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有症状的良性肝肿瘤患者手术切除的长期预后

Long-term outcomes of resection in patients with symptomatic benign liver tumours.

作者信息

van Rosmalen Belle V, Bieze Matthanja, Besselink Marc G H, Tanis Pieter, Verheij Joanne, Phoa Saffire S K S, Busch Olivier, van Gulik Thomas M

机构信息

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.

出版信息

HPB (Oxford). 2016 Nov;18(11):908-914. doi: 10.1016/j.hpb.2016.07.013. Epub 2016 Aug 21.

Abstract

BACKGROUND

Benign liver tumours (e.g., hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH), and haemangioma) are occasionally resected for alleged symptoms, although data on long-term outcomes is lacking. The aim of this cross-sectional study was to assess long-term outcomes of surgical intervention.

METHODS

Forty patients with benign tumours (HCA 20, FNH 12, giant haemangioma 4, cysts 4) were included. Patients filled in Validated McGill Pain Questionnaires, preoperatively and after a median of 54 months after resection. Outcomes were evaluated using paired sample t-test and (M) ANOVA.

RESULTS

Relief of symptoms sustained in 30/40 patients, within a follow-up of 54 (24-148) months after resection. VAS scores were reduced from 5.5 preoperatively to 1.6 postoperatively (p < 0.001). Patients with left-sided tumours had higher postoperative Pain Rating Index (PRI), compared to patients with right-sided tumours: 15.3 vs. 5.8 (p = 0.018). If patients could reconsider undergoing surgery, 34/38 would again choose resection. Discomfort at the operative scar was the most common complaint: 8/40 patients, all after open surgery, of whom 3/40 had an incisional hernia. 7/40 patients had a laparoscopic resection.

CONCLUSION

Resection relieved symptoms in 30/40 patients. The operative scar was a frequent source for remaining postoperative complaints, suggesting an advantage for a laparoscopic approach when feasible.

摘要

背景

良性肝肿瘤(如肝细胞腺瘤(HCA)、局灶性结节性增生(FNH)和血管瘤)有时会因所谓的症状而被切除,尽管缺乏长期预后的数据。这项横断面研究的目的是评估手术干预的长期预后。

方法

纳入40例患有良性肿瘤的患者(HCA 20例、FNH 12例、巨大血管瘤4例、囊肿4例)。患者在术前以及切除术后中位时间54个月后填写经过验证的麦吉尔疼痛问卷。使用配对样本t检验和(M)方差分析评估结果。

结果

在切除术后54(24 - 148)个月的随访期内,30/40例患者的症状得到缓解。视觉模拟评分(VAS)从术前的5.5降至术后的1.6(p < 0.001)。与右侧肿瘤患者相比,左侧肿瘤患者术后疼痛评级指数(PRI)更高:分别为15.3和5.8(p = 0.018)。如果患者可以重新考虑是否接受手术,34/38例患者会再次选择切除。手术瘢痕处不适是最常见的主诉:40例患者中有8例,均为开放手术后,其中40例中有3例发生切口疝。40例患者中有7例行腹腔镜切除术。

结论

40例患者中有30例切除术后症状得到缓解。手术瘢痕是术后持续不适的常见原因,这表明在可行的情况下,腹腔镜手术方法具有优势。

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