背景:严重出血仍然是腹腔镜肝血管瘤切除术的重要问题。很少报道主要血管受累程度如何影响严重出血。本研究主要旨在分析肝血管瘤腹腔镜手术中受累主要血管(NIMV)数量的影响,并评估与出血增加相关的危险因素。
方法:对2018年1月至2023年12月在我科接受腹腔镜肝血管瘤切除术的连续患者进行了数据库搜索。收集的数据包括人口统计,血管瘤的特征,实验室数据,操作方法,手术和术后变量。
结果:共有72名患者被纳入研究。42例患者分为NIMV<2组,30例患者分为NIMV≥2组。NIMV≥2组与特殊节段有显著相关性,涉及血管瘤的多个节段和直径(P<0.01)。围手术期变量包括切除程度,手术时间,失血,普林格尔机动时间,术后停留时间,引流管持续时间,和术后肝功能(ALT,AST)也显示两组之间的显着差异(P<0.05)。值得注意的是,NIMV≥2是腹腔镜肝血管瘤术中出血量≥500ml的重要独立危险因素(P=0.011)。多因素分析中NIMV≥2时,独立危险因素为特殊段(P=0.000)。
结论:多个主要血管(NIMV≥2)的受累与特殊节段显着相关,导致术中失血增加,操作难度,术后恢复延迟。此外,它被认为是腹腔镜肝血管瘤切除术中失血量增加的单一独立危险因素.
BACKGROUND: Severe bleeding remains a significant concern in laparoscopic resection for hepatic hemangioma. It is rarely reported that how the degree of major vessels involvement impacts on severe bleeding. The present study primarily aimed to analyze the impacts of the number of involved major vessels (NIMV) during laparoscopic surgery for hepatic hemangioma and evaluate the risk factors associated with increased bleeding.
METHODS: A database search was carried out for consecutive patients who underwent laparoscopic resection for liver hemangiomas at our department from January 2018 to December 2023. The collected data included demographics, characteristics of the hemangiomas, laboratory data, operation method, surgical and postoperative variables.
RESULTS: A total of 72 patients were enrolled in the study. 42 patients were categorized into the group with NIMV < 2, while 30 patients were divided into the group with NIMV ≥ 2. The group with NIMV ≥ 2 demonstrated a significant correlation with special segments, involved multiple segments and diameter of the hemangiomas (P < 0.01). And the perioperative variables including the extent of resection, operative time, blood loss, Pringle maneuver times, postoperative stay, drainage tube duration, and postoperative liver function (ALT, AST) also showed significant differences between the two groups (P < 0.05). Notably, NIMV ≥ 2 was identified as the most important independent risk factor for intraoperative blood loss ≥ 500 ml in laparoscopic surgery for hepatic hemangioma (P = 0.011). For NIMV ≥ 2, the independent risk factor was special segments in multivariate analysis (P = 0.000).
CONCLUSIONS: The involvement of multiple major vessels (NIMV ≥ 2) was significantly associated with special segments, resulting in increased intraoperative blood loss, operation difficulty, and delayed postoperative recovery. Moreover, it was identified as the single independent risk factor with a considerable risk for increased blood loss during laparoscopic resection for hepatic hemangioma.