完全腹腔镜肝血管瘤切除术的临床分析

Clinical analysis of totally laparoscopic surgery for hepatic hemangioma

目的：探讨完全腹腔镜肝血管瘤切除术的临床应用。方法：2011年9月至2014年12月为33例患者行完全腹腔镜肝血管瘤切除术，其中男10例，女23例，29～59岁，平均（44．0±8．8）岁。有临床症状13例，以上腹部胀痛不适为主要表现。病程1周～15年。肝血管瘤直径6～17em，外生性生长16例。术前肝功能评级均为Child—PughA级。结果：31例成功完成手术，25例行肝血管瘤切除术，6例行肝血管瘤剥除术；2例中转开腹。20例采用3孔法施术，11例采用4孔法。手术时间平均（148．6±44．8）min，出血量200（100，400）ml。23例未输血，8例输血，其中自体血回输7例，异体输血1例，输血量150—400ml。术中均未行肝门阻断。切除血管瘤直径6—14em，平均（8．3±2．0）em。术后均经病理证实符合肝海绵状血管瘤。术后平均住院（5．9±1．3）d。1例患者出现术后低氧血症，经内科治疗痊愈。均无术后出血、胆漏、气体栓塞等严重并发症发生。结论：完全腹腔镜肝血管瘤切除术安全、有效，具有患者创伤小、康复快的优点，适于经过选择的肝血管瘤患者。

Objective ：To discuss the value of totally laparoscopic surgery for hepatic hemangioma. Methods：The clinical data of 33 patients who scheduled for laparoscopie surgery of hepatic hemangioma from Sep. 2011 to Dec. 2014 were retrospectively ana- lyzed. 10 males and 23 females were enrolled in this study, with a mean age of （44.0± 8.8） years （range ,29-59 years）. 13 cases got clinical symptom of abdominal distension. The course of disease ranged from one week to 15 years. The diameter of hepatic hemangioma ranged 6-17 era, 16 cases were extrahepatic growing. The liver functions of all the patients were normal （Child-Pugh A）. Results： Lapa- roscopic treatment of hepatic hemangioma was successfully performed in 31 patients （25 cases of resection and 6 cases of decolle- ment）, while two patients were converted to laparotomy during operation. Laparoscopic treatment was performed by three-port method in 20 cases, and four-port method was used in 11 cases. The operative time was （ 148.6 ± 44.8 ） min. The intraoperative blood loss was 200 （100,400） ml. 8 cases accepted blood transfusion,including 7 cases of autologous transfusion and one case of allogeneic transfu- sion. The intraoperative blood transfusion volume ranged from 150 to 400 ml. The hepatic inflow block was not performed in any of the cases. The average diameter of reseeted specimens was （ 8.3 ± 2. 0） em（ range 6 to 14 cm）. The diagnosis of hepatic cavernous heman- gioma was confirmed by pathology for all the cases. The postoperative hospital stay was （5.9 ± 1.3 ） d. One patient suffered from post- operative hypoxemia and cured by medical treatment. Postoperative hemorrhage, bile leakage or air embolism was not found in any ca- ses. Conclusions ： Totally laparoscopie surgery for hepatic hemangioma is a safe and effective procedure with slight pain and rapid recov- ery, which makes it suitable for selected cases.