| [Objective]:With the popularization of health examination and the progress of imaging examination,the detection rate of Hepatic hemangioma(HH)is increasing.As a benign hepatic tumor,HH usually grows slowly and has no obvious clinical symptoms,so it can be followed up regularly.However,Giant hepatic hemangioma(GHH)with a diameter ≥10cm can cause compression phenomenon on adjacent tissues and organs,resulting in corresponding clinical manifestations.HH has the risk of rupture and bleeding when impacted by external forces.Laparoscopic surgery and open surgery are the main surgical treatments for GHH.This study retrospectively analyzed the clinical data of 43 patients with GHH in our hospital,and compared the efficacy of laparoscopic surgery and open surgery in the treatment of GHH.[Methods]:The clinical data of 43 patients with GHH admitted to the Department of Hepatobiliary Surgeiy of Shenzhen Second People’s Hospital from June 2014 to June 2022 were retrospectively analyzed.Statistical data included gender,age,symptoms,signs,laboratory tests including:Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Albumin(A1b),Total bilirubin(TBIL),Indocyanine green-retention 15 minutes(ICG-R15),postoperative pathological report,color Doppler ultrasound,Contrast-enhanced ultrasound(CEUS),and Computerized Tomography(CT),Magnetic resonance imaging(MRI),three-dimensional visualization technology and other imaging features were compared between groups using the X2 test,Fisher test,and t test.Patients included in this study were divided into lapaioscopic group and open group according to different surgical methods,including 23 cases in laparoscopic group and 20 cases in open group.The intraoperative blood loss,operation time,incidence of postoperative complications,postoperative anal exhaust time,postoperative pain score at 24 hours,postoperative hospital stay and hospitalization expenses were recorded and compared between the two groups to explore the differences in the efficacy of laparoscopic surgery and open surgery in the treatment of GHH.[Results]:1.General data:the clinical data of 43 patients with GHH were collected.There were 23 patients(53.5%)in the lapaioscopic group,and the male to female ratio was 1:2.83.There were 20 patients(46.5%)in the open surgery group,and the male to female ratio was 1:1.86.The mean age was(46.22±9.62)years in the lapaioscopic group and(43.60±9.04)years in the open group.There was no significant difference in age between the two groups(P>0.05).There was no significant difference in the maximum diameter of the tumor between the two groups(11.80±1.17cmvs.11.16±1.02cm,P>0.05).2.Clinical manifestations:there were 14 asymptomatic patients in this study,including 8 cases(34.8%)in the lapaioscopic group and 6 cases(30.0%)in the open group.The most common symptoms in the lapaioscopic group were upper abdominal discomfort and pain(52.2%),followed by digestive symptoms such as dyspepsia and belching(8.7%).The most common symptoms in the laparotomy group were upper abdominal discomfort and pain(45.0%),followed by dyspepsia and belching(15.0%).There was no statistically significant difference in clinical symptoms between the two groups(P>0.05).Among the symptomatic patients,18 patients(62.1%)underwent preoperative gastrointestinal endoscopy,and the results were normal,which ruled out that the symptoms were caused by other gastrointestinal diseases.3.Laboratory tests:there was no significant difference in preoperative liver function tests(ALT,AST,ALB,TBIL)between the lapaioscopic group and the laparotomy group(P>0.05).The preoperative ICG-R15 in the lapaioscopic group was lower than that in the open group(0.041±0.002vs.0.047±0.005,P>0.05),and the preoperative Child-Pugh score was grade A in both groups.4.Imaging examination:the diagnostic accuracy of B-ultrasound,CEUS,CT and MRI for GHH was 86.05%,100%,97.5%and 100%,respectively.In the laparoscopic group,the single tumor was more common(60.9%),and the most common location was the right lobe of the liver(65.2%).In the laparotomy group,multiple tumors were more common(55.0%),and most tumors were located in the right lobe of the liver(50.0%).There was no significant difference in the number and location of GHH tumors between the two groups(P>0.05).5.Comparison of intraoperative and postoperative indicators:there was no significant difference in the average operation time between the laparoscopic group and the open group(231.52±31.63min vs.247.70±47.43min,P>0.05).The intraoperative blood loss in the laparoscopic group was significantly lower than that in the open group(263.52±109.70ml vs.325.00±79.48ml,P<0.05).The postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group(7.87±1.87d vs.10.90±2.13d,P<0.05).The postoperative anal exhaust time of the laparoscopic group was earlier than that of the open group(3.1±0.9d vs.4.3±0.9d,P<0.05).The postoperative pain score of the laparoscopic group was lower than that of the open group(4.0±0.74 vs.4.95±0.76,P<0.05).The total cost of hospitalization in the laparoscopic group was higher than that in the open group(42080.17± 10316.34 yuan vs.36894.98±10625.70yuan,P>0.05).The incidence of postoperative complications in the laparoscopic group was significantly lower than that in the open group(17.4%vs.45.0%,P<0.05).[Conclusion]:1.GHH occurs more frequently in middle-aged people and females.2.Abdominal discomfort and pain are common in patients with GHH,and the clinical manifestations are lack of specificity.For some gastrointestinal symptoms,preoperative gastrointestinal endoscopy should be performed to distinguish them from other gastrointestinal diseases.3.Preoperative liver function test,Child-Pugh score and ICG examination can accurately evaluate the liver reserve function of patients.4.The accuracy rate of B-ultrasound in the diagnosis of GHH was 86.05%,which can be used as the initial diagnosis of lesions and the observation of the growth of lesions during clinical follow-up;The diagnostic rates of CEUS,CT and MRI for GHH were 100%,97.5%and 100%,respectively,which had high clinical value.5.Compared with open surgery,laparoscopic surgery in the treatment of GHH has the advantages of less intraoperative bleeding,lower incidence of postoperative complications,less postoperative liver function damage,less postoperative pain,faster recovery and shorter hospital stay.In conclusion,laparoscopic surgery is a safe and effective method for the treatment of GHH with rapid postoperative recovery.However,in the face of complex GHH or intraoperative hemorrhage caused by tumor rupture,traditional open surgery still has certain advantages in clinical practice because of better surgical exposure and faster hemostasis. |
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