肝血管瘤直径与手术风险的关系  

Relationship between diameter of liver hemangioma and operation risk

作　　者：肖年军 余强[1] 段伟东[1] 董家鸿[1] 

机构地区：[1]解放军总医院肝胆外科医院全军肝胆外科研究所,北京100853

出　　处：《中华消化外科杂志》2015年第9期737-740,共4页Chinese Journal of Digestive Surgery

基　　金：基金项目：国家科技部科技支撑计划项目（2012BA106801）

摘　　要：目的探讨肝血管瘤直径与手术风险的关系。方法回顾性分析2006年1月至2014年1月解放军总医院收治的362例肝血管瘤患者的临床资料。217例肿瘤直径为5-10cm肝血管瘤患者设为大血管瘤组，119例肿瘤直径〉10cm且〈20cm肝血管瘤患者设为巨大血管瘤组，26例肿瘤直径≥20cm肝血管瘤患者设为特大血管瘤组。手术方法包括开腹手术和腹腔镜手术，手术方式主要包括肝切除术和肝血管瘤剜除术。评价指标包括手术时间、术中出血量、术中输血例数、术后并发症例数、术后住院时间。计数资料比较采用，检验。正态分布的计量资料以面±s表示，多组间比较采用方差分析；偏态分布的计量资料以中位数M（P25，P75）表示，多组间比较采用Kruskal-Wallis检验，两两比较采用Mann—WhinetyU检验。结果362例患者均成功完成手术，无围术期死亡患者。其中行开腹手术315例（大血管瘤组175例、巨大血管瘤组114例、特大血管瘤组26例），行腹腔镜手术47例（大血管瘤组42例、巨大血管瘤组5例）。大血管瘤组、巨大血管瘤组、特大血管瘤组患者手术时间分别为160min（125min，205min）、220min（175min，275min）、330min（280min，420min），术中出血量分别为300mL（100mL，500mL）、500mL（300mL，1000mL）、1975mL（800mL，4000mL），术中输血例数分别为31、36、20例，术后并发症例数分别为5、5、7例，术后住院时间分别为8d（7d，9d）、9d（8d，10d）、11d（9d，13d），3组上述指标比较，差异均有统计学意义（矿=84．24，80．94，53．65，31．54，47．67，P〈0．05）。大血管瘤组与巨大血管瘤组患者手术时间、术中出血量、术中输血例数、术后住院时间比较，差异均有统计学意义（Z=6．39，6．51，x^2=11．29，Z=4．73，P〈0．05）；大血管瘤组与特大血管瘤组患者上述4项指标比较，差异均有统计学意义（Z=7．28，6Objective To explore the relationship between diameter of liver hemangioma and operation risk. Methods The clinical data of 362 patients with liver hemangioma who were admitted to the PLA General Hospital from January 2006 to January 2014 were retrospectively analyzed, All patients were divided into the 3 groups according to diameter of gross specimen, 217 with tumor diameter≥5 cm and ≤ 10cm in the large heman- gioma group, 119 with tumor diameter 〉 10 cm and ≤20 cm in the giant hemangioma group and 26 with tumor diameter ≥ 20 cm in the extremely large hemangioma group. The operation method included open surgery and lapa- roseopie surgery. Hepatectomy and enueleation of liver hemangioma were major operation procedures. The opera- tion time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, number of patients with postoperative complications and duration of hospital stay were evaluated. Count data were analyzed using the ehi-square test. Measurement data with normal distribution were presented as x± s, and comparison among groups was analyzed using the ANOVA. Skewed distribution data were described as M （P25, P75 ）,comparison among groups was analyzed by Kruskal-wallis test and pairwise comparison was done by the Mann- Whitney U test. Results All patients underwent operation successfully without perioperative death, including 315 receiving open surgery （175 in the large hemangioma group, 114 in the giant hemangioma group and 26 in the extremely large hemangioma group） and 47 receiving laparoscopic surgery （42 in the large hemangioma group and 5 in the giant hemangioma group）. The operation time, volume of intraoperative blood loss, number of patients with blood transfusion, number of patients with postoperative complications and duration of hospital stay were 160 minutes （125 minutes, 205 minutes） , 300 mL （100 mL, 500 mL） , 31, 5 and 8 days （7 days, 9 days） in the large hemangioma group, 220 minutes （175 minutes, 275 minutes）, 500

关 键 词：肝血管瘤 肝切除术 并发症 

分 类 号：R735.7[医药卫生—肿瘤]