腹腔镜辅助下血管瘤剥除术与解剖性肝切除术治疗巨大肝血管瘤疗效比较  

Comparison of laparoscopic assisted hemangioma removal and anatomical hepatectomy in the treatment of patients with huge hepatic hemangioma

作　　者：贾江坤[1] 余淼[1] 贾萌[1] 徐健[1] 王佳佳[1] 宋红霞[1] 申权[1] 薛焕洲[1] 陈旭晓 Jia Jiangkun;Yu Miao;Jia Meng(Department of Hepatobiliary and Pancreatic Surgery,Provincial People's Hospital,Affiliated to Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学河南省人民医院肝胆胰腺外科,郑州市450000 [2]上海交通大学医学院附属瑞金医院普外科

出　　处：《实用肝脏病杂志》2024年第2期287-290,共4页Journal of Practical Hepatology

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20220019)

摘　　要：目的比较腹腔镜辅助下血管瘤剥除术与解剖性肝切除术治疗巨大肝血管瘤(HH)患者的疗效。方法2020年1月~2022年6月我院诊治的HH患者68例,接受腹腔镜下血管瘤剥除术治疗34例,接受腹腔镜下解剖性肝切除术治疗34例。常规检测血生化指标。结果剥除组手术时间、术中出血量、腹腔引流量和住院花费分别为(144.6±37.2)min、(402.3±132.5)mL、(257.2±48.6)mL和(3.2±0.7)万元,均显著短于或低于切除组【分别为(169.5±42.8)min、(537.4±155.8)mL、(335.4±71.2)mL和(3.6±0.6)万元,P<0.05】;在术后3 d,剥除组血清ALT和AST水平分别为(71.6±14.8)U/L和(48.8±9.2)U/L,均显著低于切除组【分别为(83.1±15.7)U/L和(57.6±10.6)U/L,P<0.05】;术后,剥除组出现胸腔积液、切口液化、切口感染和胆漏等并发症发生率为17.6%,与切除组的26.5%比,无显著性统计学差异(P>0.05)。结论采取腹腔镜辅助下血管瘤剥除术与解剖性肝切除术治疗巨大HH均为有效的手术方案,但血管瘤剥除术更有利于缩短手术时间,减少出血量和腹腔引流量,可根据情况适当选择。Objective This study was conducted to observe the efficacy of laparoscopic assisted hemangioma removal and anatomical hepatectomy in the treatment of patients with huge hepatic hemangioma(HH).Methods 68 patients with huge HH were encountered in our hospital between January 2020 and June 2022,and the enrolled patients had HH with diameter≥10 cm.They were divided into two groups,with 34 cases in each,receiving laparoscopic peeling off tumors or anatomical hepatectomy for removal of the tumors.The BK-200 automatic biochemical analyzer was used to detect the liver function tests.Results The operation time,intraoperative blood loss,peritoneal drainage and hospitalization cost in patients with peeling off tumor treatment were(144.6±37.2)min,(402.3±132.5)mL,(257.2±48.6)mL and(32000±700)yuan,all significantly shorter or less than[(169.5±42.8)min,(537.4±155.8)mL,(335.4±71.2)mL and(36000±6000)yuan,respectively,P<0.05]in patients receiving anatomical hepatectomy;at day three after operation,serum alanine aminotransferase and aspartate aminotransferase levels in patients receiving peeling off tumors were(71.6±14.8)U/L and(48.8±9.2)U/L,both significantly lower than[(83.1±15.7)U/L and(57.6±10.6)U/L,respectively,P<0.05]in patients underwent anatomical hepatectomy;post-operationally,the incidence of complications,such as pleural effusion,incision liquefaction or infection and biliary leakage in patients receiving peeling off tumors was 17.6%,not significantly different compared to 26.5%in patients underwent anatomical hepatectomy(P>0.05).Conclusion The laparoscopic assisted hemangioma peeling and anatomical hepatectomy in treatment of patients with giant HH are both efficacious,and we recommend the peeling off operation,which might shorten the operation time,reduce blood loss with less liver injury.

关 键 词：肝血管瘤 腹腔镜 血管瘤剥除术 解剖性肝切除术 治疗 

分 类 号：R735.7[医药卫生—肿瘤]