CAJ | 학술논문

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。
목적：탐토긴린중요혈관적간장해면상혈관류적안전수술방식병평개기림상응용개치。방법대72례긴린중요혈관적간장해면상혈관류환자실시박제술，제일간문、간하하강정맥예치조단대，박제과정중우도불역공제적출혈시，행Pringle법가간하하강정맥조단。결과전부간해면상혈관류균피성공박제，무수술사망，술중실혈（443±128）ml，성공완성간우정맥파구수보4례，간중정맥파구수보2례，술후발생우측흉강반응성적액화복강국한성적액공9례，간단면담루1례，균경대증치료후전유。결론류체박제술시치료긴린중요혈관간장해면상혈관류안전유효적방법，제일간문、간하하강정맥예치조단대유리우차수술적안전실시。
Objective To investigate the safe surgical approaches and clinical values for hepatic cavernous hemangioma closely attached to important vessels. Methods Stripping operation was used for the treatment of hepatic cavernous hemangioma attached to important vessels in 72 patients. Under the ex-trahepatic control of blood flow of the first hilum and inferior vena cava,Pringle method and inferior vena cava clamping were applied if uncontrollable bleeding occurred during the stripping. Results All cavern-ous hemangiomas were successfully stripped without mortality. The intraoperative blood loss was( 443 ± 128)ml. Right hepatic vein injury was repaired in 4 cases and middle hepatic vein injury was repaired in 2 cases. Postoperative complications developed in 10 patients,including pleural effusion and peritoneal ef-fusion in 9cases and biliary fistula from liver section in 1 case. All patients recovered after symptomatic treatment. Conclusion Stripping operation is a safe and effective surgical approach for hepatic cavernous hemangioma closely attached to important vessels. Extrahepatic control of blood flow of the first hilum and inferior vena cava helps the safe implementation for stripping operation.