探讨腹腔镜肝切除术治疗肝血管瘤的安全性和疗效。

回顾性分析2010年1月至2018年1月在南通大学附属海安医院行腹腔镜肝切除术的58例肝血管瘤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男22例，女36例；年龄33～68岁，中位年龄48岁。肝血管瘤多发5例，单发53例。血管瘤直径为6～19 cm，位于肝Ⅱ～Ⅵ段。患者行腹腔镜非解剖性肝切除或解剖性肝切除。分析患者术中及预后情况。

58例患者1例中转开腹，另外57例顺利完成腹腔镜肝切除术。解剖性肝切除术24例，其中肝左外叶切除术15例，左半肝切除术3例，右半肝切除术2例，肝段切除术4例；非解剖性肝切除术33例。手术时间中位数为176（107～244）min，术中出血量372（190～553）ml。无围手术期死亡和术后腹腔内大出血、胆漏、肝衰竭等并发症发生。术后平均住院时间（7.1±2.3）d。术后病理检查示肝海绵状血管瘤。随访期间未发现血管瘤复发。

腹腔镜肝切除术治疗肝血管瘤安全、可行，疗效确切，具有恢复快、切口小等优势。

To evaluate the safety and clinical efficacy of laparoscopic hepatectomy in the treatment of hepatic hemangioma.

Clinical data of 58 patients with hepatic hemangioma who underwent laparoscopic hepatectomy in Hai'an People's Hospital Affiliated to Nantong University from January 2010 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 58 patients, 22 cases were male and 36 female, aged from 33 to 68 years with a median age of 48 years. 5 patients were diagnosed with multiple hepatic hemangiomas and 53 cases with single hepatic hemangioma. The diameter of hemangioma was 6-19 cm, and located at liver segments Ⅱ-Ⅵ. Laparoscopic non-anatomical or anatomical hepatectomy were performed in the patients. The intraoperative status and prognosis were analyzed.

One case was converted to open surgery, and the remaining 57 cases underwent laparoscopic hepatectomy successfully. Anatomical hepatectomy was performed in 24 cases including 15 cases left lateral lobectomy, 3 left hemihepatectomy, 2 right hemihepatectomy and 4 segmental hepatectomy. Non-anatomical hepatectomy was performed in 33 cases. The median operation time was 176 (107-244) min and the intraoperative blood loss was 372 (190-553) ml. No perioperative death, postoperative complication, such as massive intra-abdominal hemorrhage, bile leakage and liver failure, was observed. The average postoperative length of hospital stay was (7.1±2.3) d. Hepatic cavernous hemangioma was confirmed by postoperative pathological examination. No hemangioma recurrence was observed during the follow-up.

Laparoscopic hepatectomy is a safe, feasible and efficacious treatment for hepatic hemangioma, which possesses the advantages of rapid recovery and small incision, etc.