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目的:探讨肝切除术在肝良性病变治疗中的价值。方法:回顾性研究和分析空军总医院与解放军总医院1986-2010年955例连续性肝切除手术病例临床资料。结果:本组病例数最多的疾病是肝血管瘤和肝内胆管结石,分别占所有良性疾病的44.3%(423例)和27.7%(265例)。术中失血≤200 ml者596例(62.4%),200～400 ml者122例(12.8%),400～1 000 ml者164例(17.2%),>1 000 ml者73例(7.9%)。术中输异体血者359例(37.6%),自体血回输者81例(8.5%)。手术时间平均(240.60土98.31)min。术后住院时间平均(14.01±8.23)d。术后并发症发生率为13.7%,围手术期病死率为0.2%。经多因素Logistic回归分析,与并发症相关的独立影响因素是手术时间(P=0.004,OR=1.003)和白蛋白(ALB)值(P=0.040,OR=0.938),其中手术时间的延长为危险因素,ALB值的升高为保护因素。结论:肝切除术是治疗肝脏良性占位性病变的安全、有效方法,但手术适应证需严格评价。
Objective: To investigate the value of hepatectomy in the treatment of benign liver diseases. Methods: The clinical data of 955 cases of continuous hepatectomy from 1986 to 2010 in Air Force General Hospital and PLA General Hospital were retrospectively studied and analyzed. Results: The most common diseases in this group were hemangiomas and intrahepatic bile duct stones, accounting for 44.3% (423 cases) and 27.7% (265 cases) of all benign diseases respectively. There were 596 cases (62.4%) with blood loss less than 200 ml, 122 cases (12.8%) with 200-400 ml, 164 cases (17.2%) with 400-1000 ml and 73 cases (7.9% . 359 cases (37.6%) had transfusion of blood and 81 cases (8.5%) had autologous blood transfusion. The average operation time (240.60 ± 98.31) min. The average postoperative hospital stay was (14.01 ± 8.23) days. The postoperative complication rate was 13.7% and the perioperative mortality rate was 0.2%. Logistic regression analysis showed that the independent factors associated with complications were operative time (P = 0.004, OR = 1.003) and albumin (ALB) (P = 0.040, OR = 0.938) Risk factors, ALB value increased as a protective factor. Conclusions: Hepatectomy is a safe and effective method for the treatment of benign liver lesions. However, surgical indication should be strictly evaluated.