[Modified total hepatic vascular exclusion for liver extracapsular resection of giant hepatic cavernous hemangioma].

OBJECTIVE: To explore the feasibility of intraoperative autologous transfusion in modified total hepatic vascular exclusion under normal temperature for extracapsular resection of giant hepatic hemangioma. METHODS: The clinical data of 32 patients undergoing hepatic resection with total hepatic vascular exclusion requiring intraoperative autologous transfusion were analyzed retrospectively. The tumors in these cases involved the proximal hepatic veins and inferior vena cava, with hemangioma volume ranging from 12 cm x 15 cm to 18 cm x 40 cm. RESULTS: The hemangioma were completely resected in all patients, who all recovered smoothly. In one case, hemangioma rupture occurred during dissociation of the liver, resulting in massive hemorrhage which required blood transfusion of 6000 ml. Four patients received blood transfusion of 400-800 ml, and the other 27 had no blood transfusion. Only 8 patients underwent pringle maneuver with resection, whereas the other 27 underwent total hepatic vascular exclusion during liver resection for 5-30 min (mean 16 min). CONCLUSION: Intraoperative autologous transfusion in modified total hepatic vascular exclusion under normal temperature is feasible and safe for extracapsular resection of huge hepatic hemangioma adjacent to the major arteries.