What to do if there is a hemangioma in the right liver

Hemangioma mainly refers to abnormal protrusions that appear on blood vessels due to lesions in vascular organs. This is what we often call hemangioma. This disease can occur anywhere in the body where there are blood vessels, but there are different treatment options for hemangiomas in different parts of the body. For example, hemangiomas in the brain can only be treated with chemotherapy, while other organs such as the liver can be restored to health by directly removing the root cause of the disease.

Treatment of hepatic hemangioma

Segmentectomy

With the development of surgical techniques and the improvement of liver surgical skills, the mortality and complications of liver resection have been greatly reduced, and the scope of application has been expanded to benign liver disease variants, among which hepatic hemangioma is the most commonly used benign liver disease variant for liver resection. Most patients with hepatic hemangioma have no history of cirrhosis, have better liver compensatory function, and can tolerate larger-scale liver resection surgery. For giant hepatic hemangiomas or multiple hemangiomas, regular segmental or lobectomy or even hemihepatectomy can usually be performed, but the amount of liver resection should not exceed 70%-75% of the entire liver. The main problem of liver segment resection in treating hepatic hemangioma is controlling bleeding. Since hemangioma has rich blood supply, the tumor itself is prone to bleeding, which increases the difficulty of surgery. Sometimes even improper operation during surgery can lead to uncontrollable massive bleeding. How to control bleeding is the key to the success of the operation.

Hepatic hemangioma resection

Hepatic hemangiomas often grow in an expansive manner, which can compress normal liver tissue, bile ducts, and blood vessels to form a thin fibrous capsule. There are few blood vessels at this interface, so blunt separation can be performed along this interface to peel off the hemangioma, which is called "hemangioma extracapsular resection" and can achieve the purpose of less bleeding and complete removal of the lesion. Alper et al. first reported this surgical procedure in 1988. Several large-sample clinical studies compared liver resection and hemangioma dissection and found that: the operation time, blood loss and blood transfusion volume of dissection were significantly less than those of liver resection; the liver damage was mild, normal liver tissue was preserved to the maximum extent, and the patient's liver function recovered quickly after surgery; the damage to important intrahepatic blood vessels and bile ducts was reduced, bleeding was reduced, and the incidence of bile fistula was lowered.

It is currently highly praised by many scholars at home and abroad and has become the main surgical procedure for treating hepatic hemangioma. Regular liver resection is only performed when malignancy is suspected or a lobe of the liver is completely occupied by tumor. However, some scholars believe that in some cases it is difficult to confirm the gap between the hemangioma and the liver parenchyma during surgery, and the removal may result in excessive bleeding, especially for hemangiomas close to important structures such as the main hepatic vein and the retrohepatic inferior vena cava. Blunt dissection can easily tear large blood vessels or damage the tumor, leading to uncontrollable massive bleeding.

Expert opinion:

(1) If the tumor is located in the left lateral lobe of the liver, liver resection should be chosen because it is easier to operate. In addition, liver resection is also performed when multiple hemangiomas are confined to a certain liver lobe. In this case, if the tumors are removed one by one, it will cause great damage, heavy bleeding and be time-consuming.

(2) Since right hepatectomy is relatively complex and traumatic, right lobe hemangioma resection has advantages over hepatectomy;

(3) Hemangiomas in the middle lobe of the liver are close to the liver hilum and are closely related to the large blood vessels entering and exiting the liver. They may also invade the left and right liver lobes. Hepatectomy is more difficult to treat such tumors. Decortication can not only effectively avoid damage to the ducts at the liver hilum, but also avoid the need to remove too much normal liver tissue and significantly reduce intraoperative bleeding.

Once a disease like hepatic hemangioma occurs in life, it is indeed not easy to recover. It is even more necessary for us to learn more about relevant treatment methods for hepatic hemangioma diseases, and take timely and correct treatment measures when we are sick, so as to avoid missing the best time for treatment and causing too much health hazards and impacts to patients with hepatic hemangioma diseases.