腹腔镜肝囊肿去顶减压术的临床疗效

Laparoscopic unroofing of liver cysts

目的:探讨降低腹腔镜肝囊肿去顶减压术后囊肿复发率的方法.方法:对唐山工人医院72例接受手术治疗的肝囊肿患者的临床及术后随访资料进行回顾性分析.比较开腹与腹腔镜肝囊肿开窗引流术两种手术方法治疗效果.结果:腹腔镜手术患者术中出血量(10.3 m L±6.1 m L)少于开腹手术(50.3 m L±4.7 m L);腹腔镜手术患者术后镇痛时间、肠功能恢复时间及平均住院日(13.3 h±4.7 h、28.1 h±8.9 h、9.5 d±3.6 d)较开腹手术明显缩短(56.5 h±26.5 h、78.5 h±16.3 h、25.3 d±2.9 d);腹腔镜手术患者术后肝囊肿复发率5/24(20.1%)高于开腹手术3/48(6.3%),在腹腔镜组中,15例术中未使用透明质酸钠的患者有5例术后出现囊肿复发,而术中使用透明质酸钠的9例患者,未发现囊肿复发(P<0.05).结论:腹腔镜下肝囊肿开窗引流术安全、可行,术中尽可能多的去除肝囊肿顶壁、合理使用硬化剂失活残余囊腔上皮细胞以及在正确使用透明质酸钠等防黏连剂的前提下有效放置引流等措施的综合运用,可以有效地减少腹腔镜术后囊肿复发.

AIM： To explore the method of decreasing liver cyst recurrence after laparoscopic decompression.METHODS： The clinical and postoperative follow-up data for 72 patients who underwent liver cyst surgery at Tangshan Worker Hospital were analyzed retrospectively. Efficacy of open surgery and laparoscopic liver cyst drainage for treatment of liver cysts was compared. RESULTS： Compared with open surgery, laparoscopic liver cyst drainage had the advan- tages of less pain and shorter hospitalization time. However, the liver cyst recurrence rate was 5/24 （20.1%） after drainage, which was higher than 3/48 （6.3%） after open surgery. Sodium hyaluronate could effectively reduce cyst recurrence after laparoscopic liver cyst drainage by preventing postoperative liver wound adhesions. CONCLUSION： Laparoscopic liver cyst drainage is safe and feasible. Unroofing of the liver cyst as much as possible, using sclerosing agents rationally to inactivate residual cyst epithelial cells, and effective drainage on the premise of proper use of sodium hyaluronate and other anti-adhesion agents could effectively reduce cyst recurrence after laparoscopic surgery.