腹腔镜开窗引流术治疗单纯性肝囊肿的临床评价

Clinical evaluation of laparoscopic fenestration and drainage in the treatment of simple hepatic cyst

目的：评价腹腔镜开窗引流术治疗单纯性肝囊肿的临床疗效。方法：回顾分析近5年为78例单纯性肝囊肿患者行腹腔镜开窗引流术的临床资料。其中单发囊肿41例,2枚及以上37例（96枚囊肿）,共计137枚囊肿。肝后部（Ⅳa、Ⅵ、Ⅶ、Ⅷ）囊肿24枚,余113枚位于肝前部。23例囊肿最大直径〈5 cm,作为腹腔镜胆囊切除等手术的附属手术行肝囊肿开窗引流术。结果：78例手术均获成功,无一例中转开腹,无手术并发症发生。手术时间平均（37.4±10.2）min,中位术中出血量10 ml（5-150 ml）,术后平均住院（3.2±0.9）d。随访观察12个月,囊肿复发6例（其中3例复发囊肿位于肝后部）,直径〈5 cm,且无临床症状。结论：腹腔镜开窗引流术治疗单纯性肝囊肿疗效确切,患者创伤小,术后康复快,已成为治疗单纯性肝囊肿的首选方法。囊肿较小但合并胆囊结石等的患者,可适当扩大手术适应证。

Objective： To investigate the clinical effectiveness of laparoscopic fenestration and drainage in the treatment of simple hepatic cyst. Methods： Retrospective analysis was made on the clinical data of 78 patients who suffered from simple cysts of the liver and underwent laparoscopic fenestration and drainage in last five years. There were 41 cases of single cyst,37 cases of multiple cysts（ 96 cysts）,137 cysts in total. 24 cysts located at the posterior segment of the liver（ Ⅳa,Ⅵ,Ⅶ,Ⅷ）,and the other 113 cysts located at the anterior segment of the liver. Cyst diameter of 23 patients was 〈5 cm,for whom laparoscopic fenestration and drainage was additional operation of laparoscopic cholecystectomy and so on. Results： Laparoscopic fenestration and drainage was successfully accomplished in all the 78 cases,neither conversions to open surgery nor surgery related complications occurred. The operation time was（ 37. 4 ±10. 2） min; The intraoperative median blood loss was 10 ml（ 5 - 150 ml）. The postoperative hospital stay was（ 3. 2 ± 0. 9） d. After observation of 12 months,the cyst without clinical symptoms recurred in 6 cases（ diameter 〈5 cm）,and 3 cases located at the posterior segment of the liver. Conclusions： Laparoscopic fenestration and drainage has been the preferred method to treat simple cysts of the liver,because it has the dominance such as outstanding curative effects,minimal invasion,fast recovery. The indications of the operation could be expanded for patients with little cysts combined with cholecystolithiasis and so on.