探讨手术切除治疗肝血管瘤的方法选择、疗效和安全性。

回顾性研究2000年1月至2011年12月在青海省人民医院行手术切除治疗，经病理检查证实为肝海绵状血管瘤的96例患者临床资料。其中男34例，女62例；年龄28~67岁,中位年龄47岁。肝血管瘤单发病灶者69例，多发病灶者27例。患者均签署知情同意书，符合医学伦理学规定。手术方法有肝血管瘤切除术或肝段切除、肝叶切除、半肝切除和肝血管瘤缝扎术。观察患者手术方式、术中出血量、术后并发症及复发情况。出院患者接受门诊随访，行肝脏超声检查以确诊有否血管瘤复发。

所有患者均顺利完成手术，未发生围手术期死亡。96例患者中，行肝血管瘤切除术68例，右半肝切除术3例，左半肝切除术1例，尾状叶切除术5例，其他肝段切除19例；其中27例多发病灶者先切除主要病灶，然后再采用肝血管瘤缝扎术处理较小病灶。术中出血量中位数为630（60~5700）ml。患者术后发生胸腔积液9例、胆漏3例、膈下积液2例、切口感染1例，均经保守治疗治愈。69例患者随访时间1~3年，未见复发。

手术切除是安全、有效的肝血管瘤治疗方法，其中肝血管瘤切除术最为常用。肝血管瘤缝扎术多用于多发性血管瘤主要病灶切除后对其余较小病灶的处理。

To discuss the selection of surgical procedure, the curative effect and the safety of resection for hepatic hemangioma.

Clinical data of 96 patients with pathologically confirmed hepatic hemangioma who received resection in the People's Hospital of Qinghai Province from January 2000 to December 2011, were analyzed retrospectively. There were 34 males and 62 females with the age of 28 to 67 years old and the median age of 47 years old. There were 69 patients with single lesion and 27 patients with multiple lesions. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received resection of hepatic hemangioma, or segmental hepatectomy, lobectomy, hemihepatectomy and hepatic hemangioma ligation. The procedure, intraoperative bleeding, postoperative complications and recurrence were observed. Patients were followed up after being discharged from hospital and liver ultrasonography was applied to check whether there was hemangioma recurrence.

All the patients underwent operation successfully without perioperative death. Of the 96 patients, 68 patients received resection of hepatic hemangioma, 3 patients underwent right hemihepatectomy, 1 patient underwent left hemihepatectomy, 5 patients underwent hepatic caudate labectomy, and 19 patients underwent segmental hepatectomy; 27 patients with multiple lesions underwent resection of major lesions firstly and then the smaller lesions were ligated. The median of intraoperative bleeding was 630(60-5700)ml. Pleural effusion was observed in 9 patients, bile leakage in 3 cases, subphrenic hydrops in 2 cases and incision infection in 1 case. All the patients were cured by conservative treatment. Sixty-nine patients were followed up for 1-3 years and no hemangioma recurrence was found.

Surgical resection is a safe and effective treatment for hepatic hemangioma, in which hemangioma resection is the most common approach. Liver hemangioma ligation is usually performed to deal with the smaller lesions in patients after the major lesions are resected.