腹腔镜肝囊肿开窗引流术(附39例报告)

Laparoscopic fenestration in hepatic cysts: with a report of 39 cases

目的：探讨腹腔镜肝囊肿开窗引流术的可行性、安全性及临床效果。方法：回顾分析2009年10月至2014年10月为39例患者行腹腔镜肝囊肿开窗引流术的临床资料,其中单发性囊肿32例,多发性囊肿7例。囊肿位于右肝27例,其中膈面21例,脏面6例;左肝12例,其中膈面7例,脏面5例。结果：39例患者均在腹腔镜下完成肝囊肿开窗引流术,无一例中转开腹及术中并发症发生。手术时间平均（48.2±15.4）min,术中出血量（30.7±12.5）ml,囊肿直径平均（14.0±4.3）cm,术后放置引流管2~5 d,确认无出血、胆漏后拔除,术后第2~3天正常进食,术后平均住院（4.3±2.1）d,无术后并发症发生。术后5年内每6个月常规行肝脏B超检查,随访4~60个月,囊肿无复发。结论：腹腔镜肝囊肿开窗引流术安全、可行,具有创伤小、疼痛轻、康复快的优点,充分体现了微创的优势,具有良好的临床应用价值。

Objective： To evaluate the feasibility,safety and clinical effect of laparoscopic fenestration of hepatic cyst. Methods： From Oct. 2009 to Oct. 2014,39 patients with hepatic cyst were treated by laparoscopic fenestration,among which there were 32 cases of single cyst and 7 cases of multiple cysts,and the clinical data were analyzed retrospectively. Cyst location： 27 cases were in the right part of the liver,among which 21 cases located in the diaphragmatic surface,6 cases in the visceral surface; and 12 cases were in the left part of the liver,among which 7 cases located in the diaphragmatic surface,5 cases in the visceral surface. Results： The procedure was successfully performed in all cases,with no conversion to laparotomy or intraoperative complications. The mean operation time was（ 48. 2 ± 15. 4） min,with mean blood loss of（ 30. 7 ± 12. 5） ml,and the average diameter of hepatic cyst was（ 14. 0 ± 4. 3） cm.Drainage tube was placed in all cases,and was taken away 2-5 d after surgery once bleeding or biliary leakage was excluded. Oral diet was resumed 2-3 d after operation,and the mean postoperative hospital stay was（ 4. 3 ± 2. 1） d,none suffered from any postoperative complications. Within 5 years after operation,all patients underwent liver ultrasonic examination every 6 months,and no recurrence was found during the follow-up period of 4-60 months. Conclusions： Laparoscopic fenestration is safe,feasible and mini-invasive,it has the advantages of minimal injury,slight pain and rapid recovery,so it is valuable in the clinical application for hepatic cyst.