Hazinedaroglu Selcuk Mevlut, Kayaoglu Huseyin Ayhan, Ali Yerdel Mehmet
Department of Surgery, Ankara University Medical School, Ankara, Turkey.
Dig Dis Sci. 2006 Jul;51(7):1213-7. doi: 10.1007/s10620-006-8035-6.
Two centrally located giant hepatic hemangiomas were referred with severe pain, one of which had a protruding abdominal mass was listed for transplantation at another center. Tumors were 35 and 30 cm at their longest diameter. One was centrally located involving the hilum and segments VI/VII and II/III were partially spared. Volumetric analysis and imaging suggested enucleation is feasible if the left lateral segment and the right posterior sector are left intact. Operation was straightforward except few breaks in enucleation technique in an effort to secure the venous drainage of the remnant liver. She had an uneventful recovery except a biliary fistula through the operatively severed left hepatic duct, which was repaired over a stent. This was managed by lateral segmentectomy and resection of the fistula after the enlargement of the right posterior sector was confirmed volumetrically. The other tumor-involved segments II, III, IV, V, and VIII and the hilum were totally hemangiomatic. Enucleation and postoperative recovery was uneventful. The era of liver transplantation enhanced our knowledge about complex liver surgery and these cases are good examples about the feasibility of enucleation even in extremely complicated liver hemangiomas saving both the patients and a donor liver.
两名患有严重疼痛的中央型巨大肝血管瘤患者前来就诊，其中一名患者有突出的腹部肿块，已在另一家中心登记等待移植。肿瘤最长直径分别为35厘米和30厘米。其中一个位于中央，累及肝门，Ⅵ/Ⅶ段和Ⅱ/Ⅲ段部分未受影响。体积分析和影像学检查表明，如果左侧叶和右后叶保持完整，摘除术是可行的。手术过程顺利，只是在摘除技术上有几次失误，以确保剩余肝脏的静脉引流。她恢复得很顺利，只是通过手术切断的左肝管出现了胆瘘，通过支架修复。在通过体积测量确认右后叶增大后，通过左外叶切除术和瘘管切除术进行了处理。另一个肿瘤累及Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅷ段以及肝门，完全为血管瘤样。摘除术和术后恢复均顺利。肝移植时代增进了我们对复杂肝脏手术的了解，这些病例很好地说明了即使是极其复杂的肝血管瘤，摘除术也是可行的，既挽救了患者，又节省了供肝。
