CAJ | 학술논문

目的：探讨腹腔镜肝海绵状血管瘤剥离术的可行性。方法2009年11月～2014年2月对25例肝海绵状血管瘤行区域性肝门血流阻断，使用电凝刀、超声刀等进行切除，创面采用喷洒止血凝胶。结果25例均成功完成手术，无术后并发症及死亡。手术时间（125．2±72．8）min，肝门阻断时间（40．7±20．2）min。术前储备自体血200～400 ml，术中自体血回收50～700 ml，未输异体红细胞，仅3例巨大血管瘤输血浆400 ml。放置引流管8例，术后第1天引流量10～200 ml，第3天引流量＜50 ml拔出引流管。术后第2天均可下地活动，术后住院时间（5．5±2．4）d。[ALT、AST、总胆红素和前白蛋白术后第1、3天与术前差异有统计学意义（P＜0．05），术后1周与术前比较无统计学差异（P＞0．05），即肝功能术后1周恢复至正常值范围之内。]25例随访6～18个月，平均11个月，1例合并系统性红斑狼疮复查仍有多发小血管瘤，余患者无复发。结论合理应用区域性肝门阻断技术，正确处理肝创面，腹腔镜肝海绵状血管瘤剥离术安全、可行。
목적：탐토복강경간해면상혈관류박리술적가행성。방법2009년11월～2014년2월대25례간해면상혈관류행구역성간문혈류조단，사용전응도、초성도등진행절제，창면채용분쇄지혈응효。결과25례균성공완성수술，무술후병발증급사망。수술시간（125．2±72．8）min，간문조단시간（40．7±20．2）min。술전저비자체혈200～400 ml，술중자체혈회수50～700 ml，미수이체홍세포，부3례거대혈관류수혈장400 ml。방치인류관8례，술후제1천인류량10～200 ml，제3천인류량＜50 ml발출인류관。술후제2천균가하지활동，술후주원시간（5．5±2．4）d。[ALT、AST、총담홍소화전백단백술후제1、3천여술전차이유통계학의의（P＜0．05），술후1주여술전비교무통계학차이（P＞0．05），즉간공능술후1주회복지정상치범위지내。]25례수방6～18개월，평균11개월，1례합병계통성홍반랑창복사잉유다발소혈관류，여환자무복발。결론합리응용구역성간문조단기술，정학처리간창면，복강경간해면상혈관류박리술안전、가행。
Objective To evaluate the feasibility of laparoscopic decollement of hepatic cavernous hemangioma . Methods Clinical data of 25 cases of laparoscopic decollement of hepatic cavernous hemangioma from November 2009 to February 2014 were analyzed.After regional portal blood stream block , an electronic knife and an ultrasound knife were used for resection of hemangioma and hemostatic gel was spayed on the surgical wound . Results The surgery was successful in all the 25 cases, without postoperative complications or death.The operative time was (125.2 ±72.8) min.The time of block was (40.7 ±20.2) min.Preoperative autologous blood reserve was 200 -400 ml.Intraoperative autologous blood harvesting was 50 -700 ml.The whole group had no allogeneic red blood cells transfusion , and 3 cases of giant hemangioma were given 400 ml plasma transfusion.The volume of postoperative drainage was 10-200 ml on the first postoperative day .In the second day after operation , all the patients could ambulate and the length of stay after operation was (5.5 ±2.4) d.Compared with preoperation , there were significant differences in ALT , AST, TBIL and prealbumin in 1 and 3 days after surgery (P<0.05), but there was no difference in 7 days after surgery (P>0.05).Liver function recovered to normal in 7 days after surgery .All the patients were followed for 6 -18 months ( mean, 11 months ) , during which, one patient complicated with systemic lupus erythematosus was found multiple small hemangioma , and the remaining patients had no relapse . Conclusion Laparoscopic decollement of hepatic cavernous hemangioma is safe and feasible if hepatic portal blood block technique is well used and the bleeding wound is treated correctly .