探讨腹腔镜手术治疗肝巨大血管瘤的手术策略及疗效。

回顾性分析2017年1月至2021年5月深圳大学第一附属医院行腹腔镜手术治疗的32例肝巨大血管瘤患者临床资料。其中男13例，女19例；平均年龄（41±8）岁。肝功能Child-Pugh分级均为A级；ICGR15为0.043±0.004；肝血管瘤直径（11.6±1.2）cm；Ⅰc型23例，Ⅱb型6例，Ⅱc型3例。患者均签署知情同意书，符合医学伦理学规定。观察患者手术及术后并发症发生情况。

顺利完成腹腔镜手术28例，其中肝血管瘤剥除术10例，非解剖性肝切除术7例，解剖性肝切除术11例；中转开腹4例。腹腔镜手术时间（168±7）min，术中出血量中位数240（50~420）ml，术中输血3例。23例Ⅰc型单发巨大血管瘤，主要选择肝血管瘤剥除术。9例Ⅱ型多发肿瘤，均优先剥除或切除直径最大的主瘤体。11例患者主瘤体位于左半肝采用解剖性肝切除，5例主瘤体位于右半肝和3例主瘤体位于左半肝患者采用非解剖性肝切除，其余13例患者主瘤体位置较深或靠近重要解剖位置则采用血管瘤剥除术。术后住院时间（7.3±1.9）d。术后发生并发症4例，其中胆漏1例，胸腔积液3例，引流后痊愈。术后随访未见肝血管瘤复发。

腹腔镜手术治疗肝巨大血管瘤创伤小、恢复快、安全有效，术中应根据血管瘤分型、位置等选择合理术式，积极预防术中出血，以保证手术安全。

To investigate surgical strategy and clinical efficacy of laparoscopic surgery for giant hepatic hemangioma.

Clinical data of 32 patients with giant hepatic hemangioma who underwent laparoscopic surgery in the First Affiliated Hospital of Shenzhen University from January 2017 to May 2021 were retrospectively analyzed. Among them, 13 patients were male and 19 female, aged (41±8) years on average. Preoperative liver function of all patients was classified as Child-Pugh A. ICGR15 was 0.043±0.004. The diameter of hepatic hemangioma was (11.6±1.2) cm. 23 cases were classified as type Ⅰc, 6 cases of type Ⅱb and 3 cases of type Ⅱc. The informed consents of all patients were obtained and the local ethical committee approval was received. The incidence of intraoperative and postoperative complications was observed.

28 patients successfully underwent laparoscopic surgery, including 10 cases of hepatic hemangioma dissection, 7 cases of non-anatomical resection and 11 cases of anatomical resection.4 cases were converted to open surgery. The laparoscopic operation time was (168±7) min and the median intraoperative blood loss was 240(50-420) ml. Intraoperative blood transfusion was performed in 3 cases. 23 patients with single giant type Ⅰc hemangioma mainly underwent hepatic hemangioma dissection. In9 cases with multiple type Ⅱ hemangioma, the main tumor with the largest diameter was dissected or resected primarily. 11 patients with the main tumor located in the left liver lobe received anatomical hepatectomy,5 cases with the main tumor located in the right liver lobe and 3 cases with the main tumor located in the left lobe received non-anatomical hepatectomy, and the remaining 13 cases with the main tumor deeply located or adjacent to vital anatomical sites underwent hepatic hemangioma dissection. The length of postoperative hospital stay was (7.3±1.9) d. 4 patients developed postoperative complications including bile leakage in 1 case and pleural effusion in 3 cases, and all were cured after drainage. No recurrence of hepatic hemangioma was noted during postoperative follow-up.

Laparoscopic surgery is a safe and efficacious procedure for giant hepatic hemangioma, which yields slight trauma and prompt recovery. Proper surgical methods should be selected according to the classification and location of hemangioma. Active interventions should be delivered to prevent the intraoperative bleeding and guarantee the safety of surgery.