肝囊性占位的不同外科处理策略综合评价

Evaluation of Different Surgical Treatments for Hepatic Cystic Space-occupying Lesions

目的评价不同外科手术治疗肝脏囊性占位的临床疗效以及不同外科治疗策略的优缺点。方法对1998年1月-2011年12月收治的肝囊性占位患者的临床资料进行回顾性分析。共纳入148例患者,其中单纯性肝囊肿患者86例(单发35例,多发51例),多囊肝病患者62例。43.9%(65/148)患者行腹腔镜囊肿开窗治疗,27.0%(40/148)患者行开腹囊肿开窗术,21.6%(32/148)的患者行经皮囊肿穿刺及硬化剂注入术,另有7.4%(11/148)患者行开腹肝部分切除联合囊肿开窗术。结果经过手术治疗后,患者症状缓解率高达100.0%;术中患者出血量以经皮囊肿穿刺及硬化剂注入术最少,而以开腹肝部分切除联合囊肿开窗术最多。对于单纯性肝囊肿单发患者,不同手术治疗后均未出现症状复发;对于单纯性肝囊肿多发患者,肝部分切除联合囊肿开窗术治疗未出现症状复发,而经皮囊肿穿刺及硬化剂注入、腹腔镜囊肿开窗和开腹囊肿开窗治疗则分别有3、4、2例患者发生症状或影像学复发,总复发率为17.6%(9/51);对于多囊肝病患者,经皮囊肿穿刺及硬化剂注入、腹腔镜囊肿开窗、开腹开窗和肝部分切除联合囊肿开窗治疗则分别有2、7、3和2例患者发生症状或影像学复发,总复发率为22.6%(14/62)。结论目前常用治疗方式对于单纯性肝囊肿单发患者疗效均理想,但对于单纯性多发肝囊肿和多囊肝病患者远期效果均尚不理想。

Objective To evaluate the clinical advantages and shortages of different surgical treatments for hepatic cystic space-occupying lesions. Methods The clinical data of patients with hepatic cystic space-occupying lesions in our hospital treated from January 1998 to December 2011 were retrospectively analyzed. A total of 148 patients were included in the study, including 86 patients with simple hepatic cyst （including 35 single cyst cases and 51 polycystic cases） and 62 patients with polycystic liver diseases. In this study, patients were mostly women, accounting for 58.8% （87/148） and the average age was 57.8 years. Among them, 43.9% （65/148） received laparoscopic cyst fenestration, 21.6% （32/148） received percutaneous injection sclerotherapy, 27.0% （40/148） received laparotomy liver cyst fenestration, and 7.4% （11/148） received partial hepatic resection combined with cyst fenestration. Results After receiving the above surgery, symptom relief rate was 100% for those patients. In respect to the amount of intraoperative bleeding, patients receiving percutaneous injection sclerotherapy had the least amount of bleeding. For simple hepatic cyst with single cyst, recurrence of symptoms was not observed after surgery. For simple hepatic cyst with multiple cysts, recurrence of symptoms was not observed in patients receiving partial hepatic resection combined with cyst fenestration, but three, four, and two recurrence cases were respectively reported in patients receiving percutaneous cyst drainage combined with injection of sclerosing agent, laparoscopic cyst fenestration, and laparotomy for cyst fenestration, and the total recurrence rate was 17.6% （9/51）. For patients with polycystic liver disease, there were two, seven, three and two cases of symptoms or radiographic recurrence observed respectively in patients receiving percutaneous injection sclerotherapy, laparoscopic cyst fenestration, laparotomy cyst fenestration, and partial hepatic resection combined with cyst fenestration, and the total recurrence rate was 22.6% （14/62）. Conclusion All surgical treatments are effective for simple hepatic cyst patients with single cyst, but their long-term effect is not ideal for simple polycystic cyst and polycystic liver disease.