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目的探讨紧邻重要血管的肝脏海绵状血管瘤的安全手术方式并评价其临床应用价值。方法对72例紧邻重要血管的肝脏海绵状血管瘤患者实施剥除术,第一肝门、肝下下腔静脉预置阻断带,剥除过程中遇到不易控制的出血时,行Pringle法加肝下下腔静脉阻断。结果全部肝海绵状血管瘤均被成功剥除,无手术死亡,术中失血(443±128)ml,成功完成肝右静脉破口修补4例,肝中静脉破口修补2例,术后发生右侧胸腔反应性积液和腹腔局限性积液共9例,肝断面胆瘘1例,均经对症治疗后痊愈。结论瘤体剥除术是治疗紧邻重要血管肝脏海绵状血管瘤安全有效的方法,第一肝门、肝下下腔静脉预置阻断带有利于此手术的安全实施。
Objective To investigate the safe surgical approach to cavernous hemangiomas adjacent to important vessels and to evaluate their clinical value. Methods Seventy-two patients with cavernous hemangiomas of the liver adjacent to important vessels were treated with the stripping method. The first hepatic portal and inferior vena cava inferior vena cava were pre-blocked and the bleeding was not easy to control during the stripping. Pringle method Hepatic inferior vena cava is blocked. Results All hepatic cavernous hemangiomas were successfully stripped and no operative mortality was found. Blood loss was (443 ± 128) ml during operation. Four cases of right hepatic vein debridement and two cases of middle hepatic vein puncture repair were successfully performed. Right pleural reaction effusion and celiac localized effusion in 9 cases, 1 case of liver section bile fistula, were cured after symptomatic treatment. Conclusions Tumor ablation is a safe and effective method for the treatment of cavernous hemangiomas close to the important vascular liver. The first hilar and subhepatic inferior vena cava prefab block is safe for the operation.