两种术式治疗肝巨大血管瘤临床疗效比较

Clinical efficacy of hepatectomy and extravascular exfoliation in treatment of patients with giant hepatic hemangioma

目的探讨肝叶切除术和肝血管瘤包膜外剥脱术治疗肝巨大血管瘤患者的临床疗效。方法 2014年5月～2016年4月我院肝胆外科收治的82例肝巨大血管瘤患者,41例接受肝叶切除术,另41例接受肝血管瘤包膜外剥脱术治疗。随访1年。结果接受肿瘤剥脱和肝叶切除患者的手术时间分别为(2.3±1.1) h和(3.3±1.1) h、术中出血量分别为(885.2±387.5)ml和(1567.5±751.4) ml、术中输血量分别为(928.7±412.4) ml和(1896.4±852.4) ml、肝血流阻断时间分别为(21.4±9.6) min和(27.5±8.2) min,住院日分别为(14.2±3.2) d和(16.5±3.5)d(P均<0.05);肿瘤剥脱和肝叶切除患者术后并发症发生率分别为14.6%和34.2%(P<0.05);经术后随访1年,肝叶切除患者术后血管瘤复发1例,失访11例,其余29例血管瘤消失,肿瘤剥脱患者复发1例,失访8例,其余32例血管瘤消失。结论肝切除术和肝血管瘤包膜外剥脱术均能有效治疗肝巨大血管瘤,但肝血管瘤包膜外剥脱术具有操作简便、手术创伤小、出血量少、肝血流阻断时间短、术后恢复快和术后并发症少等优点。

Objective To investigate the clinical efficacy of hepatectomy and extravascular exfoliation in treatment of patients with giant hepatic hemangioma.Methods The clinical data of 82 patients with giant hepatic hemangioma admitted to our hospital between May 2014 and April 2016 were retrospectively analyzed,and 41 patients received hepatectomy and another 41 received extravascular exfoliation.All patients were followed-up for one year.Results The operative time,intraoperative blood loss,intraoperative blood transfusion,hepatic blood flow blocking time and hospital stay were(2.3±1.1)h,(885.2±387.5)ml,(928.7±412.4)ml,(21.4±9.6)min and(14.2±3.2)d in patients receiving exfoliation and(3.3±1.1)h,(1567.5±751.4)ml,(1896.4±852.4)ml,(27.5±8.2)min and(16.5±3.5)d in patients receiving hepatectomy(all P<0.05);the incidence rate of postoperative complications was 14.6%in patients receiving exfoliation and 34.2%in patients receiving hepatectomy(P<0.05);at the end of 1 year follow-up,one patient had recurrent hepatic hemagioma,11 lost and 29 had hepatic hemagioma disappeared in patients receiving hepatectomy,and one had recurrent hemagioma,8 lost and 32 had hemagioma disappeared in patients receiving tumor exfoliation.Conclusions Hepatectomy and extravascular exfoliation can be applied to the removal of giant hepatic hemangioma,while the latter has the advantages of relatively simple operation,small surgical trauma,little blood loss,short liver blood flow blocking time,rapid postoperative recovery and few postoperative complications.