%）.The average operating time was（170.60±78.23） minutes,the average postoperative days of hospital stay was（12.67±10.51）.The complication rate after operation was 7.80%,and mortality was 0.Multivariate Logistic Regression analysis showed that the prolongation of operating time was independent risk factors（P = 0.004,or = 1.015） and the elevation of ALB value was independent protective predictors（P = 0.021,or = 0.852） of morbidity.Conclusion Liver resection indcation of hemangiomas should be controlled strictly.Hepatectomy of hemangioma can be undergone safely and efficiently with emphasizing optimization of perioperative management and innovative surgical technique.Complications related with operation can be controlled at low incidence.