腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病

Application of laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis

目的探讨腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病的安全性和可行性。方法2015年9月至2016年5月选择具有手术适应证的肝囊型包虫病患者，采用腹腔镜下区域半肝血流阻断或非选择性入肝血流阻断技术控制出血，利用腹腔镜多功能手术解剖器刮吸离断肝组织，行腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病8例，包括中肝叶切除1例，右肝后叶切除2例，右肝部分切除2例．左半肝切除术1例，左肝外叶切除1例，左肝内叶包虫外囊剥除术1例。结果8例肝囊型包虫病进行腹腔镜肝切除及外囊剥除术，其中7例在完全腹腔镜下完成，1例中转开腹。肝囊型包虫病病灶最大为10cm。手术时间150～260（200±35）min，术中出血100—1000（313±290）ml。术中输血1例。术后住院时间6．9（7．6±1．3）d。术后1例出现胸腔积液，经药物治疗后好转。1例术后5d出现胆漏．引流12d后好转。无术后残腔感染、腹腔出血、肝功能衰竭等并发症，无围手术期死亡。结论腹腔镜肝切除及外囊剥除术治疗肝囊型包虫病是安全、可行的。

Objective To investigate the safety and feasibility of laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis. Methods Between September 2015 and May 2016, patients with hepatic cystic echinococcosis indicated for surgery were evaluate. Selective hemihepatic inflow inclusion or non-selective hepatic inflow inclusion was adopted to control the bleeding. Laparoscopic muhifuctional operative dissector （LPMOD） was applied for liver parenchymal transection. Laparoscopic hepatectomy and cystectomy was applied for hepatic cystic echinococcosis in eight cases, including one case of mesohepatectomy, two cases of right posterior sectionectomy, two cases of right partial hepatectomy, one case of left hepatectomy, one case of left lateral sectionectomy and one case of cystectomy in the left hepatic lobe. Results 8 patients received laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis. Seven cases were performed totally laparoscopically and one case required a conversion. The maximum size of the lesion was 10 cm. Operating time was 150 - 260 min （ mean, 200±35 ） ; Blood loss was 100 - 1 000 ml （313± 290）. One patient received intraoperative transfusion. Postoperative hospital stay was 6 - 9 days （ mean, 7. 6±1.3）. One patient developed postoperative pleural effusion that resolved after medical treatment. One patient developed biliary leak in postoperative five days and recovered after drainage for twelve days. No remaining cavity infection, postoperative abdominal bleeding, liver failure occurred. No hospital death occurred. Conclusions Laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis is technically safe and feasible.