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目的 :探讨肝海绵状血管瘤的外科诊治经验。方法 :本组 6 0例 ,肿瘤直径 <4 cm者 10例 ,肿瘤直径 4～10 cm37例 ,其中 4例行腹腔镜肝切除 (直径分别为 4、4、3.5、3cm)。肿瘤直径 10～ 34 cm13例 ,均行刮吸解剖法断肝。断肝时采用间歇性入肝血流阻断。结果 :6 0例中 4 8例出血量在 4 0 0～ 6 0 0 m l以下 ,其中 17例出血量非常少而未输血 ,10例出血量 4 0 0～ 6 0 0 m l,2例出血量各为 80 0 0 m l和 110 0 0 m l。术后均愈合 ,病理检查均为海绵状血管瘤。结论 :对于直径小于 4 cm的肝血管瘤 ,可观察 ,但位于第一二肝门的肝血管瘤 ,不论肿瘤大小 ,应早期手术切除。肿瘤较小 ,位置表浅者 ,可试行刮吸法腹腔镜肝切除 ,肿瘤巨大合并有临床症状者 ,采用刮吸解剖法进行断肝 ,断肝时采用间歇入肝血流阻断 ,肝内解剖清晰 ,出血量少 ,总阻断时间不受限制 ,可施行一系列高难度肝切除手术。
Objective: To investigate the surgical diagnosis and treatment of hepatic cavernous hemangioma. Methods: There were 60 cases in this group, 10 cases with tumor diameter less than 4 cm, and 37 cases with tumor diameter 4 ~ 10 cm. Among them, 4 cases underwent laparoscopic hepatectomy (diameter of 4, 4, 3.5 and 3 cm, respectively). Tumor diameter 10 ~ 34 cm13 cases, were scrape suction anatomical method to break the liver. Intermittent hepatic blood flow occlusion is used when breaking the liver. Results: The blood loss of 40 cases in 60 cases was less than 400 ~ 600 ml, of which 17 cases had very little blood loss without blood transfusion, 10 cases with blood loss of 400 ~ 600 ml and 2 cases with bleeding Each is 80 0 ml and 110 0 ml. All patients were healed after operation. The pathological examination was cavernous hemangioma. Conclusions: Hepatic hemangiomas less than 4 cm in diameter are observable, but hepatic hemangiomas located in the first two hilar, irrespective of tumor size, should be surgically removed early. Tumor smaller, superficial position, can be tested scratch suction laparoscopic hepatectomy, with huge clinical symptoms were merged, the use of scraping suction anatomical method to break the liver, intermittent hepatectomy when the blood flow is blocked, intrahepatic Anatomical clear, less bleeding, the total blocking time is not limited, can be a series of difficult liver resection surgery.