Giant cavernous liver hemangiomas： is it the time to change the size categories？

BACKGROUND： Four different sizes （4, 5, 8 and 10 cm in diameter） can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category ＂giant＂ for liver heman- gioma. DATA SOURCES： We reviewed the reports on the categoriza- tion of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symp- tomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups： 〈5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and 〉15.0 cm in diameter. Inclu- sion criteria were noted in 34 articles involving 1972 （43.0%） hemangiomas （〉4.0 cm）. RESULTS： The patients were divided into the following groups： 154 patients （30.0%） with hemangiomas less than 5.0 cm in diameter （small）, 182 （35.5%） between 5.0 cm and 9.9 cm （large）, 75 （14.6%） between 10.0 and 14.9 cm （giant）, and 102 （19.9%） more than 15.0 cm （enormous）. There were 786 （39.9%） asymptomatic patients and 791 （40.1%） symptomatic patients. Indications for surgery related to symptoms were reported in only 75 （3.8%） patients. Operations including 137 non-anatomical resection （12.9%） and 469 enudeation （44.1%） were undearly related to size and symptoms.CONCLUSIONS： The term ＂giant＂ seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as ＂giant＂ are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.

Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma

Sclerosing cholangitis(SC)is a rarely reported morbidity secondary to transcatheter arterial chemoembolization(TACE)with bleomycin-iodinated oil(BIO)for liver cavernous hemangioma(LCH).This report retrospectively evaluated the diagnostic and therapeutic course of a patient with LDH who presented obstructive jaundice 6 years after TACE with BIO.Preoperative imaging identified a suspected malignant biliary stricture located at the convergence of the left and right hepatic ducts.Operative exploration demonstrated a full-thickness sclerosis of the hilar bile duct with right hepatic duct stricture and right lobe atrophy.Radical hepatic hilar resection with right-side hemihepatectomy and Roux-en-Y hepaticojejunostomy was performed because hilar cancer could not be excluded on frozen biopsy.Pathological results showed chronic pyogenic inflammation of the common and right hepatic ducts with SC in the portal area.Secondary SC is a long-term complication that may occur in LCH patients after TACE with BIO and must be differentiated from hilar malignancy.Hepatic duct plasty is a definitive but technically challenging treatment modality for secondary SC.

Resection of a rapid-growing 40-cm giant liver hemangioma

Hemangiomas are the most frequent benign tumors of the liver. Most hemangiomas are asymptomatic and therefore largely diagnosed only in routine screening tests. Usually they are small and require no specific treatment. In some situations they can reach great dimensions, causing some discomfort to the patient. Resection of liver hemangioma is indicated in cases of great dimension tumors causing symptoms such as pain, nausea or bloating caused by compression of adjacent organs. We report a case of a rare giant hemangioma with rapid growth in short time:a 50 year old female reported to our institution with a 40 cm giant liver hemangioma and then underwent a left hepatectomy.

Misdiagnosis of hemangioma of left triangular ligament of the liver as gastric submucosal stromal tumor:Two case reports

BACKGROUND Extragastric lesions are typically not misdiagnosed as gastric submucosal tumor(SMT).However,we encountered two rare cases where extrinsic lesions were misdiagnosed as gastric SMTs.CASE SUMMARY We describe two cases of gastric SMT-like protrusions initially misdiagnosed as gastric SMTs by the abdominal contrast-enhanced computed tomography(CT)and endoscopic ultrasound(EUS).Based on the CT and EUS findings,the patients underwent gastroscopy;however,no tumor was identified after incising the gastric wall.Subsequent surgical exploration revealed no gastric lesions in both patients,but a mass was found in the left triangular ligament of the liver.The patients underwent laparoscopic tumor resection,and the postoperative diagnosis was hepatic hemangiomas.CONCLUSION During EUS procedures,scanning across different layers and at varying degrees of gastric cavity distension,coupled with meticulous image analysis,has the potential to mitigate the likelihood of such misdiagnoses.

Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

BACKGROUND In clinical practice,the diagnosis is sometimes difficult with contrast-enhanced ultrasound(CEUS)when the case has an atypical perfusion pattern.Color parametric imaging(CPI)is an analysis software for CEUS with better detection of temporal differences in CEUS imaging using arbitrary colors.It measures the differences in arrival time of the contrast agent in lesions so that the perfusion features of atypical hemangioma and colorectal cancer(CRC)liver metastasis can be distinguished.AIM To evaluate the role of a novel type of CPI of CEUS in the differential diagnosis of atypical hemangioma from liver metastases in patients with a history of CRC.METHODS From January 2016 to July 2018,42 patients including 20 cases of atypical hemangioma and 22 cases of liver metastases from CRC were enrolled.These patients had a mean age of 60.5±9.3 years(range:39-75 years).All patients received ultrasound,CEUS and CPI examinations.Resident and staff radiologists independently and retrospectively reviewed CEUS and CPI images.Two sets of criteria were assigned:(1)Routine CEUS alone;and(2)CEUS and CPI.The diagnostic sensitivity,specificity,accuracy and receiver operating characteristic(ROC)curve of resident and staff radiologists were analyzed.RESULTS The following CPI features were significantly different between liver hemangioma and liver metastases analyzed by staff and resident radiologists:Peripheral nodular enhancement(65%-70.0%vs 4.5%-13.6%,P<0.001,P=0.001),mosaic/chaotic enhancement(5%-10%vs 68.2%-63.6%,P<0.001,P<0.001)and feeding artery(20%vs 59.1%-54.5%,P=0.010,P=0.021).CPI imaging offered significant improvements in detection rates compared with routine CEUS in both resident and staff groups.By resident radiologists,the specificity and accuracy of CEUS+CPI were significantly increased compared with that of CEUS(77.3%vs 45.5%,P=0.030;78.6%vs 50.0%,P=0.006).In addition,the area under the curve(AUC)of CEUS+CPI was significantly higher than that of CEUS(0.803 vs 0.757,P=0.036).By staff radiologists,accuracy was improved in CEUS+CPI(81.0%vs 54.8%,P=0.010),whereas no significant differences in specificity and sensitivity were found(P=0.144,P=0.112).The AUC of CEUS+CPI was significantly higher than that of CEUS(0.890 vs 0.825,P=0.013)by staff radiologists.CONCLUSION Compared with routine CEUS,CPI could provide specific information on the hemodynamic features of liver lesions and help to differentiate atypical hemangioma from liver metastases in patients with CRC,even for senior radiologists.

Recurrent giant hemangiomas of liver:Report of two rare cases with literature review

Most hepatic hemangiomas(HHs) are small,asymptomatic and do not require clinical intervention.Surgical resection is only indicated for symptomatic hemangiomas.We report here cases of recurrent HHs in 2 women of 37 and 40 years old,who initially presented with abdominal pain and mass.Radiological examination of each tumor revealed a solitary tumor of 14 and 20 cm in diameter,respectively.Surgical liver segmental resections were performed in both,and the diagnosis of cavernous hemangioma was confirmed.Both patients had recurrent tumor on subsequent radiological examination 4-5 years after the initial surgery.In the first patient,a 15 cm recurrent hemangioma was resected,but multiple hemangiomas were again detected 8 years later occupying the other hepatic lobe,which was not amendable for resection.In the second patient,a 16 cm hemangioma was seen on radiogram,and because the lesion was not symptomatic,conservative observation was offered.Recurrence after liver resection of giant hemangioma is extremely rare.The pathogenesis of tumor progression and recurrence is unknown,as is the management of these patients with recurrent hemangioma,particularly when it is extensive and unresectable.

The origin of blood supply for cavernous hemangioma of the liver

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL). METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by in jection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage. RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor. CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

An unusual case of incidental rupture of liver hemangioma during labor

Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast majority of these tumors are small and asymptomatic; however, there have been a few reported cases in which these lesions led to spontaneous fatal hemorrhage. Although liver hemangiomas occur in both sexes, most studies point to a female

Hemorrhagic hemangioma in the liver:A case report

Hemangioma is the most common type of benign tumor that arises in the liver. Although rupture and hemorrhage of hepatic hemangioma are rare complications, they can be the cause of mortality. The authors report a case of hemorrhagic hepatic hemangioma: in a 54-yearold woman who was admitted with epigastric pain.She had taken oral contraceptives several weeks prior.The results of a blood examination were normal. An abdominal computed tomography scan revealed a tumor in hepatic segment 4, and a hemorrhage inside the cystic mass was suspected. The mass was removed laparoscopically to confirm the tumor properties and control the hemorrhage. The pathologic findings of the resected mass were consistent with hepatic hemangioma with intratumoral hemorrhage. The patient was discharged 8 d after the surgery, without further complications or complaints, and the patient's condition was found to have improved during follow-up.

Source of blood supply of liver cavernous hemangioma and sclerosis and embolization treatment

AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25～57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%～30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.

Collagenous nodule mixed simple cyst and hemangioma coexistence in the liver

A 20-year-old female patient presented with two masses located in the left liver.In this patient, a computed tomography(CT) scan revealed a hypodense mass and a second well-defined mass with a calcified nodule in the left hepatic lobe.No enhancements were apparent in or around the masses.A laparotomy was performed due to the patient's symptoms, namely, the atypical CT findings and a risk of rupture of the subcapsular lesion.The operation revealed two masses in the left hepatic lobe and a left liver resection was subsequently performed.One of the masses involved segment Ⅲ and the other mass was located in segment Ⅳ.The histopathologic findings supported a diagnosis of collagenous nodule mixed simple cyst and hemangioma.A diagnosis of collagenous nodule mixed simple hepatic cyst is extremely rare and radiologically mimics a teratoma, hepatolithiasis, parasitic cyst, or hemangioma.Although hepatic hemangiomas are the most common benign tumors found in the liver, the present case showed atypical radiographic features.

Orthotophic Liver Transplantation in Giant Hepatic Hemangioma: A Case Report and Literature Review

Hemangioma is the most common benign tumor affecting the liver in 7% of general population. One of the rare presentations of this pathology is gigantic liver hemangioma, reported in the literature as anecdotal cases. In selected cases, liver transplantation has been a therapeutic option. We herein describe a case of massive liver hemangioma which was submitted to liver transplant, and the main indication for liver transplant in this case was a severe psychosocial impact of the disease in the patient’s life, altogether with Kasabach-Merritt syndrome and abdominal discomfort.

Hepatic hemangioma:What internists need to know

Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clearly elucidated.Symptoms usually correlate with the size and location of the tumor.Less commonly the presence of a large HH may cause life-threatening conditions.The diagnosis can be established by the identification of HH hallmarks in several imaging studies.In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause.In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm.Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation.Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques.Progression of the tumor is seen in less than 40%.Hormone stimulation may play a role in HH growth;however,there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence.When clinicians encounter this condition,they should discern between observation and surgical or non-surgical management based on the clinical presentation.

Spontaneous rupture of hepatic hemangiomas:A review of the literature

Hepatic hemangiomas are congenital vascular malformations,considered the most common benign mesenchymal hepatic tumors,composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepatic hemangiomas can be divided into two major groups:capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of clinical symptoms,with spontaneous or traumatic rupture being the most severe complication. In cases of spontaneous rupture,clinical manifestations consist of sudden abdominal pain,and anemia secondary to ahaemoperitoneum. Disseminated intravascular coagulopathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases,so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultrasonography,dynamic contrast-enchanced computed tomography scanning,magnetic resonance imaging,hepatic arteriography,digital subtraction angiography,and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Sur gery should be restricted to specific situations. Absolute indications for surgery are spontaneous or trau m atic rupture with hemoperitoneum,intratumoral blee ding and consumptive coagulopathy (Kassabach-Merrit syndrome). In a patient presenting with acute abdo minal pain due to unknown abdominal disease,sponta neous rupture of a hepatic tumor such as a hemangio ma should be considered as a rare differential diagnosis.

Characterization of focal liver masses using acoustic radiation force impulse elastography

AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their stiffness.METHODS:This prospective study included 62 patients with a focal liver mass that was well visualized on conventional ultrasonography performed in our institution from February 2011 to November 2011.Among them,12 patients were excluded for ARFI measurement failure due to a lesion that was smaller than the region of the interest and at an inaccessible location(deeper than 8 cm)(n = 7) or poor compliance to hold their breath as required(n = 5).Finally,50 patients with valid ARFI measurements were enrolled.If a patient had multiple liver masses,only one mass of interest was chosen.The masses were diagnosed by histological examination or clinical diagnostic criteria.During ultrasonographic evaluation,stiffness,expressed as velocity,was checked 10 times per focal liver mass and the surrounding liver parenchyma.RESULTS:After further excluding three masses that were non-diagnostic on biopsy,a total of 47 focal mass lesions were tested,including 39(83.0%) malignant masses [24 hepatocellular carcinomas(HCC),seven cholangiocellular carcinomas(CCC),and eight liver metastases] and eight(17.0%) benign masses(five hemangiomas and three focal nodular hyperplasias,FNH).Thirty-seven(74.0%) masses were confirmed by histological examination.The mean velocity was 2.48 m/s in HCCs,1.65 m/s in CCCs,2.35 m/s in metastases,1.83 m/s in hemangiomas,and 0.97 m/s in FNHs.Although considerable overlap was still noted between malignant and benign masses,significant differences in ARFI values were observed between malignant and benign masses(mean 2.31 m/s vs 1.51 m/s,P = 0.047),as well as between HCCs and benign masses(mean 2.48 m/s vs 1.51 m/s,P = 0.006).The areas under the receiver operating characteristics curves(AUROC) for discriminating the malignant masses from benign masses was 0.724(95%CI,0.566-0.883,P = 0.048),and the AUROC for discriminating HCCs from benign masses was 0.813(95%CI,0.649-0.976,P = 0.008).To maximize the sum of sensitivity and specificity,an ARFI value of 1.82 m/s was selected as the cutoff value to differentiate malignant from benign liver masses.Furthermore,the cutoff value for distinguishing HCCs from benign masses was also determined to be 1.82 m/s.The diagnostic performance of the sum of the ARFI values for focal liver masses and the surrounding liver parenchyma to differentiate liver masses improved(AUROC = 0.853;95%CI,0.745-0.960;P = 0.002 in malignant liver masses vs benign ones and AUROC = 0.948;95%CI,0.896-0.992,P < 0.001 in HCCs vs benign masses).CONCLUSION:ARFI elastography provides additional information for the differential diagnosis of liver masses.However,our results should be interpreted in clinical context,because considerable overlap in ARFI values existed among liver masses.

Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma

BACKGROUND: This paper was to review the effects of intraoperative autologous transfusion during modified, normal-temperature, total hepatic vascular exclusion (THVE) for extracapsular resection of giant hepatic cavernous hemangioma. METHODS: The clinical data from 28 patients, who underwent hepatic resection requiring intraoperative autologous transfusion with the cell-saver apparatus, were analyzed retrospectively. The tumors in the 28 patients involved the proximal hepatic veins and inferior vena cava. The diameters of these hemangiomas ranged from 12x15 cm to 18-40 cm. All patients had varying degrees of THVE. ' RESULTS: The 28 patients with hemangioma received integrated resection and recovered. One patient had rupture of tumors resulting in massive hemorrhage of 6000 ml during liver resection; 4 patients had blood transfusions of 400-800 ml; the other 23 patients had no blood transfusion. Only 6 patients underwent the Pringle maneuver with resection. The other 22 patients underwent THVE during the liver resection. The interval of THVE was 5-30 minutes (mean 16 minutes). CONCLUSIONS: Intraoperative autologous transfusion during modified, normal-temperature THVE for extracapsular resection of huge hepatic cavernous hemangioma is feasible.

Differential diagnosis and management of liver tumors in infants

During the first year of life, most of the liver neoplasms are benign in origin, but some of these histologically benign lesions may be challenging in their management. Although most hepatic hemangiomas can be safely observed until involution is documented, some patients will need treatment due to progressive hepatomegaly, hypothyroidism and/or cardiac failure. Large mesenchymal hamartomas may require extensive hepatic resection and an appropriate surgical plan is critical to obtain good results. For malignant neoplasms such as hepatoblastoma, complete surgical resection is the mainstay of curative therapy. The decision about whether to perform an upfront or delayed resection of a primary liver malignant tumor is based on many considerations, including the ease of resection, surgical expertise, tumor histology and stage, and the likely chemosensitivity of the tumor. This article reviews the initial management of the more common hepatic tumors of infancy, focusing on the differential diagnosis and treatment options.

肝脏硬化性血管瘤的CT和MRI表现分析

目的 探讨肝脏硬化性血管瘤(HSH)的影像表现。方法 回顾性分析2013年至2021年复旦大学附属中山医院经病理证实的10例HSH患者的影像学资料6例行MR检查,2例行CT检查,2例行MR+CT检查。图像分析包括病灶数目、部位、大小、形态、边缘、密度或信号、强化方式、相邻肝包膜等影像学特征,并测量病灶与肝实质的ADC值,两者ADC值比较采用独立样本t检验。结果 10例患者均为单发病灶,大小(35.8±44.4)mm,8例类圆形、1例类椭圆形、1例分叶状,边缘均清楚。CT平扫均为低密度,2例轻度均匀持续强化,2例向心性强化;T1WI呈低、稍低信号,T2WI呈高信号、3例病灶内见低信号,增强扫描4例向心性强化,2例轻度环形持续强化,1例延迟强化,1例类似环形“快进快出”强化,病灶与肝实质的ADC值差异有显著统计学意义(P<0.01),3例出现相邻肝包膜皱缩现象。结论HSH影像表现不典型但具有一定特点:动脉期环形强化,门脉期及延迟期强化不减退,病灶ADC值高于肝实质ADC值。

人工智能辅助半自动分割软件在肝脏血管瘤CT测量中的应用

目的:评估一种人工智能(AI)辅助的半自动分割软件在肝脏血管瘤CT测量上的应用的表现。方法:回顾性分析2022年2月至2023年2月收治的52例肝脏血管瘤患者的临床资料。采用联影医疗基于深度学习技术开发的肝脏血管瘤分析软件,由两名医生独立、单盲对52个肝脏血管瘤的多排螺旋计算机断层扫描(MSCT)图像进行手动分割和AI辅助的半自动分割,对其最长径及体积进行了手动和半自动的重复测量,并运用Bland-Altman方法评估两种模式下观察者内及观察者间的差异。利用组内相关系数(ICC)来评估两种模式下测量的一致性。结果:肝血管瘤病灶最长径测量中,观察者内手动、半自动测量偏移均值95%一致性区间分别为-0.70~0.55、-0.52~0.48,观察者间手动、半自动测量偏移均值95%一致性区间分别为-0.15~1.24、-0.76~0.64。肝血管瘤病灶体积测量中,观察者内纯手动、半自动测量偏移均值95%一致性区间分别为-5.95~6.79、-3.84~3.23,观察者间手动、半自动测量偏移均值95%一致性区间分别为-8.04~5.56、-6.52~5.88。观察者内手动、半自动最长径测量变异度的ICC分别为0.901、0.976,观察者间手动、半自动最长径测量变异度的ICC分别为0.865、0.892。观察者内手动、半自动体积测量变异度的ICC分别为0.907、0.982,观察者间手动、半自动体积测量变异度的ICC分别为0.825、0.913。相对于手动分割病灶,使用AI辅助的肝血管瘤自动分割软件进行半自动病灶分割所需要的时间大大缩短[(26.00±4.82)s vs(7.23±2.89)s,t=-24.289,P<0.01]。结论:AI辅助的半自动分割软件在肝脏血管瘤的分割中展现出良好的观察者内及观察者间的一致性,并显著提高了分割效率,减少了临床工作所需时间,有潜力成为临床随访和疗效评估的定量分析工具。

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。