新生儿期肝脏巨大血管瘤的外科诊治  

Surgical diagnosis and treatment of neonatal giant hepatic hemangioma

作　　者：陈子民[1] 叶明[1] 叶晓烁[1] 孙俊 高家辉 吴宙光[1] CHEN Zimin;YE Ming;YE Xiaoshuo;SUN Jun;GAO Jiahui;WU Zhouguang(WardⅡof General Surgery,Shenzhen Children’s Hospital,Shenzhen,Guangdong 518026,China)

机构地区：[1]深圳市儿童医院普外二科,广东深圳518026

出　　处：《安徽医药》2022年第7期1360-1363,共4页Anhui Medical and Pharmaceutical Journal

基　　金：深圳市医疗卫生三名工程(SZSM201812055)。

摘　　要：目的 探讨总结新生儿肝脏巨大血管瘤的外科诊治经验。方法 回顾深圳市儿童医院2014—2018年收治并采用外科手术治疗的8例新生儿肝脏巨大血管瘤病例,分析其临床资料和外科治疗效果。结果 8例新生儿肝脏血管瘤首诊症状包括腹部包块、黄疸。1例合并破裂出血、6例合并动静脉瘘及严重的心衰表现,1例合并呼吸衰竭。全部病例产后超声和CT检查均有典型的血管瘤表现,单个病灶直径在6.5~10 cm。所有病儿均接受手术并完整切除,1例术后1 d出现胆漏,其他远期并发症随访期间尚未发现,手术效果良好。术后病理报告海绵状血管瘤5例,血管内皮瘤3例。术后随访3~52个月,复查肿瘤均未复发,甲胎蛋白(AFP)恢复正常,所有病儿生长发育同正常儿。结论 新生儿肝脏巨大血管瘤可通过临床表现、超声和CT检查明确诊断。合并内科治疗棘手的破裂出血所致休克、心衰或者呼吸衰竭病儿,紧急手术治疗新生儿肝脏血管瘤是可行的,疗效满意。Objective To explore the experience of surgical diagnosis and treatment of neonatal giant hepatic hemangioma.Methods Eight cases of neonatal hepatic giant hemangioma who were admitted and treated surgically in Shenzhen Children’s Hospital from 2014 to2018 were retrospectively reviewed,and their clinical data and surgical treatment effects were analyzed.Results The first symptoms of 8neonates with hepatic hemangioma included abdominal mass and jaundice.One case was complicated with rupture and bleeding,6 cases with arteriovenous fistula and severe heart failure,1 case with respiratory failure.Postpartum ultrasound and CT examination showed typical hemangioma in all cases,with the diameter of single lesion ranging from 6.5 to 10 cm.All the children patients underwent surgery and complete resection.One case developed biliary fistula one day after the operation,but other long-term complications were not found during the follow-up period,and the operation effect was good.Postoperative pathology revealed 5 cases of cavernous hemangioma and 3 cases of hemangioendothelioma.Postoperative follow-up was conducted for 3~52 months,and the tumors were not recurred,alpha-fetoprotein(AFP) returned to normal,and all the children patients grew and developed as normal.Conclusions Neonatal giant hepatic hemangioma can be diagnosed by clinical manifestations,ultrasonography and CT.Combined with intractable shock caused by rupture,heart failure or respiratory failure,emergency surgery for neonatal giant hepatic hemangioma is feasible and effective.

关 键 词：肝肿瘤 肝切除术 血管瘤 肝肿大 动静脉瘘 婴儿 新生 

分 类 号：R735.7[医药卫生—肿瘤]