腹腔镜下肝包虫外囊剥除术治疗肝囊性包虫病的疗效分析

Curative effect analysis of hepatic cystic echinococcosis:laparoscopic hepatic hydatid ectocyst resection

目的:探讨腹腔镜肝包虫外囊剥除术治疗肝囊性包虫病的临床疗效及应用价值。方法:分析2016年4月至2019年2月为23例肝囊性包虫病患者行腹腔镜肝包虫外囊剥除术的临床资料。术前充分评估,术中沿包虫与肝组织间隙剥除肝包虫外囊,并在可能渗漏囊液处放置高渗盐水纱条。仔细处理汇入包虫囊壁的管道,切除外囊置入标本袋取出。结果:23例手术均获成功,无中转开腹及围手术期死亡病例,未发生术中过敏反应。术中出血量50~800 mL,平均(263.2±242.5)mL,3例患者术中输血。手术时间120~420 min,平均(240.3±80.5)min。术后住院4~13 d,平均(6.8±2.1)d。术后发生1例胆漏,经延长引流时间后治愈。结论:腹腔镜治疗肝囊性包虫病是安全、可行的,其手术指征及患者选择十分重要,对于位置表浅、易于暴露、无复杂毗邻关系的肝囊性包虫病灶,在有腹腔镜肝脏手术基础、肝囊性包虫病治疗经验的医院,腹腔镜手术治疗可作为首选术式。

Objective:To investigate the curative effects and application value of laparoscopic hepatic hydatid ectocyst resection in the treatment of hepatic cystic echinococcosis.Methods:Twenty-three patients with hepatic cystic echinococcosis accepted laparoscopic hepatic hydatid ectocyst resection from Apr.2016 to Feb.2019.Sufficient assessment was performed before the operation.The cystic echinococcosis was resected along with the fabric space between the hydatid ectocyst and the normal hepatic tissue,and hypertonic saline gauze was put at the site where the hydatid fluid might leak out.All the tubes that fed into the hydatid ectocysts were treated carefully.The resected hydatid ectocysts were taken out in the endo-pouch.Results:All the 23 operations were successful.No conversion to laparotomy or perioperative death occurred.No anaphylactic reaction occurred during the operations.The amount of intraoperative blood loss was(263.2±242.5)mL(range,50-800 mL).Intraoperative blood transfusion was performed in 3 patients.Operation time was(240.3±80.5)min(range,120-420 min),the hospital stay after operation was(6.8±2.1)d(range,4-13 d).1 bile leakage was observed and healed after prolonged drainage time.Conclusions:The laparoscopic hepatic hydatid ectocyst resection is safe and feasible.Surgical indications and patients selection are very important.When the hepatic hydatid cyst locates at a shallow position and is easy to expose without complex adjacent relationship,the laparoscopic surgery could be the first choice in the hospitals with laparoscopic liver resection skills and experiences of curing hepatic cystic echinococcosis.