腹腔镜手术治疗肝脏巨大血管瘤疗效分析

Effective of laparoscopic surgery for giant hepatic hemangiomas

目的探讨有症状的肝脏巨大血管瘤腹腔镜手术治疗的临床效果。方法回顾性分析2015年3月至2018年6月湖南省人民医院肝胆外科收治并手术的89例肝脏巨大血管瘤病人的临床资料,所有病人均伴有临床症状且血管瘤直径>10 cm,51例行腹腔镜手术,38例行开腹手术,分析比较两组病人手术时间、术中出血量、术后胃肠功能恢复时间、下床活动时间、住院时间、术后疼痛评分(采用疼痛视觉模拟评分)以及术后并发症发生情况。结果腹腔镜组术后胃肠功能恢复时间、下床活动时间、住院时间分别为(3.52±1.60) d、(2.22±0.92) d、(8.50±1.44) d,均明显短于开腹组的(4.60±1.32) d、(3.12±0.66) d、(11.62±2.10) d,P<0.05;腹腔镜组术中出血量为(241.82±33.21) ml,明显少于开腹组的(305.22±30.44) ml,P<0.05;术后24 h疼痛评分腹腔镜组为(3.18±0.36)分,明显低于开腹手术组的(5.12±0.52)分(P<0.05);腹腔镜组和开腹组手术时间分别为(188.45±33.51) min、(200.21±31.23) min,两者比较差异无统计学意义(P=0.095);腹腔镜组术后并发症发生率为5.8%,明显低于开腹组的23.7%(χ~2=5.916,P=0.015)。术后随访1~3年,两组均未见血管瘤残留或复发。结论腹腔镜手术治疗有症状的肝脏巨大血管瘤安全可行,较开腹手术具有创伤小、恢复快、并发症少等优势,精准的手术操作是手术成功的保证。

Objective To explore the clinical effect of laparoscopic surgery in the treatment of symptomatic giant hepatic hemangiomas.Methods The clinical data of 89 patients with giant hepatic hemangiomas who were admitted and operated in the Department of Hepatobiliary Surgery, the People′s Hospital of Hunan Provincial, from March 2015 to June 2018 were retrospectively analyzed. All patients had clinical symptoms and hemangioma diameter >10 cm. The patients were divided into two groups, 51 in laparoscopic surgery group and 38 in laparotomy group. The operation time, intraoperative blood loss, postoperative recovery time of gastrointestinal function, time for getting out of bed, hospital stay, postoperative pain score and postoperative complications were analyzed and compared between the two groups.Results The time of gastrointestinal function recovery, time of getting out of bed and hospitalization time in the laparoscopic surgery group were(3.52±1.60) d,(2.22±0.92) d and(8.50±1.44) d, respectively, which were significantly shorter than those in laparotomy group [(4.60±1.32) d,(3.12±0.66) d and(11.62±2.10) d, respectively, P<0.05];the intraoperative blood loss in laparoscopic surgery group was(241.82±33.21) ml, which was significantly less than that in laparotomy group [(305.22±30.44) ml, P<0.05];the postoperative 24 h pain score in laparoscopic surgery group was(3.18±0.36), which was significantly lower than that in laparotomy group(5.12±0.52)(P<0.05);the operation time in laparoscopic surgery group and laparotomy group was(188.45±33.51) min,(200.21±31.23) min, and the difference was not statistically significant(P=0.095). All patients were followed up for 1 to 3 years. No residual or recurrent hemangioma was found in both groups.Conclusion Laparoscopic surgery is safe and feasible for the treatment of symptomatic giant hepatic hemangiomas. Compared with open surgery, it has many advantages such as less trauma, quick recovery and less complications. For laparoscopic surgery, precise surgical procedures are the key to its success.