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題名 | Clinical Manifestations of Hepatic Hemangioma Undergoing Partial Liver Resection=肝臟血管瘤手術前後的臨床表現 |
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作者 | 范揚國; 邱仁輝; 周嘉揚; 龍藉泉; 李潤川; 蔡世豪; 吳秋文; 雷永耀; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:2 民89.03-04 |
頁次 | 頁59-65 |
分類號 | 416.246 |
關鍵詞 | 海綿狀血管瘤; 肝臟血管瘤; Cavernous hemangioma; Hepatic resection; |
語文 | 英文(English) |
中文摘要 | 鑑別肝臟血管瘤與肝細胞癌或轉移性肝臟腫瘤仍然是常見、且具有挑戰性的課題。我們收集了過去十年在本院接受肝臟血管瘤切除的十五個病例,其手術適應症包括:四例懷疑因肝外惡性腫瘤合併肝內轉移、三例是乙型肝炎帶原者在門診追蹤的過程中認為有惡性的可能、一例是肝臟血管瘤在門診追蹤的過程中顆數短時間增加、一例巨大肝腫瘤放射線科大夫無法確定診斷、二例意外發現認為有惡性的可能、一例伴隨其他主手術進行的楔型肝切除、三例是肝臟血管瘤合併有明顯症狀者;同時回顧過去十五餘年相關文獻報導,分析比較各種不同診斷工具的優缺點,包括:腹部超音波、電腦斷層掃瞄、核振攝影、血管攝影...等,並嚐試著提出一套肝臟血管瘤的診斷流程;根據此流程以及本院多年成功手術切除肝臟腫瘤的經驗,因此我們認為:對於以下四種情況,手術切除肝臟腫瘤可以提供一有效且可治癒的選擇。第一:術前無法確定診斷的肝臟腫瘤(如:良性、惡性無法鑑別時)、第二:出現腫瘤引起的相關症狀(如:疼痛、易飽...等)、第三:血中腫瘤指數明顯增加、第四:在門診追蹤的過程中,肝臟腫瘤大小或顆數明顯增加,特別在乙型及丙型肝炎高盛行的地區(如:臺灣),錯失診斷肝癌的情況是可以避免的。 |
英文摘要 | The differentiation between hepatic hemangioma and hepatocellular carcinoma or metastasis has always been a challenging problem. From Jan. 1988 to Dec. 1997, fifteen patients having undergone partial hepatectomy with the liver specimens proved to be hemangioma were retrospectively reviewed. There were nine women and six men with ages ranging from 40 to 75 years old. The tumor size ranged from 1 to 18 cm in diameter. Operative interventions were suggested under the following circumstances: suspected metastasis due to extrahepatic malignancy (n=4), suspected malignancy during the routine survey for the patients with hepatitis carrier or hemangioma (n=4),incidental finding and hepatocellular carcinoma is highly suspected (n=2), intra-lesion hemorrhage with chronic anemia (n=1), fever of unknown origin (n=1), equivocal diagnosis after images studies (n=1), huge with abdominal complaint (n=l) and ancillary hepatic resection to other major operation (n=1). The surgical procedures included extended right lobectomy (n=1), right lobectomy (n=1), caudate & lateral segmentectomy (n=1), medial segmentectomy (n=1), posterior segmentectomy (n=1), lateral segmentectomy (n=4), subsegmentectomy (n=2), and wedge resections (n=4). One patient (1/15) died of esophageal varices bleeding and one patient had wound infection. Symptoms were relieved in the follow-up periods from 8 months to 11 years. Surgery is the treatment of choice for patients with equivocal tumor character, tumor-related symptoms, serum elevation of tumor markers, or increase in tumor size or number. Missing a malignancy should be avoided especially in the high HBV/HCV prevalence area. |
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