Abstract：
BACKGROUND: Laparoscopic treatment has been increasingly adopted for giant hepatic hemangioma (HH), but the role of liver resection or enucleation remains uncertain. The aim of this study is to compare the laparoscopic resection (LR) with laparoscopic enucleation (LE) for HH, and to provide evidence on how to choose the most suitable approach for HH.
METHODS: A retrospective analysis of HH patients underwent laparoscopic treatment between March 2015 and August 2022 was performed. Perioperative outcomes were compared based on the surgical approaches, and risk factors for increased blood loss was calculated by logistic regression analysis.
RESULTS: A total of 127 patients in LR group and 287 patients in LE group were enrolled in this study. The median blood loss (300 vs. 200 mL, P < 0.001) was higher in LE group than that in LR group. Independent risk factors for blood loss higher than 400 mL were tumor size ≥ 10 cm, tumor adjacent to major vessels, tumor occupying right liver or caudate lobe, and the portal phase enhancement ratio (PER) ≥ 38.9%, respectively. Subgroup analysis showed that LR was associated with less blood loss (155 vs. 400 mL, P < 0.001) than LE procedure in patients with high PER value. Both LR and LE approaches exhibited similar perioperative outcomes in patients with low PER value.
CONCLUSIONS: Laparoscopic treatment for HH could be feasibly and safely performed by both LE and LR. For patients with PER higher than 38.9%, the LR approach is recommended.
METHODS: A retrospective analysis of HH patients underwent laparoscopic treatment between March 2015 and August 2022 was performed. Perioperative outcomes were compared based on the surgical approaches, and risk factors for increased blood loss was calculated by logistic regression analysis.
RESULTS: A total of 127 patients in LR group and 287 patients in LE group were enrolled in this study. The median blood loss (300 vs. 200 mL, P < 0.001) was higher in LE group than that in LR group. Independent risk factors for blood loss higher than 400 mL were tumor size ≥ 10 cm, tumor adjacent to major vessels, tumor occupying right liver or caudate lobe, and the portal phase enhancement ratio (PER) ≥ 38.9%, respectively. Subgroup analysis showed that LR was associated with less blood loss (155 vs. 400 mL, P < 0.001) than LE procedure in patients with high PER value. Both LR and LE approaches exhibited similar perioperative outcomes in patients with low PER value.
CONCLUSIONS: Laparoscopic treatment for HH could be feasibly and safely performed by both LE and LR. For patients with PER higher than 38.9%, the LR approach is recommended.
摘要：
背景：巨大肝血管瘤（HH）越来越多地采用腹腔镜治疗，但肝切除或摘除的作用仍不确定。这项研究的目的是比较腹腔镜切除术（LR）与腹腔镜摘除术（LE）的HH，并为如何选择最适合HH的方法提供证据。
方法：回顾性分析2015年3月至2022年8月接受腹腔镜治疗的HH患者。根据手术入路比较围手术期结果，通过logistic回归分析计算失血量增加的危险因素。
结果：本研究共纳入LR组127例患者和LE组287例患者。中位失血量（300vs.200mL,LE组P<0.001)高于LR组。失血量大于400mL的独立危险因素是肿瘤大小≥10cm。邻近主要血管的肿瘤，肿瘤占据右肝或尾状叶，门静脉相位增强率（PER）≥38.9%，分别。亚组分析显示，LR与更少的失血有关（155vs.400mL,P<0.001）比LE手术患者的PER值高。LR和LE方法在PER值低的患者中表现出相似的围手术期结果。
结论：LE和LR均可安全地进行腹腔镜治疗HH。对于PER高于38.9%的患者，建议采用LR方法。
方法：回顾性分析2015年3月至2022年8月接受腹腔镜治疗的HH患者。根据手术入路比较围手术期结果，通过logistic回归分析计算失血量增加的危险因素。
结果：本研究共纳入LR组127例患者和LE组287例患者。中位失血量（300vs.200mL,LE组P<0.001)高于LR组。失血量大于400mL的独立危险因素是肿瘤大小≥10cm。邻近主要血管的肿瘤，肿瘤占据右肝或尾状叶，门静脉相位增强率（PER）≥38.9%，分别。亚组分析显示，LR与更少的失血有关（155vs.400mL,P<0.001）比LE手术患者的PER值高。LR和LE方法在PER值低的患者中表现出相似的围手术期结果。
结论：LE和LR均可安全地进行腹腔镜治疗HH。对于PER高于38.9%的患者，建议采用LR方法。
