Semptomatik hepatik hemanjiomlarda cerrahi tedavi deneyimi

Amaç: Hemanjiom, karaciğerin en sık görülen benign tümörüdür. Nadiren büyük, semptomatik ve atipik görüntüleme paterninde olabilirler. Cerrahi tedavi endikasyonları, persistan semptomlar, hızlı boyut artışı, yaşamı tehdit eden komplikasyonlar ve tanısal belirsizliktir. Bu çalışmada boyuttan bağımsız olarak persistan semptomatik karaciğer hemanjiomları nedeniyle cerrahi tedavi uygulanan hastalarımızın sonuçlarını sunmayı amaçladık. Yöntemler: 2017-2021 yılları arasında semptomatik hepatik hemanjiyom nedeniyle opere ettiğimiz 10 hastanın klinikodemografik verilerini, perioperatif bulgularını ve postoperatif sonuçlarını retrospektif olarak değerlendirdik. Tanıyı ultrasonografi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme ile koyduk. Hastalar yaş, cinsiyet, semptomlar, tümör boyutu ve yerleşimi, perioperatif kan transfüzyonu, operasyon süresi, postoperatif komplikasyonlar, hastanede kalış süresi ve takip sonuçları açısından değerlendirildi.Bulgular: Hastaların ortanca yaşı 51 yıl (25-60) idi ve hepsi kadındı. Hastaların tamamında persistan semptom karın ağrısı olmakla birlikte, dispepsi ve bulantı gibi ek semptomu olan hastalarımız da mevcuttu. İki hastada enükleasyon, birinde sol lateral segmentektomi, iki hastada sağ hepatektomi ve diğerlerinde anatomik olmayan segmenter rezeksiyon yaptık. Perioperatif kan transfüzyonu medyan 1 (0-3) ünite idi ve yedi hastada transfüzyon ihtiyacı oldu. Ortalama ameliyat süresi 170 (135-230) dakika ve ameliyat sonrası ortalama hastanede kalış süresi 8,5 (4-13) gündü. Postoperatif dönemde ciddi bir komplikasyon gelişmedi. Medyan takip süresi 23,5 (9-40) aydı ve, nüks veya ciddi uzun dönem komplikasyon olmadı.Sonuç: Semptomatik hepatik hemanjiyomlu hastalarda cerrahi tedavi, deneyimli merkezlerde güvenli ve etkin bir şekilde uygulanabilir.

Anahtar Kelimeler:

hepatik hemanjiom, karaciğer rezeksiyonu, enükleasyon

Experience in surgical treatment of symptomatic hepatic hemangiomas

Aim: Hemangioma is the most common benign tumor of the liver. They are rarely large, symptomatic, and show atypical imaging patterns. Surgical treatment indications are persistent symptoms, rapid size increase, lifethreatening complications, and diagnostic uncertainty. In this study, we aimed to present the results of our patients who underwent surgical treatment for persistent symptomatic hepatic hemangiomas regardless of size.Methods: We retrospectively evaluated the clinicodemographics, perioperative findings, and postoperative results of ten patients that we operated for symptomatic hepatic hemangiomas between 2017 and 2021. We made the diagnosis based on ultrasonography, computed tomography, and magnetic resonance imaging. Patients were evaluated in terms of age, gender, symptoms, tumor size and location, perioperative blood transfusion, operation time, postoperative complications, length of stay, and follow-up results.Results: The median age was 51 (25-60) and all of them were female. Although the persistent symptom in all patients was abdominal pain, we also had patients with additional symptoms such as dyspepsia and nausea. We performed enucleation in two, left lateral segmentectomy in one, right hepatectomy in two patients and, nonanatomical segmental resection in the rest. Perioperative blood transfusion was median 1 (0-3) unit and required in seven. The median operation time was 170 (135-230) minutes, and the median postoperative stay was 8.5 (4-13) days. No serious complications developed in the postoperative period. The median follow-up time was 23.5 (9-40) months and, there was no recurrence or notable long-term complications.Conclusion: Surgical treatment can be performed safely and effectively in experienced centers for patients with symptomatic hepatic hemangioma.

Keywords:

hepatic hemangioma, liver resection, enucleation,

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