症状性非寄生虫性肝囊肿的三种治疗方法比较

COMPARISON OF THREE TREATMENT METHODS FOR SYMPTOMATIC NON-PARASITIC HEPATIC CYSTS

目的比较囊肿穿刺抽液+注射硬化剂术、开腹囊肿开窗术、腹腔镜下囊肿开窗术三种方法处理症状性非寄生虫性肝囊肿的优缺点,探索症状性非寄生虫性肝囊肿的最佳处理方法。方法回顾性分析1999年7月～2011年12月采用三种不同术式治疗症状性非寄生虫性肝囊肿68例,其中囊肿穿刺抽液+注射硬化剂术20例、开腹囊肿开窗术30例、腹腔镜下囊肿开窗术18例,比较3组的手术时间、术中失血量、术后近期并发症率、复发率、住院天数。结果囊肿穿刺抽液+注射硬化剂术复发8例(40%);开腹手术出现并发症4例(13.3%);腹腔镜手术无复发病例。腹腔镜下开窗术及剖腹开窗术术后囊肿复发率明显低于超声引导下囊肿穿刺抽液+注射硬化剂术,其差别有显著的统计学意义,p<0.05。腹腔镜下开窗术与剖腹开窗术相比,其手术时间、住院时间、手术并发症又明显少于剖腹开窗术,其差别有统计学意义,p<0.05。结论囊肿抽液+注射硬化剂术复发率高,需多次操作,适合于年老体弱、不愿手术者或手术有禁忌证的患者。剖腹行肝囊肿开窗术创伤大,恢复慢,并发症多。腹腔镜下肝囊肿开窗术创伤小,患者术后恢复快,并具有操作简单、住院时间短、复发率低等优点,长期疗效等同于开腹手术,值得临床推广应用。

Objective To compare three methods dealing with symptomatic non-parasitic hepatic cyst（cyst puncture ＋ injection of sclerosing agent,cyst fenestration open surgery,laparoscopic cyst fenestration） about the advantages and disadvantages,exploring the best treatment method for symptomatic non-parasitic hepatic cyst. Methods A retrospective analysis from 1999 July to 2011 December on 68 cases using three different surgical treatment of symptomatic non-parasitic hepatic cyst,in which the cyst puncture and injection of sclerosing agent in 20 cases,abdominal cyst fenestration in 30 cases,laparoscopic fenestration of the cyst in 18 cases,compared with 3 groups of operation time,intraoperative blood loss volume,postoperative complications rate,recurrence rate,length of hospital stay. Results The cyst puncture＋injection of sclerosing agent postoperative recurrence in 8 cases（40%）;open operation complications occurred in 4 cases（13.3%）;laparoscopic operation without recurrence cases.Laparoscopic fenestration and laparotomy fenestration after enucleation of the cyst recurrence rate was significantly lower than ultrasound-guided puncture drainage and injection of sclerosing agent operation,the difference is statistically significant,p 0.05.Laparoscopic fenestration compared with caesarean section fenestration,the operation time,hospitalization time,complications are significantly less than laparotomy operation fenestration,the difference was significant,p0.05. Conclusion The cyst fluid pumping and injection of sclerosing agent with high recurrence rate,need of multiple operations,is suitable for the old and weak,who cannot sustain operation or operation is contraindicated in patients.Laparotomy liver cyst fenestration is with more traumas,slow recovery,and more complications.Laparoscopic fenestration of hepatic cyst in patients with minor trauma,rapid postoperative recovery,and has the advantages of simple operation,short hospitalization time,low recurrence rate,long-term efficacy equivalent to the conventional operation,worthy of clinical application.