巨大肝血管瘤腹腔镜下血管瘤剥除术与解剖性肝切除术疗效比较

doi:10.3877/cma.j.issn.2095-3232.2025.06.011

目的

比较腹腔镜下血管瘤剥除术和解剖性肝切除术治疗巨大肝血管瘤的临床疗效。

方法

回顾性分析2017年1月至2024年4月绍兴文理学院附属中心医院收治的42例巨大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12例，女30例；年龄33~68岁，中位年龄54岁；肿瘤位于右半肝18例，左半肝24例。根据手术方式不同将患者分为切除组和剥除组，观察两组手术、肝功能、住院时间、住院费用、并发症发生情况。两组相关指标比较采用t检验、Mann-Whitney U检验，率的比较采用χ²检验或Fisher确切概率法。

结果

在右半肝血管瘤患者中，剥除组手术时间为（219±10） min，明显少于切除组的（417±10） min （t=2.48，P<0.05）；而两组术后ALT、AST、TB肝功能指标等比较差异均无统计学意义（P>0.05）。在左半肝血管瘤患者中，术中术后各项指标等比较差异无统计学意义（P>0.05）。42例患者无中转开腹，左半肝血管瘤术后无胆漏、出血、发热等术后并发症；右半肝血管瘤术后胆漏3例，其中切除组1例、剥除组2例，均经保守治疗治愈，无发热、腹腔感染等并发症发生。

结论

对于巨大肝血管瘤，腹腔镜下肝血管瘤剥除术可以最大程度保留正常肝组织，尤其是右半肝血管瘤，手术操作时间更短。

关键词: 腹腔镜, 肝血管瘤, 肝切除术, 剥除术, 解剖性肝切除术

Objective

To compare clinical efficacy between enucleation and anatomical resection in the treatment of giant hepatic hemangioma.

Methods

Clinical data of 42 patients with giant hepatic hemangiomas admitted to the Affiliated Central Hospital of Shaoxing University from January 2017 to April 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 30 female, aged from 33 to 68 years, with a median age of 54 years. 18 cases were diagnosed with hemangiomas in the right lobe and 24 cases in the left lobe. According to different surgical methods, all patients were divided into the resection and enucleation groups. The operation time, liver function, length of hospital stay, hospitalization expense and incidence of complications were observed between two groups. Relevant indexes between two groups were compared by t-test and Mann-Whitney U-test. The rate comparison was conducted by Chi-square test or Fisher's exact test.

Results

In patients with hemangiomas in the right lobe, the operation time in the enucleation group was (219±10) min, significantly shorter than (417±10) min in the resection group (t=2.48, P<0.05). However, no statistical significance was observed in liver function indexes such as ALT, AST and TB levels between two groups (all P>0.05). In patients with hemangiomas in the left lobe, no statistical significance was noted in all indexes during and after operation between two groups (all P>0.05). None of 42 cases was converted to open surgery. No postoperative complications such as bile leakage, bleeding and fever occurred in patients with hemangiomas in the left lobe. Postoperative bile leakage occurred in 3 cases of hemangiomas in the left lobe, including 1 case in the resection group and 2 in the enucleation group. All patients were cured by conservative treatment, and no complications such as fever and abdominal infection occurred.

Conclusions

For giant hepatic hemangioma, laparoscopic enucleation of hepatic hemangioma can preserve normal liver tissues to the largest extent, especially for the right hepatic hemangioma, and requires shorter operation time.

Key words: Laparoscopy, Hepatic hemangioma, Liver resection, Enucleation, Anatomical liver resection

图1 巨大肝血管瘤腹腔镜下血管瘤剥除与解剖性肝切除术中过程注：a为血管瘤剥除术中寻找合适的切入点；b为血管瘤剥除术中明确血管瘤包膜边界；c为肝切除术中逐步分离管道结构

表1 两组右半肝血管瘤患者一般资料比较

组别	例数	性别(男/女)	年龄(岁, $x ¯$ ±s)	BMI(kg/m², $x ¯$ ±s)	ASA分级(例, Ⅰ/Ⅱ级)	肿瘤直径(cm, $x ¯$ ±s)	AST(U/L, $x ¯$ ±s)	ALT(U/L, $x ¯$ ±s)	TB(μmol/L, $x ¯$ ±s)	PT(s, $x ¯$ ±s)	ALB(g/L, $x ¯$ ±s)
切除组	7	2/5	46±9	23.2±1.2	6/1	16.0±1.4	20.4±3.9	23.4±15.4	13.6±3.2	11.3±0.8	42.3±5.1
剥除组	11	2/9	50±10	23.6±1.4	9/3	14.4±2.7	24.8±11.7	27.8±21.2	13.7±7.8	11.1±1.3	43.1±2.4
统计值		-	t=-0.85	t=0.62	-	t=1.36	t=-0.95	t=-0.47	t=-0.40	t=0.37	t=-0.47
P值		>0.999	0.41	0.54	>0.999	0.19	0.36	0.64	0.97	0.71	0.64

表1 两组右半肝血管瘤患者一般资料比较

组别	例数	性别(男/女)	年龄(岁, $x ¯$ ±s)	BMI(kg/m², $x ¯$ ±s)	ASA分级(例, Ⅰ/Ⅱ级)	肿瘤直径(cm, $x ¯$ ±s)	AST(U/L, $x ¯$ ±s)	ALT(U/L, $x ¯$ ±s)	TB(μmol/L, $x ¯$ ±s)	PT(s, $x ¯$ ±s)	ALB(g/L, $x ¯$ ±s)
切除组	7	2/5	46±9	23.2±1.2	6/1	16.0±1.4	20.4±3.9	23.4±15.4	13.6±3.2	11.3±0.8	42.3±5.1
剥除组	11	2/9	50±10	23.6±1.4	9/3	14.4±2.7	24.8±11.7	27.8±21.2	13.7±7.8	11.1±1.3	43.1±2.4
统计值		-	t=-0.85	t=0.62	-	t=1.36	t=-0.95	t=-0.47	t=-0.40	t=0.37	t=-0.47
P值		>0.999	0.41	0.54	>0.999	0.19	0.36	0.64	0.97	0.71	0.64

表2 两组左半肝血管瘤患者一般资料比较

组别	例数	性别(男/女)	年龄(岁, $x ¯$ ±s)	BMI(kg/m², $x ¯$ ±s)	ASA分级(例, I/Ⅱ)	肿瘤直径[cm, M (Q₁, Q₃)]	AST[U/L, M (Q₁, Q₃)]	ALT[U/L, M (Q₁, Q₃)]	TB(μmol/L, $x ¯$ ±s)	PT[s, M (Q₁, Q₃)]	ALB(g/L, $x ¯$ ±s)
切除组	18	7/11	54±9	23.2±1.9	15/3	15 (14, 17)	18(15, 24)	16(11, 26)	12±5	11.6(10.7, 12.7)	40.5±3.3
剥除组	6	1/5	54±10	24.1±1.5	6/1	14(12, 16)	25(22, 31)	30(19, 35)	15±6	12.0 (11.6, 12.4)	39.8±1.7
统计值		-	t=0.05	t=1.05	-	Z=-0.64	Z=-1.80	Z=-1.70	t=-1.14	Z=-0.90	t=0.45
P值		0.62	0.96	0.30	>0.999	0.52	0.07	0.08	0.27	0.37	0.66

表2 两组左半肝血管瘤患者一般资料比较

组别	例数	性别(男/女)	年龄(岁, $x ¯$ ±s)	BMI(kg/m², $x ¯$ ±s)	ASA分级(例, I/Ⅱ)	肿瘤直径[cm, M (Q₁, Q₃)]	AST[U/L, M (Q₁, Q₃)]	ALT[U/L, M (Q₁, Q₃)]	TB(μmol/L, $x ¯$ ±s)	PT[s, M (Q₁, Q₃)]	ALB(g/L, $x ¯$ ±s)
切除组	18	7/11	54±9	23.2±1.9	15/3	15 (14, 17)	18(15, 24)	16(11, 26)	12±5	11.6(10.7, 12.7)	40.5±3.3
剥除组	6	1/5	54±10	24.1±1.5	6/1	14(12, 16)	25(22, 31)	30(19, 35)	15±6	12.0 (11.6, 12.4)	39.8±1.7
统计值		-	t=0.05	t=1.05	-	Z=-0.64	Z=-1.80	Z=-1.70	t=-1.14	Z=-0.90	t=0.45
P值		0.62	0.96	0.30	>0.999	0.52	0.07	0.08	0.27	0.37	0.66

表3 两组右半肝血管瘤患者手术相关指标及术后并发症比较

组别	例数	手术时间(min. $x ¯$ ±s)	术中出血量[ml, M (Q₁, Q₃)]	自体血回输(例)	异体输血(例)	术后ALT[U/L, M (Q₁, Q₃)]	术后AST[U/L, M (Q₁, Q₃)]	术后TB(μmol/L, $x ¯$ ±s)
切除组	7	417±10	800 (400, 2 500)	5	3	390 (167, 489)	203 (110, 215)	17±8
剥除组	11	219±10	500 (100, 1 000)	5	1	227 (150, 283)	83 (67, 162)	15±7
统计值		t=2.48	Z=-1.45	-	-	Z=-0.68	Z=-1.13	t=0.60
P值		0.02	0.14	0.37	0.25	0.50	0.19	0.56

表3 两组右半肝血管瘤患者手术相关指标及术后并发症比较

组别	例数	手术时间(min. $x ¯$ ±s)	术中出血量[ml, M (Q₁, Q₃)]	自体血回输(例)	异体输血(例)	术后ALT[U/L, M (Q₁, Q₃)]	术后AST[U/L, M (Q₁, Q₃)]	术后TB(μmol/L, $x ¯$ ±s)
切除组	7	417±10	800 (400, 2 500)	5	3	390 (167, 489)	203 (110, 215)	17±8
剥除组	11	219±10	500 (100, 1 000)	5	1	227 (150, 283)	83 (67, 162)	15±7
统计值		t=2.48	Z=-1.45	-	-	Z=-0.68	Z=-1.13	t=0.60
P值		0.02	0.14	0.37	0.25	0.50	0.19	0.56

表4 两组左半肝血管瘤患者手术相关指标及术后并发症比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M (Q₁, Q₃)]	自体血回输(例)	术后ALT[U/L, M (Q₁, Q₃)]	术后AST[U/L, M (Q₁, Q₃)]	术后TB (μmol/L, $x ¯$ ±s)
切除组	18	139±47	100 (28, 350)	3	76 (50, 119)	42 (26, 62)	15±6
剥除组	6	108±24	50 (30, 63)	0	55 (40, 93)	37 (33, 65)	15±5
统计值		t=1.52	Z=-1.14	-	Z=-0.76	Z=-0.16	t=0.03
P值		0.14	0.25	0.53	0.44	0.86	0.98

表4 两组左半肝血管瘤患者手术相关指标及术后并发症比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M (Q₁, Q₃)]	自体血回输(例)	术后ALT[U/L, M (Q₁, Q₃)]	术后AST[U/L, M (Q₁, Q₃)]	术后TB (μmol/L, $x ¯$ ±s)
切除组	18	139±47	100 (28, 350)	3	76 (50, 119)	42 (26, 62)	15±6
剥除组	6	108±24	50 (30, 63)	0	55 (40, 93)	37 (33, 65)	15±5
统计值		t=1.52	Z=-1.14	-	Z=-0.76	Z=-0.16	t=0.03
P值		0.14	0.25	0.53	0.44	0.86	0.98

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Comparison of clinical efficacy between laparoscopic enucleation and anatomical resection for giant hepatic hemangioma

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Comparison of clinical efficacy between laparoscopic enucleation and anatomical resection for giant hepatic hemangioma