血管瘤剥除术治疗肝海绵状血管瘤

Treatment of liver cavernous hemangioma with stripping operation

目的探讨血管瘤剥除术在治疗肝海绵状血管瘤中的安全性及应用价值。方法回顾性分析2008年5月至2012年5月在华中科技大学同济医学院附属同济医院肝脏外科中心行血管瘤剥除术的56例肝海绵状血管瘤患者临床资料。其中男21例，女35例；年龄23～65岁，中位年龄44岁。所有患者均签署知情同意书，符合医学伦理学规定。患者采用气管内插管静脉复合麻醉，预置第一肝门和肝下下腔静脉阻断带，分离、夹闭肝固有动脉，待肿瘤变软、缩小后沿瘤体表面锐性分离肝海绵状血管瘤，结扎出入肿瘤的血管。剥除过程中遇到不易控制的出血时，行Pringle法加肝下下腔静脉阻断，阻断时间5～15 min。结果全部肝海绵状血管瘤均被成功剥除。患者术中平均出血量为（437±135）ml，均未输血。术中肝右静脉破裂4例、肝中静脉破裂2例，应用Prolene线修补成功。围手术期无发生死亡。术后发生右侧胸腔积液和腹腔积液7例，肝断面胆漏1例，均经引流、对症处理治愈。结论血管瘤剥除术治疗肝海绵状血管瘤是一种安全、有效的手术方法。

Objective To evaluate the safety and application value of stripping operation for the treatment of liver cavernous hemangioma. Methods Clinical data of 56 patients with liver cavernous hemangioma who underwent stripping operation in Hepatic Surgery Center, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology from May 2008 to May 2012 were analyzed retrospectively. There were 21 males and 35 females with age ranging from 23 to 65 years old and the median age of 44 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received combined intravenous and endotracheal anesthesia. Occluding stripes were preset at the first porta and infrahepatic inferior vena cava, and the proper hepatic artery was dissected and clamped. Liver cavernous hemangioma was sharply dissected along its surface when the tumor got soft and shrunken. And the vessels in and out of the tumor were ligated. Pringle maneuver and infrahepatic inferior vena cava interruption （interruption length： 5-15 min） were performed in case of uncontrolled bleeding during the stripping operation. Results All the liver cavernous hemangiomas were enucleated successfully. The mean intraoperative blood loss of the patients was （437±135）ml, and no case received blood transfusion. Rupture of right hepatic vein was observed in 4 cases and rupture of middle hepatic vein in 2 cases during the operations, and they were successfully＆amp;nbsp;repaired with Prolene sutures. No death was observed during the perioperative period. Right-sided pleural effusion and peritoneal effusion were observed in 7 cases and bile leakage at the cut surface of liver in 1 case after the operations, and all were cured by drainage and symptomatic treatment. Conclusion Stripping operation is a safe and effective surgical procedure for liver cavernous hemangioma.