巨大肝海绵状血管瘤的外科治疗

随着B超、CT检查的普及,肝海绵状血管瘤的检出率日渐增高。本院自1991年1月～1996年1月收治肝血管瘤18例,其中10例巨大肝海绵状血管瘤经手术治愈。术中出血量少,其中9例100～200ml,仅1例达到1600ml,术后均无严重并发症。肝血管瘤的检查首选B超、CT或ECT。本组B超检查符合率77.8％,CT90％。经以上系统检查仍不能确诊的可切除肿瘤,尽早手术具有鉴别诊断和治疗的双重临床意义。血管瘤剥除术式治疗第Ⅶ、Ⅷ段血管瘤为首选而又简便、安全的方法。预防术中大出血是手术的关键。     

14例巨大肝海绵状血管瘤的手术治疗

肝脏海绵状血管瘤(hepatic cavernous heman-gioma,HCH)是最常见的良性肝脏占位性病变之一。随着近年来彩超、CT的普及,其诊断率明显提高。我院肝胆外科近5年来手术治疗肝脏巨大海绵状血管瘤14例,疗效良好,现报告如下。     

肝海绵状血管瘤治疗进况

肝海绵状血管瘤治疗进况杨甲梅，吴孟超，陈汉，姚晓平，严以群（上海第二军医大学东方肝胆外科医院上海２００４３３）肝海绵状血管瘤（下称肝血管瘤）是一种常见的肝脏良性肿瘤。我院１９６０年１月至１９９５年９月共收治８２１例，至今未发现有恶变者。故对瘤体直径≤...     

应用剥离术治疗肝海绵状血管瘤22例体会

目的 介绍一种治疗肝海绵状血管瘤的方法，并探讨该方法的优缺点。方法 对８年中采用剥离术治疗肝海绵状血管瘤２２例进行分析。结果 全且病例恢复良好，无一例出现术后并发症，经随访３个月至３年，情况良好，未见复发。结论（１）该方法手术创伤小，不必切除正常肝组织。（２）术中输血少，大部分病人不用输血。（３）对于一些位于解剖困难部位的肿瘤，应用该方法可安全切除。（４）此方法疗效确切。（５）瘤体较小，深在肝实质     

巨大肝脏海绵状血管瘤术中肝门的处理

肝脏海绵状血管瘤的最好治疗方法是手术切除，但对已侵犯肝门的血管瘤手术风险较大，肝门的处理是手术的最大难题。我们科自９４年２月至９７年２月共收治２１例紧贴一、二、三肝门的世故因管瘤，瘤体最大径线１２－３６ｃｍ，平均２４ｃｍ。术中先忆患侧肝动脉，然后再解剖分离肝门，在第一肝门阻下全部完整切除了瘤体，行中三叶及尾状叶切除５例，右半肝及尾状叶切除７例，在右半肝切除１例，右肝上段切除３例。右后叶切除２例，一     

第Ⅰ第Ⅷ肝段巨大型海绵状血管瘤手术治疗4例报告

根据本组手术体会结合近年国内报道的经验，对第Ⅰ及第Ⅷ肝段肿瘤手术，本文提出不必常规进行全肝血流阻断，胆下腔静脉需要预先安置阻断带。手术是在阻断入肝血流情况下进行的，术中如必须阻断下腔静脉时，可采取分步阻断法，以缩短阻断时间，防止由于回心血流骤减所致的血压下降。第Ⅰ肝段的血管瘤用剥除法是困难的，可采用肿瘤根部缝扎后切除的方法，将其切除。如仍残留一部分肿瘤的基底，可用连续褥式缝合法将其缝扎。第Ⅷ肝段的     

129例肝海绵状血管瘤临床治疗分析

肝海绵状血管瘤（简称肝血管瘤）是肝脏较常见的良性肿瘤。小的肝血管瘤往往无症状，对较大的肝血管瘤和有临床症状者，要采取相应的治疗措施。我院自1989—1996年共收治肝血管瘤129例，分别进行手术切除、缝扎治疗、肝动脉栓塞及放射治疗，现将其临床结果进行分析、讨论。1临床资料129例中男59例，女70例。年龄23～68岁。临床表现以上腹部不适、饱胀、食欲下降等就诊者62例，以上腹区包块就诊者28例，查体时发现肝内占位性病变就诊者39例，全部病例均经B超检查，其中98例行CT检查，59例行MRI检查，除6例诊断为肝癌，l例诊断为多发转移瘤…     

肝海绵状血管瘤捆扎术

目的 观察,总结和分析捆扎疗法治疗肝海绵状血管瘤的临床疗效。方法 选择总结了１４２例肝海绵状血管瘤病例,术中对瘤体地完整缝扎,术后９７例随访１－１９年,分组评定疗效。结果 显著疗效病例占６５．９％,有效病例占１２．５％,无效或暂无变化病例占２１．６％,结论 捆扎术治疗肝海绵状血管瘤,确为一种简便易行,损伤小,安全和病人恢复快,疗效好的方法。     

肝脏海绵状血管瘤有关问题的探讨

目的本文旨在探讨肝脏海绵状血管瘤（CHL）的某些相关问题，以求提高该病的手术疗效。方法总结我院169例CHL的手术经验，探讨该病手术的有关问题（如诊断难度、手术指征、术式选择以及其他问题）。结果169例CHL均经手术与病理确诊。施行各种范围肝切除74例；CHL剥除术92例；CHL缝扎术1例；肝固有动脉结扎2例。本组术后除2例因严重并发症死亡（手术死亡率1．2％）外，167例均治愈。结论（1）目前巨大CHL尚无公认的大小，所以我们期待在不久的将来能制定出国内统一的大小标准；（2）不典型的CHL诊断困难，尤其伴有AFP假阳性的CHL很难与HCC鉴别；（3）对CHL的手术适应证要灵活掌握，只要症状明显，CHL发展增大、快或不能除外肝恶性肿瘤者，不论CHL大小都应手术治疗；（4）术式中条件合适者应首选CHL剥除术，较小的CHL可用无水酒精注射或缝扎术；（5）有关手术的其他问题也予以探讨，并提出明确观点。     

紧邻肝门巨大肝海绵状血管瘤51例手术治疗体会

目的 探讨紧邻肝门的巨大肝海绵状血管瘤的手术治疗。方法 回顾性分析中国医科大学附属盛京医院1997年3月至2007年10月手术治疗的51例紧邻肝门的巨大肝海绵状血管瘤的临床资料。结果 血管瘤包膜外剥除29例,肝切除19例,缝扎3例。术中平均失血量（1085±1539） mL,22例出现不同程度并发症,全组无手术死亡。结论 手术治疗紧邻肝门的巨大肝海绵状血管瘤是安全的、切实可行的,方法首选血管瘤包膜外剥除术。对限于半肝或尾状叶的病例可分别采用半肝或尾状叶切除。     

Evaluation of indications for the surgical treatment of cavernous hemangioma of the liver

The indications for liver resection performed in 18 patients with cavernous hemangioma of the liver at the Second Department of Surgery, Kyushu University Hospital, from 1985 to 1993, were reevaluated. The mean age of the patients was 49.7 years. Two patients had abdominal pain and 3 had gastric symptoms. Hepatocellular carcinoma could not be ruled out in 4 patients. None of the other patients had any clinical manifestations other than detection of the tumor. The average size of the tumors was 7.8cm (range 1–21 cm). In all, five partial resections, three subsegmentectomies, seven segmentectomies, and three bisegmentectomies of the liver were performed. No severe complications were encountered postoperatively, and no recurrences were found after the operation. A review of the literature revealed that spontaneous rupture of such tumors is infrequent. It therefore seems that there was no indications for surgery in our patients, except for the 4 in whom hepatocellular carcinoma could not be ruled out. Although elective liver resection for cavernous hemangioma is safe, the indications for surgery should be more narrowly defined in the future.     

Extrathecal cavernous hemangioma

A case of extrathecal cavernous hemangioma, a rare entity, is presented. Some clinical, radiological, and histological features of the lesion are discussed. The unusual dumbbell-like growth of the tumor through an intervertebral foramen is considered, as well as the potential effectiveness of radiation therapy. The literature dealing with spinal hemangiomas and hemangioblastomas is summarized.     

Pulmonary cavernous hemangioma

We report a rare case of pulmonary cavernous hemangioma in a 54-year-old man. A computed tomographic scan of the chest showed an ill-defined mass measuring 4 × 3 cm at the angle of the left upper lobe bronchus and the lower lobe bronchus. Surgical resection was performed to obtain a definitive diagnosis. Postoperative histological examination revealed an encapsulated mass comprising large dilated vessels lined with squamous endothelium and filled with blood, which led to the diagnosis of pulmonary cavernous hemangioma. A total of 23 cases including the present case reported in the English-language and Japanese literature were reviewed.     

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目的 探讨肝脏海锦状血管瘤的手术指征和手术方法。方法 回顾性分析采用手术治疗39例肝脏海绵状血管瘤病人资料，判断其手术指征，评价不同手术方法的结果及其手术发症发生情况。结果 39例病人中，27例采用肝叶或肝段切除术，8例采用血管瘤摘除术、缝扎或结扎等方法4例。10例出现手术并发症，以胸腔积液和膈下积液多见。结论 对肝脏海绵状血管瘤最大径大于5cm并有明显临床症状，或不能除外恶性肿瘤病人可以采用手术治疗。血管瘤摘除术和2个或2个以下肝段切除术是安全有效、并发症少的手术方法。     

大肠海绵状血管瘤的诊治(附8例报告)

目的探讨大肠海绵状血管瘤的临床特点、诊治原则和疗效。方法回顾1997年至2004年收治的8例大肠海绵状血管瘤患者的临床资料。结果8例患者平均年龄18岁,其中直肠海绵状血管瘤4例,直肠和乙状结肠海绵状血管瘤3例,全大肠海绵状血管瘤1例。临床表现为反复发作的无痛性便血和贫血。术前行电子结肠镜、腹部X线平片、气钡双重对比造影、CT和MRI等检查明确诊断。所有患者均行手术治疗,平均随访36月(10~96月),全部治愈。结论增强对本病的认识,重视电子结肠镜在大肠海绵状血管瘤的首诊作用,影像学检查进一步确定病变部位和血管瘤的范围,手术治疗是有效的治疗手段。     

肾上腺巨大海绵状血管瘤1例

患者女,70岁,因“左上腹间断疼痛1个月”入院;既往高血压病史十余年,控制良好。查体及实验室检查均未见明显异常。CT平扫示左侧腹膜后13.8 cm×10.5 cm×8.7 cm团块状混杂密度影,边界清,密度不均,边缘散在斑点状钙化灶(图1A),增强后病灶不均匀强化,外周见多发结节状高强化灶(图1B、1C),左肾上腺下缘与病灶分界不清;诊断:腹膜后巨大占位,考虑肾上腺来源良性病变。1周后于全身麻醉状态下行腹膜后肿瘤切除术。     

Dorsal foramenal extraosseous epidural cavernous hemangioma

Cavernous hemangiomas are vascular hamartomatous malformations that affect the central nervous system. This pathology is frequently encountered in the cerebral hemispheres, cerebellum, and brainstem. Cavernous hemangiomas infrequently occur at the spinal level or relative to an intramedullary localization; extramedullary epidural sites are also sometimes affected by this pathology. We report an extradural, extramedullary, cavernous hemangioma with foramenal extension of the dorsal section and discuss the differential diagnosis with dorsal foramenal neurinoma. A 52-year-old woman was admitted with irritation and deficit symptoms radiating into the left D3 spinal root space. The first radiological diagnosis was of a foramenal neurinoma beginning at the D3 root. The presence of a heterogeneous MR signal in both T1 and T2 images led us to consider the differential diagnosis of a cavernous hemangioma lesion. The patient underwent microsurgical treatment with a far lateral extraforamenal approach. Symptoms quickly improved: pain and dysesthesia disappeared after surgery and only light hypoesthesia was found. We want to stress the importance of MR imaging in formulating a correct differential diagnosis with foramenal neurinoma and underline that microsurgical treatment with a far lateral extraforamenal approach allowed us to remove the lesion completely without affecting Denis's posterior column, the lamina, and the articular facet.