腹腔镜手术治疗肝血管瘤围术期疗效及术中出血量、术后并发症危险因素分析

Perioperative effect of laparoscopic surgery on hepatic hemangioma,and analysis of intraoperative blood loss and postoperative complication risk factors

目的探讨腹腔镜手术治疗肝血管瘤围术期的临床效果,以及影响术中出血量、术后并发症的危险因素。方法回顾性分析自2015年2月至2021年7月于北部战区总医院接受手术治疗的45例肝血管瘤患者的临床资料,观察患者围术期的各项指标。采用多因素Logistic回归分析探讨术中出血量、术后并发症的危险因素。根据手术方式将患者分为肝部分切除术组(n=17)与血管瘤剥除术组(n=28),比较两组患者围术期指标。结果45例患者的平均手术时长(196.4±93.3)min,肝部分切除术中出血量200(100,475)ml,术中输液量(2333.0±847.8)ml;7例患者术中输血,输血量为400(350,775)ml,无术后输血;术后出现手术相关并发症15例,均为Clavien-DindoⅠ级;术后下床活动时间为2(2,3)d,术后进食时间为2(2,3)d,术后引流管拔除时间为5.0(4.0,6.3)d,术后住院时间为6(5,8)d。多因素Logistic回归分析结果发现,巨大血管瘤、血管瘤位置是术中出血量较多的独立危险因素(P<0.05);合并基础疾病、术中出血量是术后并发症的独立危险因素(P<0.05)。两组患者术后引流管拔除时间、术后住院时间比较,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗肝血管瘤围术期疗效确切,安全可行。

Objective To investigate the perioperative clinical effect of laparoscopic surgery on hepatic hemangioma and the risk factors affecting intraoperative blood loss and postoperative complications.Methods Clinical data of 45 patients with hepatic hemangioma who received surgical treatment in General Hospital of Northern Theater Command from February 2015 to July 2021 were retrospectively analyzed,and perioperative indexes of the patients were observed.Multiple Logistic regression analysis was used to investigate the risk factors of intraoperative blood loss and postoperative complications.Patients were divided into partial hepatectomy group(n=17)and hemangioma excision group(n=28),and perioperative indexes of the two groups were compared.Results In 45 patients,the mean operation time was(196.4±93.3)minutes,the blood loss during partial hepatectomy was 200(100,475)ml,and the intraoperative infusion volume was(2333.0±847.8)ml.Seven patients received intraoperative blood transfusion.The transfusion volume was 400(350,775)ml.No postoperative transfusion was performed.Postoperative operation-related complications occurred in 15 cases,all of which were Clavien-DindoⅠ.The time of getting out of bed was 2(2,3)days,the time of eating was 2(2,3)days,the time of drainage tube removal was 5.0(4.0,6.3)days,and the time of hospitalization was 6(5,8)days.Multivariate Logistic regression analysis showed that giant hemangioma and location of hemangioma were independent risk factors for more intraoperative blood loss(P<0.05).Combined underlying diseases and intraoperative blood loss were independent risk factors for postoperative complications(P<0.05).The postoperative drainage tube removal time and postoperative hospital stay between the two groups were statistically significant(P<0.05).Conclusion Laparoscopic surgery is effective and safe in the perioperative treatment of hepatic hemangioma.