腹腔镜Ⅶ与Ⅷ段肝血管瘤剥离术的临床应用

Clinical application of laparoscopic dissection of hepatic hemangioma segments Ⅶ and Ⅷ

目的探讨腹腔镜肝血管瘤剥除术治疗Ⅶ、Ⅷ段肝血管瘤的可行性及安全性。方法回顾性分析昆明医科大学第二附属医院2019年1月至2020年12月收治的21例Ⅶ、Ⅷ段肝血管瘤临床资料,统计手术时间、出血量、术后第1天及术后1周转氨酶检验结果、术后拔除引流管时间、术后是否合并胸腔积液及肺部感染、住院时间。术后3个月复查腹部彩超。结果21例患者均顺利完成手术,手术时间(198.0±41.7)min;出血量为(251.0±196.8)mL,1例患者术中输血。术后第1天天冬氨酸氨基转移酶(AST)为(171.2±85.8)U/L,丙氨酸氨基转移酶(ALT)为(170.0±117.5)U/L,术后1周AST为(37.3±20.1)U/L,ALT(100.8±60.2)U/L。术后拔除引流管时间为(5.0±2.0)d,术后胸腔积液5例,肺部感染2例,均保守治疗治愈,无再次手术和死亡病例。术后病理诊断21例均为肝海绵状血管瘤,住院时间为(9.0±4.0)d。术后3个月复查腹部彩超了解肝脏,未见复发。结论腹腔镜下Ⅶ、Ⅷ段肝血管瘤剥除术安全可行,术中充分暴露、准确寻找瘤体包膜和有效控制出血是手术成功的关键。

Objective To explore the feasibility and safety of laparoscopic hepatectomy for hepatic hemangioma of segmentⅦandⅧ.Methods Clinical data of 21 patients with stageⅦandⅧhepatic hemangioma admitted to the Second Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were retrospectively analyzed,and the operation time,blood loss,transaminase test results on the first day and one week after surgery,postoperative drainage tube removal time,postoperative combination of pleural effusion and pulmonary infection,and hospital stay were counted.Abdominal color ultrasound was reviewed 3 months after surgery.Results All 21 patients successfully completed the operation,and the operation time was(198.0±41.7)min.The blood loss was(251.0±196.8)ml,and 1 patient had blood transfusion during the operation.Aspartate aminotransferase(AST)on the first postoperatively is(171.2±85.8)U/L,alanine aminotransferase(ALT)is(170.0±117.5)U/L,and one week after surgery,the AST was(37.3±20.1)U/L,and the ALT was(100.8±60.2)U/L.The drainage tube removal time was(5.0±2.0)d after operation.There were 5 cases of pleural effusion and 2 cases of pulmonary infection after operation.All cases were cured by conservative treatment,and there were no cases of reoperation and death.21 cases of hepatic hemangioma were diagnosed pathologically after operation,and the hospital stay was(9.0±4.0)d.Three months after the operation,the abdominal ultrasound showed no recurrence of tumor.Conclusion Laparoscopic removal of hepatic hemangioma in segmentsⅦandⅧis safe and feasible.