【摘要】：目的探討肝切除術(shù)與包膜外剝脫術(shù)在肝巨大血管瘤切除術(shù)中的應(yīng)用價(jià)值,為肝巨大血管瘤的外科手術(shù)治療提供指導(dǎo)。方法本研究回顧性分析2010年6月到2015年6月寧夏自治區(qū)人民醫(yī)院總院和寧夏醫(yī)科大學(xué)附屬醫(yī)院肝膽外科74例肝巨大血管瘤患者的病歷資料。其中行肝切除術(shù)37例(肝切組),行包膜外剝脫術(shù)37例(剝脫組)。比較兩組患者術(shù)前一般情況,術(shù)中手術(shù)時(shí)間(h)、術(shù)中出血量(ml)、術(shù)中輸血量(ml)、肝血流阻斷時(shí)間(min)、住院天數(shù)(d)等情況。術(shù)后主要觀察兩組患者術(shù)后胸腔積液、膽漏、腹腔出血等并發(fā)癥發(fā)生情況。術(shù)后隨訪患者癥狀改善及血管瘤復(fù)發(fā)情況。結(jié)果剝脫組患者的手術(shù)時(shí)間[(2.38±0.93)h)]、術(shù)中出血量[(889.19±756.37)ml]、術(shù)中輸血量[(723.78±801.14)ml]、肝血流阻斷時(shí)間[(22.48±10.87)min]、住院天數(shù)[(14.84±3.24)d]均低于肝切組手術(shù)時(shí)間[(3.26±1.16)h)]、術(shù)中出血量[(1551.35±1755.88)ml]、術(shù)中輸血量[(1693.24±2117.72)ml]、肝血流阻斷時(shí)間[(26.84±17.30)min]、住院時(shí)間[(16.19±5.01)d],差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。剝脫組胸腔積液發(fā)生率低于肝切組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者在膽漏、腹腔出血、患者死亡等并發(fā)癥方面比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后隨訪死亡率、癥狀改善、血管瘤復(fù)發(fā)等無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論肝切除術(shù)和包膜外剝脫術(shù)都是治療肝巨大血管瘤的有效術(shù)式。肝巨大血管瘤包膜外剝脫術(shù)在手術(shù)時(shí)間、術(shù)中出血量、術(shù)中輸血量、肝血流阻斷時(shí)間及住院天數(shù)方面明顯優(yōu)于肝切組,該術(shù)式術(shù)后并發(fā)癥發(fā)生率低。肝巨大血管瘤包膜外剝脫術(shù)是一種更為安全、簡(jiǎn)便、高效的術(shù)式,值得在臨床工作中推廣應(yīng)用。
[Abstract]:Objective to evaluate the value of hepatectomy and extracapsular excision in the resection of giant hepatic hemangioma and to provide guidance for the surgical treatment of hepatic giant hemangioma. Methods from June 2010 to June 2015, the medical records of 74 patients with giant hepatic hemangioma in the General Hospital of the people's Hospital of Ningxia Autonomous region and the affiliated Hospital of Ningxia Medical University were retrospectively analyzed. Among them, 37 cases were treated with hepatectomy (hepatectomy group) and 37 cases with exfoliation of envelope (exfoliation group). The average preoperative condition, intraoperative time, (h), intraoperative blood loss, (ml), blood transfusion, (ml), hepatic blood flow occlusion time, (min), hospitalization time and (d) were compared between the two groups. Postoperative complications such as pleural effusion, bile leakage and abdominal hemorrhage were observed. Symptom improvement and recurrence of hemangioma were followed up. Results in the exfoliation group, the operative time [(2.38 鹵0.93) h)], intraoperative blood loss (889.19 鹵756.37) ml], intraoperative blood transfusion (723.78 鹵801.14) ml), hepatic blood flow occlusion time (22.48 鹵10.87) min) were measured. The days of hospitalization [(14.84 鹵3.24) d] were lower than those in the hepatectomy group [(3.26 鹵1.16) h), (1551.35 鹵1755.88) ml, (1693.24 鹵2117.72) ml]. Hepatic blood flow occlusion time [(26.84 鹵17.30) min] and hospitalization time [(16.19 鹵5.01) d] were significantly different (P0.05). The incidence of pleural effusion in exfoliation group was lower than that in hepatectomy group (P0.05). There was no significant difference between the two groups in biliary leakage, abdominal hemorrhage, death and other complications (P0.05). There was no significant difference in postoperative mortality, improvement of symptoms and recurrence of hemangioma. Conclusion hepatectomy and extracapsular exfoliation are effective methods for the treatment of giant hepatic hemangioma. Extracapsulation of giant hepatic hemangioma was significantly better than that of hepatectomy in terms of operation time, intraoperative blood loss, intraoperative blood transfusion, hepatic blood flow occlusion time and hospitalization days, and the incidence of postoperative complications was lower. Extracapsular exfoliation of giant hemangioma of liver is a more safe, simple and efficient procedure, which is worth popularizing in clinical work.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7
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本文編號(hào)：2341719