探讨加速康复外科（ERAS）理念指导下腹腔镜肝巨大血管瘤剥除术的安全性和疗效。

回顾性分析2015年11月至2021年10月河北医科大学第二医院在ERAS理念指导下行腹腔镜肝巨大血管瘤剥除术的45例患者临床资料。其中男23例，女22例；平均年龄（57±10）岁；肝血管瘤直径（13.1±2.3）cm。Ⅰc型11例，Ⅱb型28例，Ⅱc型6例。患者均签署知情同意书，符合医学伦理学规定。围手术期采用ERAS措施促进患者康复，观察患者围手术期情况。

患者均顺利完成手术，无中转开腹，无发生术后出血、胆漏等严重并发症，无围手术期死亡。手术时间（162±45）min；45例均采用第一肝门阻断，阻断时间（32±5）min；术中出血量中位数280（200，353）ml；术中输血11例，最多者输注悬浮红细胞4 U。胃管、腹腔引流管均在术后1 d拔除；首次肛门排气时间（1.1±0.3）d；术后1 d视觉模拟评分法疼痛评分（2.8±0.7）分；术后住院时间（5.3±0.5）d；住院费用（4.6±0.4）万元；肝功能指标均于术后5~10 d恢复正常。随访期间均未见血管瘤复发。

ERAS理念指导下腹腔镜肝巨大血管瘤剥除术安全、可行，具有手术创伤小、恢复速度快等优势。

To evaluate the safety and efficacy of laparoscopic resection for giant liver hemangioma guided by the concept of enhanced recovery after surgery (ERAS).

Clinical data of 45 patients who underwent ERAS concept-guided laparoscopic resection of giant liver hemangioma in the Second Hospital of Hebei Medical University from November 2015 to October 2021 were retrospectively analyzed. Among them, 23 patients were male and 22 female, aged (57±10) years on average. The diameter of liver hemangioma was (13.1±2.3) cm. 11 patients were classified as type Ⅰc, 28 cases of type Ⅱb and 6 cases of type Ⅱc. The informed consents of all patients were obtained and the local ethical committee approval was received. Perioperatively, ERAS protocol was adopted to promote the recovery of patients, and perioperative conditions of patients were observed.

All patients successfully completed the surgery without conversion to open surgery. No postoperative bleeding, bile leakage or other severe complications occurred. No perioperative death was observed. The operation time was (162±45) min. 45 patients received occlusion of the porta hepatis and the occlusion time was (32±5) min. The median intraoperative blood loss was280 (200, 353) ml. Intraoperative blood transfusion was performed in 11 cases, and the the largest transfusion amount was 4 U suspended red blood cells. The gastric and abdominal drainage catheters were removed at postoperative 1 d. The first anal exhaust time was (1.1±0.3) d. At postoperative 1 d, the visual analogue scale (VAS) pain score was 2.8±0.7. The length of postoperative hospital stay was (5.3±0.5) d. The hospitalization expense was (4.6±0.4)×10⁴ yuan. Liver function indexes were restored to normal at postoperative 5-10 d. No recurrence of hemangioma was found during the postoperative follow-up.

ERAS concept-guided laparoscopic resection of giant liver hemangioma is safe and feasible, which yields slight trauma and accelerates postoperative recovery.