Surgical Treatment of Complex Giant Cavernous Hemangioma of Liver: An Analysis of 55 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIAChang-jun ,  DAIChao-liu , BUXian-min , XUFeng , PENGSong-lin , XUYong-qing , ZHAOYang , ZHAOChuang , ZHAOLiang

Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding?author：

DAIChao-liu, Email: daicl@sj-hospital.org

Keywords：

Complex giant cavernous hemangioma of liver; Surgical treatment

DOI：

10.7507/1007-9424.20160041

Video：

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Objective To summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. Method The clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. Results Among these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. Conclusions The essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.

Citation： JIAChang-jun, DAIChao-liu, BUXian-min, XUFeng, PENGSong-lin, XUYong-qing, ZHAOYang, ZHAOChuang, ZHAOLiang. Surgical Treatment of Complex Giant Cavernous Hemangioma of Liver: An Analysis of 55 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 151-155. doi: 10.7507/1007-9424.20160041 Copy

1.	?梁廷波. 復雜肝臟血管瘤的手術治療. 中國實用外科雜志, 2010, 30(8):659-662.
2.	陳孝平, 何松青. 復雜肝臟手術實施的難點與技術進步. 中國實用外科雜志, 2010, 30(8):629-632.
3.	張尊義, 黃志勇. 提高復雜肝切除術的安全性. 肝膽外科雜志, 2012, 20(1):4-6.
4.	Toro A, Mahfouz AE, Ardiri A, et al. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol, 2014, 13(4):327-339.
5.	周儉, 黃成, 樊嘉. 肝移植相關技術在復雜肝臟腫瘤切除術中的應用. 中華肝臟外科手術學電子雜志, 2012, 1(3):147-150.
6.	羅皓, 王瑞豐, 陳濤, 等. 吲哚氰綠測定與Child-Pugh分級在肝儲備評估中的價值. 中國普外基礎與臨床雜志, 2011, 18(12):1314-1316.
7.	Li MH, Yan LN, Wang SR. Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma. Hepatobiliary Pancreat Dis Int, 2007, 6(1):43-48.
8.	Li M, Zhang C, Zhang T, et al. Outcome using selective hemihepatic vascular occlusion and Pringle maneuver for hepatic resection of liver cavernous hemangioma. World J Surg Oncol, 2015, 13:267.
9.	Fu SY, Lau WY, li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1):62-69.
10.	Jin S, Dai CL. Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma. World J Gastroenterol, 2010, 16(46):5895-5900.
11.	趙英鵬, 李曉延, 范蜀濱, 等. 肝血管瘤手術切除血流阻斷方法的選擇. 中國普外基礎與臨床雜志, 2011, 18(1):81-83.
12.	戴朝六. 肝臟巨大尾狀葉腫瘤切除術應注意的幾個問題. 中華普通外科學文獻:電子版, 2010, 4(1):3-6.
13.	Zhang W, Huang ZY, Ke CS, et al. Surgical treatment of giant liver hemangioma larger than 10 cm:A single center,s experience with 86 patients. Medicine (Baltimore), 2015, 94(34):e1420.
14.	楊甲梅. 特大肝海綿狀血管瘤的安全手術治療. 中華肝膽外科雜志, 2006, 12(6):361-363.
15.	何小東, 劉衛, 葉松, 等. 肝臟巨大血管瘤手術切除的臨床經驗. 中華消化外科雜志, 2010, 9(6):457-458.
16.	Strücker B, Stockmann M, Denecke T, et al. Intraoperative place-ment of external biliary drains for prevention and treatment of bile leaks after extended liver resection without bilioenteric anastomosis. World J Surg, 2013, 37(11):2629-2634.
17.	王建新, 蔡衛華, 肖旭, 等. 術中白試驗在肝切除術中肝斷面漏膽檢測中的應用. 中國普外基礎與臨床雜志, 2013, 20(12):1407-1409.
18.	Sakamoto K, Tamesa T, Yukio T, et al. Risk factors and managements of bile leakage after hepatectomy. World J Surg, 2016, 40(1):182-189.
19.	Ishii H, Ochiai T, Murayama Y, et al. Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis. Dig Surg, 2011, 28(3):198-204.
20.	Russell MC. Complications following hepatectomy. Surg Oncol Clin N Am, 2015, 24(1):73-96.

1. ?梁廷波. 復雜肝臟血管瘤的手術治療. 中國實用外科雜志, 2010, 30(8):659-662.
2. 陳孝平, 何松青. 復雜肝臟手術實施的難點與技術進步. 中國實用外科雜志, 2010, 30(8):629-632.
3. 張尊義, 黃志勇. 提高復雜肝切除術的安全性. 肝膽外科雜志, 2012, 20(1):4-6.
4. Toro A, Mahfouz AE, Ardiri A, et al. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol, 2014, 13(4):327-339.
5. 周儉, 黃成, 樊嘉. 肝移植相關技術在復雜肝臟腫瘤切除術中的應用. 中華肝臟外科手術學電子雜志, 2012, 1(3):147-150.
6. 羅皓, 王瑞豐, 陳濤, 等. 吲哚氰綠測定與Child-Pugh分級在肝儲備評估中的價值. 中國普外基礎與臨床雜志, 2011, 18(12):1314-1316.
7. Li MH, Yan LN, Wang SR. Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma. Hepatobiliary Pancreat Dis Int, 2007, 6(1):43-48.
8. Li M, Zhang C, Zhang T, et al. Outcome using selective hemihepatic vascular occlusion and Pringle maneuver for hepatic resection of liver cavernous hemangioma. World J Surg Oncol, 2015, 13:267.
9. Fu SY, Lau WY, li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1):62-69.
10. Jin S, Dai CL. Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma. World J Gastroenterol, 2010, 16(46):5895-5900.
11. 趙英鵬, 李曉延, 范蜀濱, 等. 肝血管瘤手術切除血流阻斷方法的選擇. 中國普外基礎與臨床雜志, 2011, 18(1):81-83.
12. 戴朝六. 肝臟巨大尾狀葉腫瘤切除術應注意的幾個問題. 中華普通外科學文獻:電子版, 2010, 4(1):3-6.
13. Zhang W, Huang ZY, Ke CS, et al. Surgical treatment of giant liver hemangioma larger than 10 cm:A single center,s experience with 86 patients. Medicine (Baltimore), 2015, 94(34):e1420.
14. 楊甲梅. 特大肝海綿狀血管瘤的安全手術治療. 中華肝膽外科雜志, 2006, 12(6):361-363.
15. 何小東, 劉衛, 葉松, 等. 肝臟巨大血管瘤手術切除的臨床經驗. 中華消化外科雜志, 2010, 9(6):457-458.
16. Strücker B, Stockmann M, Denecke T, et al. Intraoperative place-ment of external biliary drains for prevention and treatment of bile leaks after extended liver resection without bilioenteric anastomosis. World J Surg, 2013, 37(11):2629-2634.
17. 王建新, 蔡衛華, 肖旭, 等. 術中白試驗在肝切除術中肝斷面漏膽檢測中的應用. 中國普外基礎與臨床雜志, 2013, 20(12):1407-1409.
18. Sakamoto K, Tamesa T, Yukio T, et al. Risk factors and managements of bile leakage after hepatectomy. World J Surg, 2016, 40(1):182-189.
19. Ishii H, Ochiai T, Murayama Y, et al. Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis. Dig Surg, 2011, 28(3):198-204.
20. Russell MC. Complications following hepatectomy. Surg Oncol Clin N Am, 2015, 24(1):73-96.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment of Complex Giant Cavernous Hemangioma of Liver: An Analysis of 55 Cases

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