肝血管瘤128例外科治疗分析

Hepatic hemangoma treated by surgical resection： a analysis of 128 patients

目的 探讨肝血管瘤的手术适应证.方法 回顾分析2008年1月至2012年12月在西安交通大学第一附属医院行肝切除治疗的128例肝血管瘤患者资料.根据肿瘤直径将患者分为大血管瘤（直径5 ～ 10 cm,A组）与巨大血管瘤（直径≥10 cm,B组）两组,比较两组围手术期临床因素,采用单因素及多因素分析方法研究与肝血管瘤切除术后并发症及输血相关的因素.结果 128例中大血管瘤组90例、巨大血管瘤组30例.B组手术时间（232±116） min、ICU住院天数（2.63±1.10）d、手术出血量（1 261 ±1 520） ml及输血量（3.93±5.19）U与A组的手术时间（172±63.8）min、ICU住院天数（2.12±0.95）d、手术出血量（405±365）ml及输血量（1.36±2.05）U比较,差异有统计学意义（P＜0.05）.分析结果表明肿瘤直径不是术后并发症的危险因素;单因素分析表明肿瘤直径是手术输血的危险因素,但多因素分析表明肿瘤直径不是手术输血的独立危险因素.结论 巨大血管瘤外科手术风险与大血管瘤相比无明显增加,肿瘤直径不是肝血管瘤手术术中输血和术后并发症的独立危险因素.

Objective To analyse the surgical indications of hepatic hemangioma.Methods The data of 128 consecutive patients with hepatic hemangioma who underwent hepatectomy from January 2008 to December 2012 at the Department of Hepatobiliary Surgery,First Affiliated Hospital of Medical College,Xi＇an Jiaotong University were analyzed retrospectively.The patients were divided into two groups according to tumor size：the large hemangioma group （group A,diameter：5 to 10 cm） and the giant hemangioma group （group B,diameter：≥ 10 cm）.The differences in perioperative clinical factors were compared.Univariate analysis and multivariate analysis were used to determine the risk factors of postoperative complication and blood transfusion.Results 90 patients had hemangiomas of 5-10 cm in diameter and 28 patients had hemangiomas of ≥10 cm in diameter.For group B,the operation time was （232 ± 116）min,ICU hospitalization （2.63 ± 1.10） days,blood loss（1 261 ± 1 520） ml and blood transfusion volume （3.93 ±5.19） u.These were significantly higher than those in group A （172 ± 63.8 min,2.12 ± 0.95 d,405 ± 365 ml,1.36 ±2.05 u） （P 〈0.05）.Univariate analysis showed tumor diameter was not a significant risk factor of postoperative complications,but it was a significant risk factor of blood transfusion.However,multivariate analysis showed tumor diameter was not an independent risk factor of blood transfusion.Conclusion In patients with hepatic hemangioma undergoing hepatectomy,giant hemangioma was not an independent risk factor of postoperative complication.Multivariate analysis showed that tumor diameter was not an independent risk factor of blood transfusion and postoperative complications.