肝动脉栓塞联合延期腹腔镜肝切除治疗巨大肝血管瘤临床疗效分析

Clinical application of transcatheter arterial embolization followed by laparoscopic hepatectomy for giant hepatic hemangioma

目的 探讨肝动脉栓塞(TAE)联合延期腹腔镜肝切除术治疗巨大肝血管瘤的应用价值。方法 回顾性分析2022年1月至2023年11月南方医科大学珠江医院肝胆一科收治的42例巨大肝血管瘤(瘤体直径≥10 cm)病人的临床资料。根据治疗方式分为TAE联合延期腹腔镜肝切除术19例(延期手术组)和一期腹腔镜肝切除术23例(一期手术组)。比较两组病人术前肿瘤总直径、术后并发症等围手术期指标。结果 延期手术组病人经TAE治疗后肿瘤总直径明显减小[(15.1±3.0)cm vs.(11.2±2.5)cm,P<0.001]。与一期手术组相比,延期手术组病人手术时间较短[240(180~270)min vs. 300(240~360)min,P=0.035]、术中出血量减少[100(80~200)mL vs. 180(100~400)mL,P=0.024]、术后住院时间缩短[7(5~8)d vs. 8(7~9)d,P=0.049]。两组病人腹腔镜肝切除术后肝功能等实验室检查指标以及术后并发症差异无统计学意义(P>0.05)。结论 TAE联合延期腹腔镜肝切除术的序贯治疗有助于简化手术操作、促进病人术后快速恢复,是一种安全、可行的治疗策略,为临床上治疗巨大肝血管瘤提供了一种新思路。

Objective To explore the feasibility of transcatheter arterial embolization(TAE)followed by laparoscopic hepatectomy in the treatment of giant hepatic hemangioma.Methods Forty-two patients with giant hepatic hemangioma who had been hospitalized during the period from January 2022 to November 2023 in our center were analyzed.According to different treatment methods,they were divided into two groups,whereby 19 cases in the delayed surgery group were treated with TAE and delayed laparoscopic hepatectomy,while 23 cases in the one-stage surgery group were treated with laparoscopic hepatectomy.The tumor diameters before laparoscopic surgery or TAE,the operation characteristics,and short-term complications of the two groups were compared and analyzed.Results After TAE treatment,the tumor diameters of the delayed surgery group were significantly decreased((15.1±3.0)cm vs.(11.2±2.5)cm,P<0.001).The operation time(240(180-270)min vs.300(240-360)min,P=0.035),intraoperative blood loss(100(80-100)mL vs.180(100-400)mL,P=0.024),and the postoperative hospital stay(7(5-8)d vs.8(7-9)d,P=0.049)in the delayed surgery group were significantly lower than in the one-stage surgery group.The postoperative serum levels of the hepatic function index were not statistically different between the two groups.There was no significant difference in the incidence of Clavien-Dindo complications and postoperative complications.Conclusion Transcatheter arterial embolization followed by laparoscopic hepatectomy in the treatment of giant hepatic hemangioma is not only safe and effective,but can also promote the early discharge of patients and simplify the operative procedures,which provides a new train of thought for the treatment of giant hepatic hemangioma.