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x2检验.正态分布的计量资料以(x)±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Kruskal-Wallis检验,两两比较采用Mann-Whinety 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,500mL)、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8d(7d,9d)、9d(Sd,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(x2=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,x2=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,x2=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,x2=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(x2=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(x2=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.
目的 探討肝血管瘤直徑與手術風險的關繫.方法 迴顧性分析2006年1月至2014年1月解放軍總醫院收治的362例肝血管瘤患者的臨床資料.217例腫瘤直徑為5 ～ 10 cm肝血管瘤患者設為大血管瘤組,119例腫瘤直徑＞10 cm且＜20 cm肝血管瘤患者設為巨大血管瘤組,26例腫瘤直徑≥20 cm肝血管瘤患者設為特大血管瘤組.手術方法包括開腹手術和腹腔鏡手術,手術方式主要包括肝切除術和肝血管瘤剜除術.評價指標包括手術時間、術中齣血量、術中輸血例數、術後併髮癥例數、術後住院時間.計數資料比較採用x2檢驗.正態分佈的計量資料以(x)±s錶示,多組間比較採用方差分析;偏態分佈的計量資料以中位數M(P25,P75)錶示,多組間比較採用Kruskal-Wallis檢驗,兩兩比較採用Mann-Whinety U檢驗.結果 362例患者均成功完成手術,無圍術期死亡患者.其中行開腹手術315例(大血管瘤組175例、巨大血管瘤組114例、特大血管瘤組26例),行腹腔鏡手術47例(大血管瘤組42例、巨大血管瘤組5例).大血管瘤組、巨大血管瘤組、特大血管瘤組患者手術時間分彆為160 min(125 min,205 min)、220 min (175 min,275 min)、330 min(280 min,420 min),術中齣血量分彆為300 mL(100 mL,500mL)、500 mL(300 mL,1 000 mL)、1 975 mL(800 mL,4 000 mL),術中輸血例數分彆為31、36、20例,術後併髮癥例數分彆為5、5、7例,術後住院時間分彆為8d(7d,9d)、9d(Sd,10 d)、11 d(9 d,13 d),3組上述指標比較,差異均有統計學意義(x2=84.24,80.94,53.65,31.54,47.67,P＜0.05).大血管瘤組與巨大血管瘤組患者手術時間、術中齣血量、術中輸血例數、術後住院時間比較,差異均有統計學意義(Z =6.39,6.51,x2=11.29,Z=4.73,P＜0.05);大血管瘤組與特大血管瘤組患者上述4項指標比較,差異均有統計學意義(Z =7.28,6.91,x2=51.22,Z=5.57,P＜0.05);巨大血管瘤組與特大血管瘤組患者上述4項指標比較,差異均有統計學意義(Z=5.33,4.86,x2=17.69,Z=3.51,P＜0.05).17例患者術後髮生併髮癥,併髮癥髮生率為4.70％ (17/362).其中腹腔齣血7例,肝週積液4例,胸腔積液3例,膽汁漏2例,傷口脂肪液化1例.大血管瘤組與巨大血管瘤組患者術後併髮癥例數比較,差異無統計學意義(x2=0.41,P＞0.05);大血管瘤組與特大血管瘤組,巨大血管瘤組與特大血管瘤組患者比較,差異均有統計學意義(x2=24.96,11.67,P＜0.05).結論 肝血管瘤直徑與手術時間、術中齣血量、術中輸血例數、術後併髮癥例數、術後住院時間關繫密切;直徑≥20 cm肝血管瘤的手術風險較高.
목적 탐토간혈관류직경여수술풍험적관계.방법 회고성분석2006년1월지2014년1월해방군총의원수치적362례간혈관류환자적림상자료.217례종류직경위5 ～ 10 cm간혈관류환자설위대혈관류조,119례종류직경＞10 cm차＜20 cm간혈관류환자설위거대혈관류조,26례종류직경≥20 cm간혈관류환자설위특대혈관류조.수술방법포괄개복수술화복강경수술,수술방식주요포괄간절제술화간혈관류완제술.평개지표포괄수술시간、술중출혈량、술중수혈례수、술후병발증례수、술후주원시간.계수자료비교채용x2검험.정태분포적계량자료이(x)±s표시,다조간비교채용방차분석;편태분포적계량자료이중위수M(P25,P75)표시,다조간비교채용Kruskal-Wallis검험,량량비교채용Mann-Whinety U검험.결과 362례환자균성공완성수술,무위술기사망환자.기중행개복수술315례(대혈관류조175례、거대혈관류조114례、특대혈관류조26례),행복강경수술47례(대혈관류조42례、거대혈관류조5례).대혈관류조、거대혈관류조、특대혈관류조환자수술시간분별위160 min(125 min,205 min)、220 min (175 min,275 min)、330 min(280 min,420 min),술중출혈량분별위300 mL(100 mL,500mL)、500 mL(300 mL,1 000 mL)、1 975 mL(800 mL,4 000 mL),술중수혈례수분별위31、36、20례,술후병발증례수분별위5、5、7례,술후주원시간분별위8d(7d,9d)、9d(Sd,10 d)、11 d(9 d,13 d),3조상술지표비교,차이균유통계학의의(x2=84.24,80.94,53.65,31.54,47.67,P＜0.05).대혈관류조여거대혈관류조환자수술시간、술중출혈량、술중수혈례수、술후주원시간비교,차이균유통계학의의(Z =6.39,6.51,x2=11.29,Z=4.73,P＜0.05);대혈관류조여특대혈관류조환자상술4항지표비교,차이균유통계학의의(Z =7.28,6.91,x2=51.22,Z=5.57,P＜0.05);거대혈관류조여특대혈관류조환자상술4항지표비교,차이균유통계학의의(Z=5.33,4.86,x2=17.69,Z=3.51,P＜0.05).17례환자술후발생병발증,병발증발생솔위4.70％ (17/362).기중복강출혈7례,간주적액4례,흉강적액3례,담즙루2례,상구지방액화1례.대혈관류조여거대혈관류조환자술후병발증례수비교,차이무통계학의의(x2=0.41,P＞0.05);대혈관류조여특대혈관류조,거대혈관류조여특대혈관류조환자비교,차이균유통계학의의(x2=24.96,11.67,P＜0.05).결론 간혈관류직경여수술시간、술중출혈량、술중수혈례수、술후병발증례수、술후주원시간관계밀절;직경≥20 cm간혈관류적수술풍험교고.
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.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s,and comparison among groups was analyzed using the ANOVA.Skewed distribution data were described as M (P25,P75),comparison among groups was analyzed by Kruskal-wallis 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 (x2 =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,x2 =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,x2=51.22,Z =5.57,P ＜ 0.05;Z =5.33,4.86,x2=17.69,Z =3.5 1,P ＜ 0.05).Seventeen patients had postoperative complications with an incidence of 4.70％ (17/362),intra-abdominal 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 (x2 =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 (x2 =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.
