Bornman P C, Terblanche J, Blumgart R L, Jones E P, Pickard H, Kalvaria I
Surgery. 1987 Apr;101(4):445-9.
This report describes four cases of surgically treated giant hepatic hemangiomas which illustrate some diagnostic and therapeutic difficulties encountered in the management of this condition. An important diagnostic triad has emerged, which should alert the physician to the possibility of a complicated hepatic hemangioma: the clinical signs of an acute inflammatory liver process contrasted with a normal white blood cell count and liver function tests. Hemangiomas of the left lobe were either missed or poorly demonstrated on selective hepatic angiographic examination, and in two patients the diagnosis was made only at the time of laparotomy. Hepatic resection was successfully performed in all patients; there was minimal morbidity and none of the patients died. In two patients with multiple hemangiomas, only symptomatic or easily resectable lesions were removed. All patients are alive and well; three have been followed up for more than 5 years. We conclude that resection in asymptomatic cases should be carried out only in those cases that require a diagnostic laparotomy and in those where the lesion is easily resectable. The majority of patients with symptomatic and complicated tumors should undergo resection, but even in these patients continued conservative treatment is appropriate when the risk of major resection outweighs the small risk of live-threatening bleeding.
本报告描述了4例经手术治疗的巨大肝血管瘤病例，这些病例说明了在处理这种疾病时遇到的一些诊断和治疗难题。一个重要的诊断三联征已经出现，它应提醒医生注意复杂肝血管瘤的可能性：急性炎症性肝病变的临床体征与正常的白细胞计数及肝功能检查结果形成对比。左叶血管瘤在选择性肝血管造影检查中要么被漏诊，要么显示不佳，在2例患者中，仅在剖腹手术时才做出诊断。所有患者均成功实施了肝切除术；发病率极低，且无患者死亡。在2例患有多发性血管瘤的患者中，仅切除了有症状的或易于切除的病变。所有患者均存活且情况良好；3例患者已随访5年以上。我们得出结论，无症状病例的肝切除术仅应在那些需要诊断性剖腹手术的病例以及病变易于切除的病例中进行。大多数有症状和复杂肿瘤的患者应接受切除术，但即使在这些患者中，当大手术切除的风险超过危及生命的小出血风险时，持续的保守治疗也是合适的。
