手术切除与介入栓塞治疗肝血管瘤的疗效分析

发布时间：2018-03-05 21:20

本文选题：肝血管瘤　切入点：手术切除　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]通过对比分析手术切除(SR)与经导管动脉栓塞(TAE)两种不同方法在肝血管瘤治疗上的临床疗效,以制定对肝血管瘤比较合理的治疗策略。[方法]收集昆明医科大学第一附属医院(云大医院)于2009年08月到2016年05月接收治疗的86例肝血管瘤病患病例资料,其中手术切除治疗患者45例,介入栓塞治疗41例。并综合最新发表的文献信息总结,从性别、年龄、肝血管直径、手术操作时长、失血量、住院时间、总费用、并发症、有效率等方面进行统计分析。[结果]共纳入研究对象86例,男性血管瘤患者21例,女患者65例,两者比例为1:3.09。独发血管瘤患者21例,多发患者64例,平均直径是8.3±2.9cm,最大直径20.0cm。手术切除治疗组45例患者,男患者11例,女患者34位,比率为1:3.09,年龄29～63岁,平均年龄42.8±8.2岁。平均手术时间为(219.0±58.2)min,术中出血量(562.2 ± 636.1)ml,术后住院天数(17.3 ± 5.6)d,总住院费用(34341.3±8093.3)元。19例出现并发症,13例患者出现发热,4例发生肺部感染,2例出现胸腔积液,7例出现轻重不一的切口液化或感染,术后随访无复发病例及死亡病例,19例患者有症状的患者有4位无明显改善,总有效率88.9%。介入栓塞治疗组41例,男性病患10例,女性病患31例,比例为1:3.11,年龄28～67岁,平均年龄44.6±8.8岁,平均手术时间为(94.7 ±18.2)min,术中出血量(5.7±2.0)ml,平均住院天数(7.9±2.3)d,总住院费用(16071.5±2610.7)元。9例发生并发症,此中7位患者介入治疗后表现发热,2例穿刺部位发生血肿、1人发生肺部感染,13例有症状患者有4个术后疗效不明显,总有效率82.9%,无死亡病例。普通血管瘤行手术治疗与介入治疗有效率分别是90.9%、84.8%。两组病人在平均手术时间、在院时间、术中失血量、住院总费用及并发症发生率上差异有统计学意义(P0.05)。在年龄、性别上差异无统计学意义(P0.05)。[结论]1、临床工作中应该从严把握肝血管瘤的手术指征。2、对于直径5～10cm有手术指征的大肝血管瘤,介入栓塞治疗较手术切除更有优势,值得推荐。3、对于直径10cm的巨大的肝血管瘤,单纯行介入栓塞治疗疗效欠佳,选择行手术切除或先行介入栓塞治疗,待瘤体缩小后再行手术切除治疗,更为安全有效。
[Abstract]:[objective] to compare and analyze the clinical effects of two different methods of surgical resection and transcatheter arterial embolization (TAE) in the treatment of hepatic hemangioma. [methods] 86 patients with hepatic hemangioma received treatment from August 2009 to May 2016 in the first affiliated Hospital of Kunming Medical University (Yunda Hospital) were collected. Among them, 45 cases were treated by surgical resection and 41 cases were treated by interventional embolization. According to the newly published literature and information summary, from gender, age, diameter of hepatic vessels, length of operation, amount of blood loss, length of hospitalization, total cost, complications, The effective rate was statistically analyzed. [results] A total of 86 cases were included in the study, including 21 cases of male hemangioma and 65 cases of female. The ratio of the two was 1: 3.09. There were 21 patients with single hemangioma and 64 patients with multiple hemangioma. The mean diameter was 8.3 卤2.9 cm, and the maximum diameter was 20.0 cm. In the surgical treatment group, there were 45 patients (11 males and 34 females) with a ratio of 1: 3.09 and an age of 2963 years. The average age was 42.8 卤8.2 years, the average operative time was 219.0 卤58.2 min, the intraoperative bleeding volume was 562.2 卤636.1 ml, the postoperative hospital stay was 17.3 卤5.6 days, the total hospitalization cost was 34341.3 卤8093.3) yuan. 19 cases had complications, 13 cases had fever, 4 cases had pulmonary infection and 2 cases had pleural effusion. There were 7 cases of incision liquefaction or infection with different severity. The total effective rate was 88.90.There were 41 patients in the interventional embolization group, 10 males and 31 females, the proportion was 1: 3.11, age 2867.The total effective rate was 88. 97.The total effective rate was 88. 97.In the interventional embolization group, there were 10 male patients and 31 female patients, the proportion was 1: 3.11, and the total effective rate was 88. 9 years old. The average age was 44.6 卤8.8 years, the average operative time was 94.7 卤18.2min, the intraoperative bleeding volume was 5.7 卤2.0ml, the average hospital stay was 7.9 卤2.3 days, the total hospitalization cost was 16071.5 卤2610.7yuan. Among them, 7 patients showed fever after interventional therapy, 2 patients had hematoma at puncture site, 1 patient had pulmonary infection and 13 patients had symptoms after interventional therapy, 4 of them had no obvious curative effect after operation. The total effective rate was 82.9 and there were no death cases. The effective rates of surgical treatment and interventional treatment were 90.9 and 84.8 respectively. There were significant differences in the total hospitalization expenses and the incidence of complications between the two groups (P 0.05). There was no significant difference in sex (P 0.05). [conclusion] 1. In clinical work, the surgical indications of hepatic hemangioma should be strictly grasped. For the large hepatic hemangioma with a diameter of 5 ~ 10 cm, interventional embolization is more advantageous than surgical resection. It is recommended that for the giant hepatic hemangioma with a diameter of 10 cm, the effect of interventional embolization is not good. It is more safe and effective to choose surgical resection or interventional embolization, and then to remove the tumor after the tumor has been reduced.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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