Borgonovo G, Razzetta F, Arezzo A, Torre G, Mattioli F
University of Genoa, Istituto di Clinica Chirurgica Generale, Italy.
Hepatogastroenterology. 1997 Jan-Feb;44(13):231-4.
The correct therapeutic strategy of giant hemangiomas of the liver is debated and based on two main techniques: resection and enucleation.
We report seven consecutive typical hepatic resections for giant cavernous hemangiomas in symptomatic patients. Most frequent symptom was pain at the right hypochondrium, associated with epigastric discomfort. Hepatectomy was carried out after extraparenchymal ligation of the hilary structures and parenchymal resection was performed with kellyclasia and ligation of the intraparenchymal vessels with clips. In all cases the resection was performed after intermittent clamping of the hepatic pedicle.
Three right hepatectomies, 1 right extended hepatectomy, 1 left hepatectomy and 2 left lobectomies (segments 2 and 3) were performed. Estimated blood loss ranged from 350 to 1000 ml with a mean loss of 550 ml. No major postoperative complication and no long term sequela occurred. Two episodes of cholangitis in an old patient after emergency operation regressed under medical treatment.
Enucleation is an option when a lesion is small and superficial. In the case of large and deep hemangiomas in proximity of vascular structures, typical liver resection is a safe operation entailing lower morbidity and blood loss.
肝巨大血管瘤的正确治疗策略存在争议，主要基于两种技术：切除和摘除。
我们报告了连续7例对有症状患者的典型肝巨大海绵状血管瘤进行肝切除的病例。最常见的症状是右季肋部疼痛，伴有上腹部不适。在肝门结构肝外结扎后进行肝切除术，采用钳夹法进行实质切除，并用钛夹结扎肝内血管。所有病例均在间歇性阻断肝蒂后进行切除。
进行了3例右半肝切除术、1例右扩大肝切除术、1例左肝切除术和2例左肝叶切除术（第2和3段）。估计失血量在350至1000毫升之间，平均失血量为550毫升。未发生重大术后并发症和长期后遗症。1例老年患者急诊手术后发生2次胆管炎，经药物治疗后好转。
当病变小且表浅时，摘除是一种选择。对于靠近血管结构的大而深的血管瘤，典型的肝切除术是一种安全的手术，发病率和失血量较低
