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目的总结肝尾状叶海绵状血管瘤手术切除的指征及技巧。方法对我科2005年9月至2010年9月期间开展的8例肝尾状叶海绵状血管瘤切除病例的临床资料进行分析。结果全组患者均在无血流阻断下顺利完成手术,无手术死亡。术中出血量为1 000~5 000 ml,(2 500±800)ml;手术时间为3~6 h,(4.2±0.8)h。1例肝硬变患者术后1 d即出现腹水,经积极治疗后得以控制。3例患者术后1周发现右侧胸腔积液,经1~2次胸腔穿刺抽液后治愈。1例患者术后1周出现不全性肠梗阻,经保守治疗1周后痊愈。术后应用B超每半年复查肝脏情况,随访0.5~5年,(2.5±1.2)年,1例失访,1例患者死于心肌梗死,余均存活,仍在随访中。所有病例均未复发。结论肝尾状叶海绵状血管瘤手术应充分显露、精准操作,彻底切除肿瘤,避免大出血和空气栓塞,减少和防止残肝的热缺血再灌注损伤。
Objective To summarize the indications and techniques of surgical resection of cavernous hemangiomas of the caudate lobe. Methods The clinical data of 8 cases of cavernous hemangiomas resected from September 2005 to September 2010 in our department were analyzed. Results All the patients underwent successful operation without blood flow interruption and no operative death. Intraoperative blood loss was 1 000 to 5 000 ml (2 500 ± 800) ml; the operative time was 3 to 6 h and (4.2 ± 0.8) h. One patient with cirrhosis showed ascites 1 d after operation and was controlled after active treatment. Three patients were found right pleural effusion 1 week after surgery, after 1 or 2 thoracentesis and drainage cured. One patient had incomplete intestinal obstruction at 1 week after operation and recovered after 1 week of conservative treatment. Liver biopsies were reviewed every six months after operation. The patients were followed up for 0.5-5 years (2.5 ± 1.2 years) and one case was lost to follow-up. One patient died of myocardial infarction and all remained alive. All cases did not relapse. Conclusions The cavernous cavernous hemangioma of the caudate lobe should be fully exposed and be operated accurately to completely remove the tumor and avoid massive hemorrhage and air embolism to reduce and prevent the warm ischemic reperfusion injury of the residual liver.