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

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

Abstract

Abstract:

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

Hongjun Huang, Zhiqiang Huang, Minjie Lin, Xingcheng Meng, Zhiming Wu, Jiangtao Li. Comparison of clinical efficacy between laparoscopic enucleation and anatomical resection for giant hepatic hemangioma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 882-887.

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Figures/Tables 5

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

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

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

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

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

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

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

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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