巨大肝血管瘤119例外科治疗经验

Surgical treatment for giant liver hemangioma： an expeience on 119 cases

目的总结巨大肝血管瘤的外科治疗经验。方法回顾119例巨大肝血管瘤（直径≥10cm）患者的资料，并根据瘤体直径分为2组，10～〈20cm组、≥20cm组，比较瘤体大小对临床表现、手术方式以及治疗效果的影响。结果全组共119例患者，瘤体直径（16±7）cm，10～〈20cm组88例，≥20cm组31例；伴有贫血、血小板降低、低纤维蛋白血症者分别为23、7、17例，均以≥20cm组更多见（P〈0．001），5例术前诊断Kasabach—Merritt综合征，全部为血管瘤直径≥20cm者，瘤体巨大压迫肝门血管在≥20cm组亦更为常见（P〈0．001）。10～〈20cm组以剥除术为主，而≥20cm更多选择肝切除（P〈0．001）,后者手术时间、术中出血、自体血回输及异体输血例数均高于前者（P〈0．001），两组术后并发症未见统计学差异（P=0．194）。结论对于肝巨大血管瘤进行剥除或肝切除均为安全有效的手术方式，可根据病灶部位、手术范围合理选择。

Objective To summarize the experience of surgical treatments for giant liver hemangioma. Methods A retrospective study was made on the clinical data of patients with liver hemangioma larger than 10 cm in diameter, which were divided into two groups （ 10 - 〈 20 cm, 88 cases, ≥ 20 cm, 31 cases）. Data included age and gender,presentation,treatment methods, peri-operative indexes, and complications. Results All patients complained symptoms, the average diameter was （ 16 ≡ 7 ） cm. There were 23, 7, and 17 cases respeetively with anemia, thrombocytopenia and hypofibrinogenemia, all were more often seen in ≥20 cm group （P 〈 0. 001 ）. Five patients were diagnosed as Kasabach-Merritt syndrome in ≥20 cm group. Patients in ≥20 cm group also had greater rates of compression of the porta hepatis （P〈 0. 001 ）. Patients in ≥20 em group were treated more often by hepatic resections, while enucleations was often done in 10- 〈20 cm group. The ≥20 cm group had more blood loss （P 〈 0. 001 ） and autologous transfusion （ P 〈 0. 001 ） , greater rates of blood transfusion （ P 〈 0. 001 ）. There was no significant difference on morbidity between the two groups （ P = 0. 194 ）. Conclusions For giant liver hemangioma both enucleation and hepatic resection could be completed safely in experienced hands.