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. 复杂肝脏血管瘤的手术治疗. 中国实用外科杂志, 2010, 30(8):659-662.
2.	陈孝平, 何松青. 复杂肝脏手术实施的难点与技术进步. 中国实用外科杂志, 2010, 30(8):629-632.
3.	张尊义, 黄志勇. 提高复杂肝切除术的安全性. 肝胆外科杂志, 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.	周俭, 黄成, 樊嘉. 肝移植相关技术在复杂肝脏肿瘤切除术中的应用. 中华肝脏外科手术学电子杂志, 2012, 1(3):147-150.
6.	罗皓, 王瑞丰, 陈涛, 等. 吲哚氰绿测定与Child-Pugh分级在肝储备评估中的价值. 中国普外基础与临床杂志, 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.	赵英鹏, 李晓延, 范蜀滨, 等. 肝血管瘤手术切除血流阻断方法的选择. 中国普外基础与临床杂志, 2011, 18(1):81-83.
12.	戴朝六. 肝脏巨大尾状叶肿瘤切除术应注意的几个问题. 中华普通外科学文献:电子版, 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.	杨甲梅. 特大肝海绵状血管瘤的安全手术治疗. 中华肝胆外科杂志, 2006, 12(6):361-363.
15.	何小东, 刘卫, 叶松, 等. 肝脏巨大血管瘤手术切除的临床经验. 中华消化外科杂志, 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, 蔡卫华, 肖旭, 等. 术中白试验在肝切除术中肝断面漏胆检测中的应用. 中国普外基础与临床杂志, 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. 复杂肝脏血管瘤的手术治疗. 中国实用外科杂志, 2010, 30(8):659-662.
2. 陈孝平, 何松青. 复杂肝脏手术实施的难点与技术进步. 中国实用外科杂志, 2010, 30(8):629-632.
3. 张尊义, 黄志勇. 提高复杂肝切除术的安全性. 肝胆外科杂志, 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. 周俭, 黄成, 樊嘉. 肝移植相关技术在复杂肝脏肿瘤切除术中的应用. 中华肝脏外科手术学电子杂志, 2012, 1(3):147-150.
6. 罗皓, 王瑞丰, 陈涛, 等. 吲哚氰绿测定与Child-Pugh分级在肝储备评估中的价值. 中国普外基础与临床杂志, 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. 赵英鹏, 李晓延, 范蜀滨, 等. 肝血管瘤手术切除血流阻断方法的选择. 中国普外基础与临床杂志, 2011, 18(1):81-83.
12. 戴朝六. 肝脏巨大尾状叶肿瘤切除术应注意的几个问题. 中华普通外科学文献:电子版, 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. 杨甲梅. 特大肝海绵状血管瘤的安全手术治疗. 中华肝胆外科杂志, 2006, 12(6):361-363.
15. 何小东, 刘卫, 叶松, 等. 肝脏巨大血管瘤手术切除的临床经验. 中华消化外科杂志, 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, 蔡卫华, 肖旭, 等. 术中白试验在肝切除术中肝断面漏胆检测中的应用. 中国普外基础与临床杂志, 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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