發(fā)布時(shí)間：2018-03-05 21:20

  本文選題：肝血管瘤　切入點(diǎn)：手術(shù)切除　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：[目的]通過(guò)對(duì)比分析手術(shù)切除(SR)與經(jīng)導(dǎo)管動(dòng)脈栓塞(TAE)兩種不同方法在肝血管瘤治療上的臨床療效,以制定對(duì)肝血管瘤比較合理的治療策略。[方法]收集昆明醫(yī)科大學(xué)第一附屬醫(yī)院(云大醫(yī)院)于2009年08月到2016年05月接收治療的86例肝血管瘤病患病例資料,其中手術(shù)切除治療患者45例,介入栓塞治療41例。并綜合最新發(fā)表的文獻(xiàn)信息總結(jié),從性別、年齡、肝血管直徑、手術(shù)操作時(shí)長(zhǎng)、失血量、住院時(shí)間、總費(fèi)用、并發(fā)癥、有效率等方面進(jìn)行統(tǒng)計(jì)分析。[結(jié)果]共納入研究對(duì)象86例,男性血管瘤患者21例,女患者65例,兩者比例為1:3.09。獨(dú)發(fā)血管瘤患者21例,多發(fā)患者64例,平均直徑是8.3±2.9cm,最大直徑20.0cm。手術(shù)切除治療組45例患者,男患者11例,女患者34位,比率為1:3.09,年齡29～63歲,平均年齡42.8±8.2歲。平均手術(shù)時(shí)間為(219.0±58.2)min,術(shù)中出血量(562.2 ± 636.1)ml,術(shù)后住院天數(shù)(17.3 ± 5.6)d,總住院費(fèi)用(34341.3±8093.3)元。19例出現(xiàn)并發(fā)癥,13例患者出現(xiàn)發(fā)熱,4例發(fā)生肺部感染,2例出現(xiàn)胸腔積液,7例出現(xiàn)輕重不一的切口液化或感染,術(shù)后隨訪(fǎng)無(wú)復(fù)發(fā)病例及死亡病例,19例患者有癥狀的患者有4位無(wú)明顯改善,總有效率88.9%。介入栓塞治療組41例,男性病患10例,女性病患31例,比例為1:3.11,年齡28～67歲,平均年齡44.6±8.8歲,平均手術(shù)時(shí)間為(94.7 ±18.2)min,術(shù)中出血量(5.7±2.0)ml,平均住院天數(shù)(7.9±2.3)d,總住院費(fèi)用(16071.5±2610.7)元。9例發(fā)生并發(fā)癥,此中7位患者介入治療后表現(xiàn)發(fā)熱,2例穿刺部位發(fā)生血腫、1人發(fā)生肺部感染,13例有癥狀患者有4個(gè)術(shù)后療效不明顯,總有效率82.9%,無(wú)死亡病例。普通血管瘤行手術(shù)治療與介入治療有效率分別是90.9%、84.8%。兩組病人在平均手術(shù)時(shí)間、在院時(shí)間、術(shù)中失血量、住院總費(fèi)用及并發(fā)癥發(fā)生率上差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在年齡、性別上差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1、臨床工作中應(yīng)該從嚴(yán)把握肝血管瘤的手術(shù)指征。2、對(duì)于直徑5～10cm有手術(shù)指征的大肝血管瘤,介入栓塞治療較手術(shù)切除更有優(yōu)勢(shì),值得推薦。3、對(duì)于直徑10cm的巨大的肝血管瘤,單純行介入栓塞治療療效欠佳,選擇行手術(shù)切除或先行介入栓塞治療,待瘤體縮小后再行手術(shù)切除治療,更為安全有效。
[Abstract]:[objective] to compare and analyze the clinical effects of two different methods of surgical resection and transcatheter arterial embolization (TAE) in the treatment of hepatic hemangioma. [methods] 86 patients with hepatic hemangioma received treatment from August 2009 to May 2016 in the first affiliated Hospital of Kunming Medical University (Yunda Hospital) were collected. Among them, 45 cases were treated by surgical resection and 41 cases were treated by interventional embolization. According to the newly published literature and information summary, from gender, age, diameter of hepatic vessels, length of operation, amount of blood loss, length of hospitalization, total cost, complications, The effective rate was statistically analyzed. [results] A total of 86 cases were included in the study, including 21 cases of male hemangioma and 65 cases of female. The ratio of the two was 1: 3.09. There were 21 patients with single hemangioma and 64 patients with multiple hemangioma. The mean diameter was 8.3 鹵2.9 cm, and the maximum diameter was 20.0 cm. In the surgical treatment group, there were 45 patients (11 males and 34 females) with a ratio of 1: 3.09 and an age of 2963 years. The average age was 42.8 鹵8.2 years, the average operative time was 219.0 鹵58.2 min, the intraoperative bleeding volume was 562.2 鹵636.1 ml, the postoperative hospital stay was 17.3 鹵5.6 days, the total hospitalization cost was 34341.3 鹵8093.3) yuan. 19 cases had complications, 13 cases had fever, 4 cases had pulmonary infection and 2 cases had pleural effusion. There were 7 cases of incision liquefaction or infection with different severity. The total effective rate was 88.90.There were 41 patients in the interventional embolization group, 10 males and 31 females, the proportion was 1: 3.11, age 2867.The total effective rate was 88. 97.The total effective rate was 88. 97.In the interventional embolization group, there were 10 male patients and 31 female patients, the proportion was 1: 3.11, and the total effective rate was 88. 9 years old. The average age was 44.6 鹵8.8 years, the average operative time was 94.7 鹵18.2min, the intraoperative bleeding volume was 5.7 鹵2.0ml, the average hospital stay was 7.9 鹵2.3 days, the total hospitalization cost was 16071.5 鹵2610.7yuan. Among them, 7 patients showed fever after interventional therapy, 2 patients had hematoma at puncture site, 1 patient had pulmonary infection and 13 patients had symptoms after interventional therapy, 4 of them had no obvious curative effect after operation. The total effective rate was 82.9 and there were no death cases. The effective rates of surgical treatment and interventional treatment were 90.9 and 84.8 respectively. There were significant differences in the total hospitalization expenses and the incidence of complications between the two groups (P 0.05). There was no significant difference in sex (P 0.05). [conclusion] 1. In clinical work, the surgical indications of hepatic hemangioma should be strictly grasped. For the large hepatic hemangioma with a diameter of 5 ~ 10 cm, interventional embolization is more advantageous than surgical resection. It is recommended that for the giant hepatic hemangioma with a diameter of 10 cm, the effect of interventional embolization is not good. It is more safe and effective to choose surgical resection or interventional embolization, and then to remove the tumor after the tumor has been reduced.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.7

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