Ho Hui-Yu, Wu Tsung-Han, Yu Ming-Chin, Lee Wei-Chen, Chao Tzu-Chieh, Chen Miin-Fu
Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2012 Jan-Feb;35(1):70-8. doi: 10.4103/2319-4170.106164.
Hepatic hemangiomas are the most common benign hepatic tumors, and they are usually asymptomatic with normal liver function. When hepatic hemangiomas reach 4 cm, we define them as giant hemangiomas. Treatment options for giant hemangiomas are observation, surgical resection, and transcatheter arterial embolization. The aim of this study was to identify the risk factors for surgical complications.
In this study, the records of 61 patients with giant hepatic hemangiomas treated with surgical resection at Chang Gung Memorial Hospital, Linkou were retrospectively reviewed. Data on clinical variables including symptoms, the size, number, and location of the tumors, preoperative liver function tests, operative method, operation time, and operative blood loss were collected and analyzed.
There were 8 patients (13.1%, 95% confidence interval 5.8% to 24.2%) with complications after resection or enucleation. Postoperative complications were associated with large tumor size (p = 0.021) and tumors that were symptomatic (p = 0.017). In addition, complications were associated with greater use of intraoperative inflow control (p = 0.053), longer operative time (p = 0.001), and greater intraoperative blood loss (p = 0.022). Most complications could be treated conservatively, but invasive interventions such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage were required for management of grade III complications.
Most giant hepatic hemangiomas can be treated with enucleation or resection. Important factors associated with complications were large tumor size, the presence of symptoms, surgical bleeding, and prolonged surgery. Most complications were grade I and could be treated conservatively. Both resection and enucleation were relatively safe with an acceptable complication rate (13.1%) and no mortality in our study.
肝血管瘤是最常见的肝脏良性肿瘤，通常无症状且肝功能正常。当肝血管瘤直径达到4厘米时，我们将其定义为巨大血管瘤。巨大血管瘤的治疗选择包括观察、手术切除和经导管动脉栓塞术。本研究的目的是确定手术并发症的危险因素。
本研究回顾性分析了长庚纪念医院林口院区61例行手术切除的巨大肝血管瘤患者的病历。收集并分析了包括症状、肿瘤大小、数量和位置、术前肝功能检查、手术方式、手术时间和术中失血量等临床变量的数据。
8例患者（13.1%，95%置信区间5.8%至24.2%）在切除或摘除术后出现并发症。术后并发症与肿瘤体积大（p = 0.021）和有症状的肿瘤（p = 0.017）有关。此外，并发症还与术中更多地使用入流控制（p = 0.053）、更长的手术时间（p = 0.001）和更多的术中失血量（p = 0.022）有关。大多数并发症可以保守治疗，但III级并发症的处理需要侵入性干预，如内镜逆行胰胆管造影和经皮经肝胆管引流。
大多数巨大肝血管瘤可以通过摘除或切除进行治疗。与并发症相关的重要因素包括肿瘤体积大、有症状、手术出血和手术时间延长。大多数并发症为I级，可以保守治疗。在我们的研究中，切除和摘除都相对安全，并发症发生率可接受（13.
