Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
Departments of Laboratory Medicine, the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, 430014, China.
Surg Endosc. 2024 Jul;38(7):3957-3966. doi: 10.1007/s00464-024-10950-4. Epub 2024 Jun 6.
Severe bleeding remains a significant concern in laparoscopic resection for hepatic hemangioma. It is rarely reported that how the degree of major vessels involvement impacts on severe bleeding. The present study primarily aimed to analyze the impacts of the number of involved major vessels (NIMV) during laparoscopic surgery for hepatic hemangioma and evaluate the risk factors associated with increased bleeding.
A database search was carried out for consecutive patients who underwent laparoscopic resection for liver hemangiomas at our department from January 2018 to December 2023. The collected data included demographics, characteristics of the hemangiomas, laboratory data, operation method, surgical and postoperative variables.
A total of 72 patients were enrolled in the study. 42 patients were categorized into the group with NIMV < 2, while 30 patients were divided into the group with NIMV ≥ 2. The group with NIMV ≥ 2 demonstrated a significant correlation with special segments, involved multiple segments and diameter of the hemangiomas (P < 0.01). And the perioperative variables including the extent of resection, operative time, blood loss, Pringle maneuver times, postoperative stay, drainage tube duration, and postoperative liver function (ALT, AST) also showed significant differences between the two groups (P < 0.05). Notably, NIMV ≥ 2 was identified as the most important independent risk factor for intraoperative blood loss ≥ 500 ml in laparoscopic surgery for hepatic hemangioma (P = 0.011). For NIMV ≥ 2, the independent risk factor was special segments in multivariate analysis (P = 0.000).
The involvement of multiple major vessels (NIMV ≥ 2) was significantly associated with special segments, resulting in increased intraoperative blood loss, operation difficulty, and delayed postoperative recovery. Moreover, it was identified as the single independent risk factor with a considerable risk for increased blood loss during laparoscopic resection for hepatic hemangioma.
肝血管瘤腹腔镜切除术中严重出血仍然是一个重要问题。术中涉及主要血管的程度如何影响严重出血的报道很少。本研究主要旨在分析肝血管瘤腹腔镜手术中涉及的主要血管数量（NIMV）对严重出血的影响，并评估与出血增加相关的危险因素。
对 2018 年 1 月至 2023 年 12 月在我科行腹腔镜肝血管瘤切除术的连续患者进行数据库检索。收集的数据包括人口统计学、血管瘤特征、实验室数据、手术方法、手术和术后变量。
共纳入 72 例患者。42 例患者分为 NIMV<2 组，30 例患者分为 NIMV≥2 组。NIMV≥2 组与特殊节段、多节段受累和血管瘤直径有显著相关性（P<0.01）。两组之间围手术期变量包括切除范围、手术时间、出血量、Pringle 操作次数、术后住院时间、引流管时间和术后肝功能（ALT、AST）也有显著差异（P<0.05）。值得注意的是，NIMV≥2 是腹腔镜肝血管瘤切除术术中出血量≥500ml 的最重要独立危险因素（P=0.011）。对于 NIMV≥2，多变量分析的独立危险因素是特殊节段（P=0.000）。
多支主要血管受累（NIMV≥2）与特殊节段显著相关，导致术中出血量增加、手术难度增加和术后恢复延迟。此外，它被确定为腹腔镜肝血管瘤切除术中出血增加的单一独立危险因素，具有相当大的风险。
