腹腔镜手术治疗小儿肝细粒棘球蚴病临床体会:附26例报告

Clinical experiences of laparoscopic treatment of hepatic echinococcosis in children: a report of 26 cases

目的探讨腹腔镜治疗小儿肝细粒棘球蚴病的临床疗效及应用价值。方法以本院2010年1月至2016年12月间采用腹腔镜治疗的26例小儿肝细粒棘球蚴病患儿为研究对象。患儿均行腹腔镜探查,外缘性肝细粒棘球蚴囊肿采用"沿肝组织与囊肿间前卫间隙切除包虫外囊"治疗方案,内缘型肝细粒棘球蚴囊肿采用"内囊部分摘除术+外引流术"治疗方案。术后服用阿苯达唑片进行治疗,同时对患儿家属进行健康宣教。结果 26例患儿手术均获成功,手术时间100～250 min,平均(150±43) min;出血量10～20 m L,平均(14±3) m L;住院天数6～18 d,平均(10±3) d。18例行腹腔镜下外囊切除术,4例行"腹腔镜下部分内囊摘除术+外引流术",4例行"腹腔镜下外囊切除+部分内囊摘除术+外引流术"; 2例术后出现残腔感染,4例术后出现残腔胆汁瘘。无1例发生肝细粒棘球蚴囊液溢出及过敏性休克,无1例死亡,随访半年无1例复发。结论腹腔镜治疗小儿肝细粒棘球蚴病整体效果良好,对于手术难度较大的肝细粒棘球蚴病,"腹腔镜下部分内囊摘除术+外引流术"可能是一种更为理想的手术方案。

Objective To explore the clinical efficacy of laparoscopic treatment of children with hepatomegaly echinococcosis. Methods From January 2010 to December 2016,retrospective analysis was conductedfor the clinical data of 26 children with hepatic hydatid disease. All children underwent laparoscopy. Ectopic hepatic cyst echinococcosis was treated by avantgarde clearance resection of hydatid capsule. And endochondralhepatic hydatid cyst was handled by partial excision plus drainage. And postoperative oral albendazole andhealth education were offered. Results All operations were successful. Average operative duration was （150 ±43） min,average bleeding volume （14 ± 3） mL and average hospitalization stay （10 ± 3） days. Eighteen casesunderwent laparoscopic external capsule resection while another 4 cases had laparoscopic partial cystectomy plusexternal drainage. Four cases underwent laparoscopic external capsule resection,partial removal of internal capsule plus external drainage. There were postoperative residual cavity infection （n = 2） and residual bile fistula（n = 4）. No fluid overflow of hepatic hydatid cyst,anaphylactic shock or intraoperative mortality. During a 6month followup period,there was no recurrence. Conclusion Both safe and feasible,laparoscopic treatment ofpediatric hepatomegaly hydatid disease has great clinical values. For more complicated cases,laparoscopic partial en bloc resection plus external drainage is preferred.