肝血管瘤直径与手术风险的关系

肖年军; 余强; 段伟东; 董家鸿

doi:10.3760/cma.j.issn.1673-9752.2015.09.010

肝血管瘤直径与手术风险的关系

100853 北京，解放军总医院肝胆外科医院全军肝胆外科研究所

基金项目: 国家科技部科技支撑计划项目(2012BAI06B01)

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出版历程

Relationship between diameter of liver hemangioma and operation risk

Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China

摘要

摘要:
目的:探讨肝血管瘤直径与手术风险的关系。
方法:回顾性分析2006年1月至2014年 1月解放军总医院收治的362例肝血管瘤患者的临床资料。217例肿瘤直径为5～10 cm肝血管瘤患者设为大血管瘤组，119例肿瘤直径>10 cm且<20 cm肝血管瘤患者设为巨大血管瘤组，26例肿瘤直径≥ 20 cm肝血管瘤患者设为特大血管瘤组。手术方法包括开腹手术和腹腔镜手术，手术方式主要包括肝切除术和肝血管瘤剜除术。评价指标包括手术时间、术中出血量、术中输血例数、术后并发症例数、术后住院时间。计数资料比较采用χ2检验。正态分布的计量资料以±s表示，多组间比较采用方差分析；偏态分布的计量资料以中位数M(P25，P75)表示，多组间比较采用KruskalWallis检验，两两比较采用MannWhinety U检验。
结果:362例患者均成功完成手术，无围术期死亡患者。其中行开腹手术315例(大血管瘤组175例、巨大血管瘤组114例、特大血管瘤组26例)，行腹腔镜手术47例(大血管瘤组42例、巨大血管瘤组5例)。大血管瘤组、巨大血管瘤组、特大血管瘤组患者手术时间分别为160 min(125 min，205 min)、220 min (175 min，275 min)、330 min(280 min，420 min)，术中出血量分别为300 mL(100 mL，500 mL)、500 mL (300 mL，1 000 mL)、1 975 mL(800 mL，4 000 mL)，术中输血例数分别为31、36、20例，术后并发症例数分别为5、5、7例，术后住院时间分别为8 d(7 d，9 d)、9 d(8 d，10 d)、11 d(9 d，13 d)，3组上述指标比较，差异均有统计学意义(χ²=84.24，80.94， 53.65，31.54，47.67，P<0.05)。大血管瘤组与巨大血管瘤组患者手术时间、术中出血量、术中输血例数、术后住院时间比较，差异均有统计学意义(Z=6.39，6.51， χ²=11.29， Z=4.73，P<0.05)；大血管瘤组与特大血管瘤组患者上述4项指标比较，差异均有统计学意义(Z=7.28，6.91， χ²=51.22，Z=5.57，P<0.05)；巨大血管瘤组与特大血管瘤组患者上述4项指标比较，差异均有统计学意义(Z=5.33，4.86， χ²=17.69，Z=3.51，P<0.05)。17例患者术后发生并发症，并发症发生率为 4.70%(17/362)。其中腹腔出血7例，肝周积液4例，胸腔积液3例，胆汁漏2例，伤口脂肪液化1例。大血管瘤组与巨大血管瘤组患者术后并发症例数比较，差异无统计学意义(χ²=0.41，P>0.05)；大血管瘤组与特大血管瘤组，巨大血管瘤组与特大血管瘤组患者比较，差异均有统计学意义(χ²=24.96，11.67，P< 0.05)。
结论:肝血管瘤直径与手术时间、术中出血量、术中输血例数、术后并发症例数、术后住院时间关系密切；直径 ≥20 cm肝血管瘤的手术风险较高。
- 肝血管瘤 /
- 肝切除术 /
- 并发症
Abstract:
Objective:To explore the relationship between diameter of liver hemangioma and operation risk.
Methods:The clinical data of 362 patients with liver hemangioma who were admitted to the PLA General Hospital from January 2006 to January 2014 were retrospectively analyzed. All patients were divided into the 3 groups according to diameter of gross specimen, 217 with tumor diameter≥5 cm and ≤10 cm in the large hemangioma group, 119 with tumor diameter>10 cm and ≤20 cm in the giant hemangioma group and 26 with tumor diameter≥20 cm in the extremely large hemangioma group. The operation method included open surgery and laparoscopic surgery. Hepatectomy and enucleation of liver hemangioma were major operation procedures. The operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, number of patients with postoperative complications and duration of hospital stay were evaluated. 〖HQK〗Count data were analyzed using the chisquare test. Measurement data with normal distribution were presented as ±s, and comparison among groups was analyzed using the ANOVA. Skewed distribution data were described as comparison among groups was analyzed by Kruskalwallis test and pairwise comparison was done by the MannWhitney U test.
Results:All patients underwent operation successfully without perioperative death, including 315 receiving open surgery (175 in the large hemangioma group, 114 in the giant hemangioma group and 26 in the extremely large hemangioma group) and 47 receiving laparoscopic surgery (42 in the large hemangioma group and 5 in the giant hemangioma group). The operation time, volume of intraoperative blood loss, number of patients with blood transfusion, number of patients with postoperative complications and duration of hospital stay were 160 minutes (125 minutes, 205 minutes), 300 mL (100 mL, 500 mL), 31, 5 and 8 days (7 days, 9 days) in the large hemangioma group, 220 minutes (175 minutes, 275 minutes), 500 mL (300 mL, 1 000mL), 36, 5 and 9 days (8 days, 10 days) in the giant hemangioma group, 330 minutes (280 minutes, 420 minutes), 1 975 mL (800 mL, 4 000mL), 20, 7 and 11 days (9 days, 13 days) in the extremely large hemangioma group, respectively, with significant differences (χ²=84.24, 80.94, 53.65, 31.54, 47.67, P<0.05). The operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion and duration of hospital stay were compared, showing significant differences between large hemangioma group and giant hemangioma group (Z=6.39, 6.51, 〖KG*4〗χ²=11.29, Z=4.73, P<0.05), with significant differences between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (Z=7.28, 6.91, χ²=51.22, Z=5.57, P<0.05; Z=5.33, 4.86, χ²=17.69, Z=3.51, P<0.05). Seventeen patients had postoperative complications with an incidence of 4.70%(17/362), intraabdominal hemorrhage were detected in 7 patients, perihepatic effusion in 4 patients, pleural effusion in 3 patients, bile leakage in 2 patients and fat liquefaction of abdominal incision in 1 patient. There was no significant difference in the number of patients with postoperative complications between large hemangioma group and giant hemangioma group (χ²=0.41, P>0.05). There were significant differences in the number of patients with postoperative complications between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (χ²=24.96, 11.67, P<0.05).
Conclusions Diameber of liver hemangioma is associated with operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, number of patients with postoperative complications and duration of hospital stay, and there is a high risk in the surgical treatment of patients with liver hemangioma diameter≥20 cm.
- Liver hemangioma /
- Hepatectomy /
- Complication