Hepatic cavernous hemangioma resection

Hepatic cavernous hemangioma is a more common benign tumor of the liver. With the wide application of imaging diagnostic techniques, the clinical discovery rate is also increasing. Small hemangioma usually has no obvious symptoms; larger hemangioma can produce hepatomegaly, abdominal pain, abdominal distension, nausea, vomiting, and jaundice; giant hemangioma can cause symptoms such as anemia and heart failure. A small number of patients may have spontaneous rupture or traumatic rupture, causing massive intra-abdominal hemorrhage and even death. Surgical methods include: hepatectomy, extracapsular dissection, hemangiomas, and hepatic artery ligation. Where hepatic vascular tumors occupy a leaf or half liver, regular hepatic lobe or hepatic resection can be performed. For the hemangioma boundary is unclear, involving most of the liver, hepatic artery ligation can be performed. For hemangioma diameter of 5 ~ 10cm, regardless of isolated single or multiple, hemangiomas or extracapsular hemangiomas can be performed. Treatment of diseases: hepatic hemangioma hepatic cavernous hemangioma hepatic hemangioma Indication Any clinically symptomatic hemangioma and a clinically significant diameter of more than 4 cm, protruding from the surface of the liver are indications for surgical treatment. Deep in the liver parenchyma, if the boundary is unclear, hepatic lobe and segmentectomy should be performed. Surgical procedure Take the right liver as an example: 1. Position: supine position, the right lower back with a yarn bag, padded high, so that the body and the operating table plane angle of 15 ° ~ 30 °. 2. Incision: Generally, the right upper transabdominal rectus muscle or the right upper right side incision is used for exploration. When the right hepatic resection is decided, because the scope of surgery is large, it can be extended to the upper right side, and the chest and abdomen are combined with the incision, and the diaphragm is cut. When the baby or child underwent right hepatectomy, the chest should not be opened. The right upper abdomen incision or the inferior costal incision should be used. If necessary, the right rib arch cartilage can be cut off. 3 Blocking the second hepatic hilum: The diagnosis is confirmed by exploration. According to the site and the boundary, it is considered suitable for exfoliation. In the first hepatic hilum, a catheter or gauze band is placed through the retina hole, and the tumor becomes soft after being blocked. Zoom out. Then carefully separate and cut off and ligature the ligament and adhesion of the liver lobe where the tumor is located, so that the tumor is fully separated and then relax the blocking band, and then prepare for tumor excision. 4. Exfoliation of the tumor: Ready to perform hepatic hilar block again. The tangential line should be selected close to the normal liver tissue around the tumor. The liver capsule is cut with a knife or an electric knife. It is bluntly separated outside the hemangioma capsule with a finger or a shank. When the cord is encountered, it should be clamped, then ligated and cut. Until the tumor is completely stripped, relax the block. If the wound surface is pressed with saline gauze, the bleeding point should be sewed. Finally, suture the liver wound or cover the wound with a large omentum, and drain the hose under the armpit.