3D腹腔镜手术治疗肝囊型包虫病的临床疗效

Clinical efficacy of three-dimensional laparoscopic surgery in treatment of hepatic cystic echinococcosis

目的：探讨3D腹腔镜手术治疗肝囊型包虫病的临床疗效。方法：用回顾性横断面研究方法。收集2016年3月至2017年7月青海省人民医院收治的40例行3D腹腔镜手术治疗肝囊型包虫病患者的临床病理资料。患者术前给予氢化可的松100 mg，预防术中发生过敏反应。手术由同一组经验丰富并已熟练掌握腹腔镜技术的外科医师完成。根据患者的具体情况分别施行3D腹腔镜肝包虫内囊摘除术＋残腔处理、肝包虫外囊切除术、肝部分切除术。观察指标：（1）术中情况：手术完成情况，手术方式、手术时间、术中出血量、输血情况。（2）术后恢复情况：术后肛门首次排气时间、术后首次进食流质食物时间、术后下床活动时间、引流管放置时间、伤口愈合情况、术后并发症、术后住院时间。（3）随访情况：获得随访的患者例数、随访时间、随访期间口服抗包虫药物治疗情况、肝包虫病复发和腹腔种植转移情况。采用门诊或电话方式进行随访，随访内容包括腹部症状，术后口服抗包虫药物及包虫病复发转移情况。随访时间截至2017年9月。正态分布的计量资料以±s表示，偏态分布的计量资料以M（范围）表示。结果：（1）术中情况：40例患者均顺利完成3D腹腔镜手术，其中17例行肝包虫内囊摘除术＋残腔处理，15例行肝包虫外囊切除术，8例行肝部分切除术。2例患者合并腹、盆腔包虫，均在3D腹腔镜下摘除。40例患者手术时间为（100±28）min，术中出血量为（86±24）mL，术中无患者输血。（2）术后恢复情况：40例患者术后肛门首次排气时间为（2.4±1.8）h，术后首次进食流质食物时间为（1.7±0.9）d。40例患者手术当天均下床活动。40例患者中，39例腹腔引流管放置时间为2～3 d；1例因术后残腔胆汁漏，引流管留置2个月后拔除。40例患者手术切口均甲级愈合，住院期间39例无出血、胆汁漏、过敏性休克、肠粘连、肠梗阻等并发症发生；1例残腔胆汁漏术后2个月拔除引流管，术后住院时间为（10.5±2.1）d。（3）随访情况：40例患者均获得随访，随访时间为2～15个月，中位随访时间为9个月。随访期间40例患者无特殊不适，均按时口服抗包虫药物，随访期间患者无肝包虫病复发和腹腔种植转移发生。结论：3D腹腔镜治疗肝囊型包虫病安全可行，其治疗不规则肝囊型包虫病优势明显，近期疗效较好。

Objective：To investigate the clinical efficacy of three-dimensional （3D） laparoscopic surgery in treatment of hepatic cystic echinococcosis. Methods：The retrospective cross-sectional study was conducted. The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People＇s Hospital from March 2016 to July 2017 were collected. All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis. The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery. Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis＋residual cavity treatment, external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions. Observation indicators： （1） intraoperative situations： operation completion, surgical procedures, operation time, volume of intraoperative blood loss and blood transfusion; （2） postoperative recovery situations： time to initial anal exsufflation, time for initial fluid diet intake, time for out-of-bed activity, time of indwelling drainage-tube, wound healing, postoperative complications and duration of postoperative hospital stay; （3） follow-up： number of patients with follow-up, follow-up time, oral anti-echinococcosis medical therapy during follow-up, hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms, oral anti-echinococcosis medicine, hepatic echinococcosis recurrence and metastasis up to September 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M （range）. Results：（1） Intraoperative situations： all the 40 patients underwent successful laparoscopic surgery, including 17 undergoing excision of internal capsule in hepatic echinococcosis＋residual cavity treatment, 15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy. Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision. Operation time and volume of intraoperative blood loss of 40 patients were respectively （100±28）minutes and （86±24）mL, without intraoperative blood transfusion. （2） Postoperative recovery situations： time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were （2.4±1.8）hours and （1.7±0.9）days. Forty patients had out-of-bed activity on the day of surgery. Of 40 patients, abdominal drainage-tubes of 39 were placed for 2-3 days; abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed. Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and （10.5±2.1）days. During hospitalization, 39 patients didn′t have bleeding, bile leakage, anaphylactic shock, intestinal adhesion and obstruction; 1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively. （3） Follow-up： all patients were followed up for 2-15 months, with a median time of 9 months. During the follow-up, 40 patients were not complicated with discomforts and received oral anti-echinococcosis medical therapy, without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Conclusion：The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis, and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis, with good short-term outcomes.