腹腔镜下肝海绵状血管瘤剥离术25例报告  

Laparoscopic Decollement of Hepatic Cavernous Hemangioma: a Report of 25 Cases

作　　者：何晓军[1] 肖梅[1] 孔亚林[1] 张辉[1] 李文兵[1] 俆新保 张洪义[1] 

机构地区：[1]北京空军总医院肝胆外科,北京100036

出　　处：《中国微创外科杂志》2015年第5期385-388,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜肝海绵状血管瘤剥离术的可行性。方法 2009年11月~2014年2月对25例肝海绵状血管瘤行区域性肝门血流阻断,使用电凝刀、超声刀等进行切除,创面采用喷洒止血凝胶。结果 25例均成功完成手术,无术后并发症及死亡。手术时间（125.2±72.8）min,肝门阻断时间（40.7±20.2）min。术前储备自体血200~400 ml,术中自体血回收50~700 ml,未输异体红细胞,仅3例巨大血管瘤输血浆400 ml。放置引流管8例,术后第1天引流量10~200 ml,第3天引流量〈50 ml拔出引流管。术后第2天均可下地活动,术后住院时间（5.5±2.4）d。[ALT、AST、总胆红素和前白蛋白术后第1、3天与术前差异有统计学意义（P〈0.05）,术后1周与术前比较无统计学差异（P〉0.05）,即肝功能术后1周恢复至正常值范围之内。]25例随访6~18个月,平均11个月,1例合并系统性红斑狼疮复查仍有多发小血管瘤,余患者无复发。结论合理应用区域性肝门阻断技术,正确处理肝创面,腹腔镜肝海绵状血管瘤剥离术安全、可行。Objective To evaluate the feasibility of laparoscopic decollement of hepatic cavernous hemangioma . Methods Clinical data of 25 cases of laparoscopic decollement of hepatic cavernous hemangioma from November 2009 to February 2014 were analyzed.After regional portal blood stream block , an electronic knife and an ultrasound knife were used for resection of hemangioma and hemostatic gel was spayed on the surgical wound . Results The surgery was successful in all the 25 cases, without postoperative complications or death.The operative time was （125.2 ±72.8） min.The time of block was （40.7 ±20.2） min.Preoperative autologous blood reserve was 200 -400 ml.Intraoperative autologous blood harvesting was 50 -700 ml.The whole group had no allogeneic red blood cells transfusion , and 3 cases of giant hemangioma were given 400 ml plasma transfusion.The volume of postoperative drainage was 10-200 ml on the first postoperative day .In the second day after operation , all the patients could ambulate and the length of stay after operation was （5.5 ±2.4） d.Compared with preoperation , there were significant differences in ALT , AST, TBIL and prealbumin in 1 and 3 days after surgery （P〈0.05）, but there was no difference in 7 days after surgery （P〉0.05）.Liver function recovered to normal in 7 days after surgery .All the patients were followed for 6 -18 months （ mean, 11 months ） , during which, one patient complicated with systemic lupus erythematosus was found multiple small hemangioma , and the remaining patients had no relapse . Conclusion Laparoscopic decollement of hepatic cavernous hemangioma is safe and feasible if hepatic portal blood block technique is well used and the bleeding wound is treated correctly .

关 键 词：腹腔镜 肝切除术 肝血管瘤 

分 类 号：R735.7[医药卫生—肿瘤]