Clinical effect of hepatectomy versus extracapsular peeling in treatment of hepatic hemangioma
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摘要: 目的对比分析肝切除术和包膜外剥脱术治疗肝血管瘤的临床疗效,为临床手术方式的选择提供依据。方法回顾性分析2010年1月-2016年5月在徐州医科大学附属医院行手术治疗的115例患者临床资料。根据手术方法的不同分成剥脱组(n=79)和肝切组(n=36),进一步根据肿瘤直径将所有患者分成2个亚组进行分层比较:肿瘤直径在510 cm的肝大血管瘤患者89例,分为大剥脱组64例和大肝切组25例;肿瘤直径>10 cm的巨大肝血管瘤26例,分为巨大血管瘤剥脱组15例和巨大血管瘤切除组11例。分别比较2组患者之间术前、术中、术后的相关临床资料。正态分布的计量资料2组间比较采用独立样本t检验;非正态分布数据2组间比较采用Mann-Whitney U检验。分类变量采用χ2检验和Fisher确切概率法进行2组间比较。结果血管瘤剥脱术和肝切除术患者的术中出血量[300(200400)ml vs 300(225500)ml]、手术时间[120(105160)min vs 140(951Abstract: Objective To investigate the clinical effect of hepatectomy versus extracapsular peeling in the treatment of hepatic hemangioma, and to provide a basis for selection of surgical procedure in clinical practice.Methods A retrospective analysis was performed for the clinical data of 115 patients who underwent surgical treatment in The Affiliated Hospital of Xuzhou Medical University from January 2010 to May2016.According to the surgical procedure, these patients were divided into peeling group (79 patients) and hepatectomy group (36 patients) .According to the tumor diameter, the patients were further divided into two subgroups for stratified comparison:89 patients with hepatic hemangioma who had a tumor diameter of 5-10 cm were divided into large peeling group with 64 patients and large hepatectomy group with 25 patients; 26 patients with a tumor diameter of >10 cm were divided into giant hemangioma peeling group with 15 patients and giant hemangioma hepatectomy group with 11 patients.The preoperative, intraoperative, and postoperative clinical data were compared between groups.The two-independent-samples t test was used for comparison of normally distributed continuous data, and the Mann-Whitney U test was used for comparison of non-normally distributed data between groups.The chi-square test and Fisher' s exact test were used for comparison of categorical data between groups.Results There were no significant differences between the hepatectomy group and the peeling group in intraoperative blood loss [300 (200-400) ml vs 300 (225-500) ml, Z=-1.065, P=0.287 ], time of operation [120 (105-160) min vs 140 (95-150) min, Z =-0.036, P = 0.971], postoperative drainage volume [280 (165-520) ml vs 310 (105-546) ml, Z=0.413, P=0.679], length of hospital stay [16 (14-19) d vs 14 (13-19.5) d, Z=-1.283, P=0.200], and hospital costs (27 973.64 ± 10 028.32 RMB vs 28 680.85 ± 10 662.87 RMB, Z=-0.344, P=0.732) .The subgroup analysis showed that there were also no significant differences between the hepatectomy group and the peeling group in intraoperative blood loss, time of operation, postoperative drainage volume, length of hospital stay, and hospital costs (all P>0.05) .Conclusion Hepatectomy and hemangioma peeling have similar clinical effects in the treatment of hepatic hemangioma.
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Key words:
- liver neoplasms /
- hemangioma /
- hepatectomy /
- enucleation
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[1]TORO A, MAHFOUZ AE, ARDIRI A, et al.What is changing in indications and treatment of hepatic hemangiomas.A review[J].Ann Hepatol, 2014, 13 (4) :327-339. [2]ZOU H, MA KS.Current situation on radiofrequency ablation of hepatic hemangioma[J].J Clin Hepatol, 2013, 29 (8) :567-569. (in Chinese) 邹华, 马宽生.射频消融治疗肝血管瘤的现状[J].临床肝胆病杂志, 2013, 29 (8) :567-569. [3]GIULIANTE F, ARDITO F, VELLONE M, et al.Reappraisal of surgical indications and approach for liver hemangioma:singlecenter experience on 74 patients[J].Am J Surg, 2011, 201 (6) :741-748. [4]DONATI M, STAVROU GA, DONATI A, et al.The risk of spontaneous rupuure of liver hemangioma:a critical review of the literature[J].J Gastrointest Surg, 2011, 15 (1) :209-214. [5]GAO J, SUN WB.Modern views on surgical treatment of hepatic hemangioma[J].Chin J Med, 2014, 49 (12) :13-15. (in Chinese) 高君, 孙文兵.肝血管瘤外科治疗的现代观[J].中国医刊, 2014, 49 (12) :13-15. [6]WU ZB, HUANG ZY.Indications and methods for surgical treatment of hepatic hemangioma[J].J Clin Surg, 2014, 22 (8) :616-618. (in Chinese) 吴珍宝, 黄志勇.肝血管瘤外科治疗的指征与方法[J].临床外科杂志, 2014, 22 (8) :616-618. [7]SCHNELLDORFER T, WARE AL, SMOOT R, et al.Management of giant hemangioma of the liver:resection versus observation[J].J Am Coll Surg, 2010, 211 (6) :724-730. [8]YEDIBELA S, ALIBEK S, MULLER V, et al.Management of hemangioma of the liver:surgical therapy on observation?[J].World J Surg, 2013, 37 (6) :1303-1312. [9]WAGN KY, FU HQ.Surgical treatment and operative indication of hepatic hemangioma[J].Chin J Hepatobiliary Surg, 2011, 17 (9) :701-702. (in Chinese) 王开阳, 傅华群.肝血管瘤的外科治疗现状及手术指征[J].中华肝胆外科杂志, 2011, 17 (9) :701-702. [10]DONG J, ZHU Y, WANG WL, et al.Hepatic hemangoma treated by surgical resection:a analysis of 128 patients[J].Chin J Hepatobiliary Surg, 2014, 20 (8) :595-598. (in Chinese) 董建, 朱迎, 王万里, 等.肝血管瘤128例外科治疗分析[J].中华肝胆外科杂志, 2014, 20 (8) :595-598. [11]LERNER SM, HIATT JR, SALAMANDRA J, et al.Giant cavernous liver hemangiomas:effect of operative approach on outcome[J].Arch Surg, 2004, 139 (8) :818-821, 821-823. [12]CHENG JJ, MA JL.Treatment progress in adult hepatic cavernous hemangioma[J].Med Recapitulate, 2013, 19 (11) :2020-2022. (in Chinese) 程炯炯, 马金良.成人肝海绵状血管瘤的治疗进展[J].医学综述, 2013, 19 (11) :2020-2022. [13]DOU KF, JIN C.Prowess in surgery for hemangioma of liver[J].Chin J Dig Surg, 2013, 12 (1) :13-15. (in Chinese) 窦科峰, 金成.肝血管瘤外科治疗进展[J].中华消化外科杂志, 2013, 12 (1) :13-15. [14]ZHOU CM, ZHANG JH, REN WX, et al.Treatment and clinical grading system of liver hemangioma among 514 patients[J].Chin J Dig Surg, 2015, 14 (2) :102-105. (in Chinese) 周成明, 张金辉, 任伟新, 等.514例肝血管瘤的治疗与临床评分[J].中华消化外科杂志, 2015, 14 (2) :102-105. [15]ZHU Q, QIAO GL, YAN JJ, et al.New perspectives on the natural history and growth pattern of hepatic hemangioma in adults:a cohort study[J].Chin J Hepatobiliary Surg, 2015, 21 (11) :721-725. (in Chinese) 朱倩, 乔国梁, 晏建军, 等.对成人肝血管瘤自然发展进程及生长方式的新认识:队列研究[J].中华肝胆外科杂志, 2015, 21 (11) :721-725. [16]GENG XP.Hepatic hemangioma and precise surgical treatment[J].Chin J Bases Clin Gen Surg, 2016, 23 (2) :137-139. (in Chinese) 耿小平.肝血管瘤与精准外科治疗[J].中国普外基础与临床杂志, 2016, 23 (2) :137-139. [17]QIU MQ.Comparison of curative effect by resection of hepatic hemangioma and traditional operation of stripping[J].China Med Herald, 2014, 11 (19) :65-68. (in Chinese) 邱明权.肝血管瘤传统手术切除和剥离术疗效对比[J].中国医药导报, 2014, 11 (19) :65-68. [18]MUAMMADCUMA DX, WEN H.Advances in surgical diagnosis and treatment of hepatic hemangioma[J].Xinjiang Med J, 2011, 41 (1) :91-95. (in Chinese) 买买提居马·对先, 温浩.肝血管瘤外科诊治进展[J].新疆医学, 2011, 41 (1) :91-95. [19]QIN XL, XU J, DI WD, et al.Laparoscopic treatment of hepatic hemangioma on the operation method and curative effect of comparative analysis[J/CD].Chin J Laparoscopic Surgery:Electronic Edition, 2014, 7 (5) :350-353. (in Chinese) 秦学良, 徐钧, 底卫东, 等.腹腔镜治疗肝血管瘤手术方式选择及疗效的比较分析[J/CD].中华腔镜外科杂志:电子版, 2014, 7 (5) :350-353. [20]WU X, XIA H, WU J, et al.Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy[J].J Clin Hepatol, 2016, 32 (9) :1756-1759. (in Chinese) 吴晓, 夏灏, 吴健, 等.规则肝切除术治疗复杂肝内胆管结石的临床体会[J].临床肝胆病杂志, 2016, 32 (9) :1756-1759. [21]LI LH, WANG JW, LIU B, et al.Clinical application of three-dimensional reconstruction in preoperative evaluation of hepatectomy[J].J Clin Hepatol, 2016, 32 (5) :938-941. (in Chinese) 李连海, 王建伟, 刘斌, 等.三维重建在肝切除术前评估中的临床应用效果[J].临床肝胆病杂志, 2016, 32 (5) :938-941.
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