| Background Hepatic hemangioma(HH)is the most common benign liver disease in clinical work.It occurs frequently in middle-aged women and the incidence rate is between 0.4%and 7.3%[1].The clinical manifestations of patients with hepatic hemangioma are not obvious,while the detection rate of hepatic hemangioma grows up with the increase of health examinations.Surgical resection is a clinically accepted and effective treatment for hepatic hemangiomas.With the advancement of endoscopic techniques and people's increasing demands for quality of life,laparoscopic techniques are gradually being used in the treatment of hepatic hemangioma.However,comparing with open surgery,the safety and effects of laparoscopic resection for Liver Hemangioma are still controversial.This article has collected and analyzed the relevant clinical data of patients undergoing surgical treatment in our hospital from January 2015 to December 2017.This article has also summarized the latest relevant literatures,in order to deepen the understanding of hepatic hemangioma and the differences between laparoscopic surgery and open surgery,or further information for the clinical consensus on the diagnosis and treatment of hepatic hemangioma.Objective Through retrospective study and analysis of clinical data,and the relative data of two different surgical methods of laparoscopic liver hemangioma resection and open hepatic hemangiomas resection,the diagnosis and treatment of hepatic hemangiomas has been discussed and also the understanding of this disease has been increased.Methods The clinical data of 152 patients with hepatic hemangiomas who had undergone concurrent surgical treatment from January 2015 to December 2017 at Qilu Hospital of Shandong University were collected,of whom 86 patients underwent open hepatic hemangioma resection group.A total of 66 patients underwent laparoscopic hepatic hemangioma resection group were recruited.And the latest relevant literature was summarized from the patient's sex,age,weight,main complaint,hospital physical examination,preoperative and radiological examination results before surgery,treatment plan,surgical report,intraoperative blood loss,operation time,postoperative recovery,postoperative course record,hospital's day,hospitalization costs and other data were statistically analyzed.Results A total of 152 cases were included in the study,including 86 cases of open hepatic hemangioma resection group and 66 cases of laparoscopic hepatic hemangioma resection group.41 cases(27%)of all enrolled cases were male cases,female cases are 111 cases(73%),and male to female ratio 1:2.7.Patients aged between 20-68 years old,average 48±9 years old,mostly 40-55 years old.Average patient weight is 64.2±11Kg.There were 101(66.4%)patients with single hemangiomas and 51(33.6%)patients with multiple hemangiomas.The lesion size ranged from 5-25cm with an average internal diameter of 9.26±3.78cm.All patients were diagnosed as hepatic hemangiomas by imaging examination.140 patients undergoing preoperative CT examination and 128 cases of patients were diagnosed as hepatic hemangioma,which showed the positive rate of diagnosis was 91.4%;40 patients underwent B-ultrasound examination and 21 cases diagnosed with hepatic hemangioma.The diagnostic positive rate was 52.5%;11 patients underwent MRI examination and 10 cases of hepatic hemangioma diagnosis.The diagnostic positive rate is 90.9%.By imaging examination,43 lesions were located in the left lobe of the liver,85 in the right lobe of the liver,24 lesions in the right and left hemispheres,3 patients with chronic hepatitis,and 8 with hepatic cysts.Among the two groups of patients,their calculated p-values were greater than 0.05 in terms of age,gender,clinical manifestations,number of tumors,tumor location,and characteristics of liver diseases.There was no statistically significant difference between the two groups while P values of weights of cases and the lesion size were less than 0.05,and there was a statistically significant difference between groups.Among the patients enrolled in the study,4 patients with elevated serum alanine aminotransferase(ALT),3 patients with elevated aspartate aminotransferase(AST),5 patients with low albumin(ALB)(<35 g/L),and total gall Six patients with elevated TBIL and three patients with elevated prothrombin were eligible.All AFPs were normal.The selected Child-Hugh gradings were grade A and no Kasabach-Merritt symptom,Budd-Chiari Syndrome(BCS),rupture of tumors,etc.The mean operation time was 183.3±92.1 minutes in the two groups,of which the mean operation time was 200.4 ± 99.8 minutes in the open hepatic hemangioma surgery group and 161.0 ± 76.1 minutes in the endoscopic surgery group.The difference was statistically significant;the mean intraoperative blood loss was 370.3±662.6ml,among which the mean intraoperative blood loss was 514.7±838.1ml in the open surgery group and 182.3±194.7 in the endoscopic surgery group.The difference was statistically significant;the average hospital stay after surgery was 10,1±5.4 days,and the mean postoperative hospital stay was 11.2±6.5 days in the open hepatic hemangioma surgery group and 8.7±2.6 days in the endoscopic surgery group.The difference was statistically significant;the average hospitalization cost was 47822±15592 yuan,including the average hospitalization cost in the open surgery group was 45,861±18,316 yuan,and the endoscopic surgery group was 50,377±10,695 yuan.The difference was not statistically significant.Conclusion 1.In clinical work,surgical indications for hepatic hemangiomas must be strictly observed and followed;2.For patients with tumor diameter less than 10cm and clear surgical indications,laparoscopic resection of hepatic hemangioma can significantly reduce the amount of bleeding in operation and shortening the length of hospital stay,which are better than open surgery;3.For patients with giant hemangiomas larger than 10cm in diameter,laparoscopic surgery does not have obvious advantages in intraoperative blood loss,length of stay,operation time,and hospitalization costs.If the preoperative consideration of large tumors,complex relationship with the surrounding blood vessels,difficulties in surgery,it is more recommended to do open surgery for hepatic hemangioma. |
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