外科手术治疗肝脏血管瘤908例临床分析

摘要

目的 探讨肝血管瘤的最佳手术方式及时机.方法 回顾性分析解放军总医院1997年12月至2017年12月经手术治疗的908例肝血管瘤患者的临床资料,比较手术方式、肿瘤大小及介入栓塞治疗(TAE)对手术安全性的影响.结果 切除血管瘤的直径为(11.1±6.2) cm,最大为60 cm.585例(64.4％)患者进行了瘤体剥除术,323例(35.6％)患者进行了解剖性肝切除.共有6例(0.7％)患者死亡,严重并发症(Clavien-Dind0 3～5级)发生率为3.8％.瘤体剥除术的严重并发症发生率(2.7％)低于解剖性肝切除(5.6％,P＜0.05).当肿瘤最大径≥20 cm时,患者并发症发生率及病死率均高于＜ 20 cm组及＜10 cm组(P＜0.05).介入术后患者外科手术并发症率及病死率高于未行介入组(P＜0.05).结论 瘤体剥除术优于肝切除术.随着肿瘤增大,手术风险升高.对于增长趋势明显的肝脏大血管瘤,提倡及时手术处理.外科手术仍是治疗肝血管瘤的主要方法.%Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.