Karahasanoglu T, Altinli E, Ergüney S, Ertem M, Numan F
Department of General Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
Surg Endosc. 2001 Dec;15(12):1489. doi: 10.1007/s004640042034.
The cavernous hemangioma is the most common benign tumor of the liver. It usually becomes symptomatic as it reaches a certain size. A 49-year-old man was admitted with a 1-year history of epigastric pain, which was not relieved by regular analgesic intake, and nausea. The results of physical examination, routine laboratory tests, and upper gastrointestinal tract endoscopy were normal. Ultrasonography showed a 10-cm mass in the left hepatic lobe. Magnetic resonance imaging (MRI) showed a 90-mm hemangioma at left hepatic lobe. Selective celiac arteriogram was performed, and polyvinyl alcohol particles were used as an embolizing agent. After the embolization, the patient underwent laparoscopic enucleation of the liver hemangioma. No blood transfusion was needed during the operation. The operative time was 75 min. The patient was allowed to take a clear liquid diet on the postoperative day 1. The postoperative course of the patient was uneventful, and he was discharged on the postoperative day 2. Enucleation is the best surgical technique for the management of symptomatic giant hemangiomas. It can be performed with no mortality or morbidity, with preservation of all normal liver parenchyma. Enucleation also has been associated with significantly fewer intraabdominal complications than anatomic resection. The laparoscopic approach for enucleation requires patience and careful dissection to prevent bleeding. In conclusion, laparoscopic enucleation of hemangiomas is safe and easy to perform in selected cases.
海绵状血管瘤是肝脏最常见的良性肿瘤。通常当它长到一定大小时会出现症状。一名49岁男性因上腹部疼痛1年入院，规律服用镇痛药不能缓解，伴有恶心。体格检查、常规实验室检查及上消化道内镜检查结果均正常。超声检查显示左肝叶有一个10厘米的肿块。磁共振成像（MRI）显示左肝叶有一个90毫米的血管瘤。进行了选择性腹腔动脉造影，使用聚乙烯醇颗粒作为栓塞剂。栓塞后，患者接受了腹腔镜下肝血管瘤摘除术。手术过程中无需输血。手术时间为75分钟。患者术后第1天允许进食清流食。患者术后恢复顺利，术后第2天出院。摘除术是治疗有症状的巨大血管瘤的最佳手术技术。它可以在不导致死亡或发病的情况下进行，能保留所有正常肝实质。与解剖性切除相比，摘除术还与显著更少的腹腔内并发症相关。腹腔镜摘除术需要耐心和仔细的解剖以防止出血。总之，在特定病例中，腹腔镜下血管瘤摘除术安全且易于实施。
