肝脏巨大血管瘤的腹腔镜手术治疗：40例报告

Laparoscopic surgery for giant liver hemangiomas： a report of 40 patients

目的探讨肝脏巨大血管瘤的腹腔镜手术治疗。方法回顾性分析2012年8月至2018年1月中日友好医院采用腹腔镜手术治疗的40例肝脏巨大血管瘤患者的临床资料。患者肝血管瘤直径均大于10cm，肝功能均为Child—PughA级。随访截止至2018年2月。结果40例患者中，完全腹腔镜肝血管瘤切除37例，中转开腹3例。肝血管瘤最大径10．0～15．0（10．8±1．3）cm。完全腹腔镜手术患者手术时间70～390（154．7±68．0）min；术中平均出血量200（100～400）ml；术中自体输血20例，自体联合异体输血2例；术后住院时间4～14（6．9±2．0）d。术后3例（8．1％）出现并发症，其中胸腔积液2例，盆腔积液1例，2例经穿刺引流后痊愈，1例经保守治疗痊愈。无术后出血、胆漏、气体栓塞等严重并发症。全组患者均获随访，未见肝血管瘤复发。结论全腹腔镜手术可安全有效地用于经过选择的肝脏巨大血管瘤患者。

Objective To analyze the clinical experience of laparoscopic surgery for giant liver he- mangiomas. Methods The clinical data of 40 patients who underwent laparoscopic surgery for giant liver he- mangiomas from August 2012 to January 2018 in the China-Japan Friendship Hospital were retrospectively analyzed. The diameters of the liver hemangiomas were more than l0 cm for all the patients. The liver func- tions of all the patients were Child-Pugh class A. The follow-up was up to the end of February 2018. Results Laparoscopic treatment of giant liver hemangioma was successfully performed in 37 patients. Three patients were converted to open hepatectomy. The mean diameter of the giant liver hemangiomas was （10.8±1.3） cm （ranged 10.0- 15.0 cm）. The mean operative time for laparoscopic therapy was （154.7±68.0） min （range 70-390 rain）. The mean intraoperative blood loss was 200 （100-400） mi. 20 patients received autologous blood transfusion. Of these 2 patients received in addition allogeneic blood transfusion. The postoperative hos- pital stay was （ 6. 9 ±2. 0 ） days （ range 4 - 14 days ）. Postoperative complications occurred in 3 patients （8. 1% ）. Two patients developed postoperative pleural effusion and one pelvic effusion. Two patients respon- ded well to puncture drainage and one to conservation management. There was no postoperative hemorrhage, bile leakage or air embolism. All patients were followed-up and no liver hemangioma recurrence was detected. Conclusion Laparoscopic surgery was a safe and efficacious procedure in selected patients with giant liver hemangioma.