| Objective : The most effective treatment for hepatic hemangioma is surgical treatment.With the continuous development of laparoscopic technology,laparoscopic resection of hepatic hemangioma has become a trend.The purpose of this study was to compare the short-term clinical effects of laparoscopic hepatectomy and hemangiomectomy in the treatment of giant hepatic hemangioma(≥ 10cm)through retrospective analysis,so as to provide some reference for the selection of surgical methods for the treatment of giant hepatic hemangioma.Methods: The clinical data of patients with hepatic cavernous hemangioma diagnosed by preoperative B-ultrasound,CT or MRI imaging examination and laparoscopic surgery in The second affiliated Hospital of Kunming Medical University from January 2018 to August 2022 were retrospectively analyzed.The patients were divided into laparoscopic hepatectomy group(group A,n = 61)and laparoscopic hemangiectomy group(group B,n = 50).The general data,preoperative and postoperative laboratory indexes,intraoperative and postoperative conditions of the two groups were collected,and the short-term clinical effects of laparoscopic hepatectomy and hemangioma removal on giant hepatic hemangioma were analyzed by comparing the intraoperative and postoperative conditions.Results: A total of 111 patients were included in this study,including 61 patients in group A(laparoscopic hepatectomy)and 50 patients in group B(laparoscopic hemangioma removal group).All patients completed the operation successfully and there was no death.The main results were as follows:(1)comparison of general conditions before operation: A total of111 subjects were included in this retrospective study,including 32 males and 79 females,with a male-to-female ratio of 1 to 2.47.There were 61 patients in group A,whose age was 45.74 ±9.61 years old and their body weight was 60.05 ±9.34 kg.There were 20 males(32.5%),41 females(67.2%),20 patients with symptoms(32.8%)and 8 patients with underlying diseases(13.1%).There were 50 patients in group B,age 45.70±11.90 years old,body weight 60.72 ±11.50 kg,male 12 cases(24.0%),female 38 cases(76.0%),symptomatic 15 cases(30%),underlying diseases7 cases(14.0%).There was no significant difference in age,body weight,sex,symptoms and basic diseases between group An and group B(P >0.05).(2)preoperative tumor condition: in group A,the median tumor size was 11.10(2.60)cm,located in the left half of the liver in 31 cases(50.8%),located in the right half of the liver in 30 cases(49.2%),single tumor in 16cases(26.2%),multiple in 45 cases(73.8%).In group B,the median tumor size was 10.30(1.83)cm,the tumor was located in the left half of the liver in 17 cases(34.0%),in the right half of the liver in 33 cases(66.0%),single tumor in 13 cases(26.0%),multiple in 37 cases(74.0%).There was no significant difference in tumor size,location and number of tumors between the two groups(P > 0.05).(3)preoperative laboratory indexes:there was no significant difference in ALT,AST,TBIL,ALP,albumin,prealbumin,creatinine,white blood cell,hemoglobin and D-dimer between the two groups before operation(P > 0.05).The median preoperative PT in group A was 12.60(1.60)s and the median PT in group B was 11.40(2.03)s.There was significant difference in preoperative PT between the two groups(Z=3.013,P<0.05).(4)Intraoperative condition: in group A,the intraoperative operation time was 322.92 ±106.84 min,the median intraoperative blood loss was 500(550)ml,the intraoperative blood transfusion rate 31.1%(19/61),the median number of intraoperative hilar occlusion was 4.00(2.00),the intraoperative hilar occlusion time was 64.43±24.70 min,the conversion rate was 16.4%(10/61),and 31 cases were complicated with cholecystectomy(50.8%).In group B,the intraoperative operation time was 368.16 ±120.91 min,the median intraoperative blood loss was 700(800)ml,the intraoperative blood transfusion rate was 28.0%(14/50),the median number of intraoperative hilar occlusion was 5.00(2.00),the hilar occlusion time was 77.40 ±32.27 min,the conversion rate to laparotomy was 22.0%(11/50),and 24 cases were complicated with cholecystectomy(48.0%).There was no significant difference in the rate of intraoperative blood transfusion,conversion to laparotomy and cholecystectomy between the two groups(P > 0.05),but there were significant differences in operation time,blood loss,hepatic hilar occlusion times and hepatic hilar occlusion time between the two groups(P< 0.05).(5)In group A,the blood transfusion rate was 21.3%(13/61),the median days of intraoperative transfer to ICU was 1.00(1.00)days,the transfer rate to ICU was 59.0%(36/61),the postoperative hospital stay was8.95 ±2.43 days,and the total cost was 5.41 ±1.96 wan yuan.In group B,the blood transfusion rate was 16.0%(8/50),the median number of days transferred to ICU was 1.00(1.00)days,the transfer rate to ICU was62.0%(31/50),the postoperative hospital stay was 10.02 ±2.74 days,and the total cost was 5.76 ±175wan yuan.There was no significant difference in the rate of postoperative blood transfusion,the days of transfer to ICU,the rate of transfer to ICU and the total cost between the two groups.(P >0.05).There was significant difference in postoperative hospital stay between the two groups(t = 2.181,P < 0.05).(6)postoperative complications: in group A,there were 5 cases of pleural effusion(8.2%),3cases of pulmonary infection(4.9%),2 cases of bile leakage(3.4%),3cases of ascites(4.9%),1 case of abdominal hemorrhage(1.6%),1 case of liver failure(1.6%)and 0 cases of death.In group B,there were 6 cases of pleural effusion(12.0%),3 cases of pulmonary infection(6.0%),1 case of bile leakage(2.0%),2 cases of peritoneal effusion(4.0%),1 case of abdominal bleeding(2.0%),1 case of liver failure(2.0%)and 0 cases of death.The total incidence of postoperative complications in group A was24.6%(15/61),and that in group B was 28.0%(14/50).There was no significant difference in the total incidence of postoperative complications between the two groups(X=0.166,P > 0.05).(7)Laboratory index 1 day after operation: there was no significant difference in ALT,TBIL,ALP,albumin,prealbumin,creatinine,white blood cell,hemoglobin,PT and D-dimer between the two groups on the 1st day after operation(P > 0.05).The median AST of group A was 154.00(167.50)U/L on the 1st day after operation,and the median AST of group B was 207.00(217.00)U/L on the1 st day after operation.There was significant difference in AST between the two groups on the 1st day after operation.(Z=2.051,P < 0.05).Conclusion: After preliminary verification,the results of this study show that laparoscopic hepatectomy and hemangiomectomy are safe and effective in the treatment of giant hepatic hemangioma.Compared with laparoscopic hemangioma removal,laparoscopic hepatectomy has shorter operation time,less intraoperative blood loss,less times and time of hepatic hilar occlusion,shorter postoperative hospital stay and less increase of AST 1 day after operation.However,there is no postoperative follow-up in this study,and the long-term effects of the two surgical methods on giant hemangioma of the liver need to be further studied. |
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