非典型CE1型肝囊型包虫病的诊断及腹腔镜治疗体会

Diagnosis and laparoscopic treatment of atypical hepatic cystic echinococcosis type CE1

目的探讨非典型CE1型肝囊型包虫病的有效诊断方法及腹腔镜手术的临床疗效。方法回顾性分析2018年6月至2019年6月新疆维吾尔自治区人民医院收治的17例非典型CE1型肝囊型包虫患者临床资料,其中男性11例,女性6例,年龄(46.0±21.6)岁,均有畜牧区接触史。术前完善包虫免疫实验、腹部超声、腹部CT检查,行腹腔镜手术治疗,术后采用门诊复查、电话等方式进行随访,随访时间截至2020年6月。对术前不同检查方法诊断情况、手术方式、包虫病复发等指标进行分析。结果17例患者术前肝包虫病血清免疫学检查11例为囊性包虫病阳性,6例阴性。腹部CT诊断结果示17例均为肝囊肿。常规彩色多普勒超声示14例患者为肝囊肿,3例示肝囊性占位,囊型包虫病不除外;更换高频探头后9例患者观察到肝囊性病灶顶部节段双轨征或局部增厚囊壁,诊断为CE1型肝囊型包虫病,8例仍诊断为肝囊肿。17例患者均行腹腔镜手术,术中均明确诊断为肝囊型包虫病,无中转开腹,手术时间(125.0±54.5)min;术中出血量为(150.0±84.5)ml,术后住院时间为(6.5±2.5)d;围手术期无严重并发症或死亡病例,2例术后出现微胆漏,术后5~10 d自行痊愈;术后随访6~12个月,无失访,未见肝脏及腹腔包虫复发。结论在肝脏单囊型病灶的诊治过程中应注意非典型CE1型肝囊型包虫与单纯性肝囊肿的鉴别诊断,腹部螺旋CT、包虫免疫实验、腹部超声有效鉴别率低,易误诊、漏诊,腹部超声高频探头可一定程度提高非典型CE1型肝囊型包虫诊断率。腹腔镜技术既是有效诊断方法也是治疗手段,需根据患者包虫病灶情况选择合理手术方式,腹腔镜手术治疗肝囊型包虫病安全、可行。

Objective To explore the effective diagnosis method and the clinical effect of laparoscopic technique for atypical CE1 hepatic cystic echinococcosis.Methods The clinical data of 17 patients with atypical liver cystic echinococcosis from June 2018 to June 2019 in the People's Hospital of Xinjiang Uygur Autonomous Region were analyzed retrospectively,including 11 males and 6 females,(46.0±21.6)years old,all patients with a history of exposure in animal husbandry area.Preoperative hydatid immunity test,abdominal ultrasound and abdominal CT examination were completed,and laparoscopic surgery was performed.Postoperative follow-up was conducted by outpatient review and telephone,and the follow-up period was up to June 2020.The diagnosis,operation and recurrence of hydatid disease by different examination methods were analyzed.Results Preoperative serum immunological examination of 17 patients showed that 11 were positive and 6 were negative for hepatic echinococcosis.The results of abdominal CT showed that 17 cases were hepatic cyst.Conventional color doppler ultrasound showed that 14 patients were hepatic cyst,3 patients showed cystic space occupying,and cystic hydatidosis was not excluded;9 patients observed double track sign or local thickening of cystic wall at the top of hepatic cystic lesions after replacement of high-frequency probe,which was diagnosed as hepatic cystic echinococcosis(CE1),8 patients as hepatic cyst.All 17 patients underwent laparoscopic operation,during which they were definitely diagnosed as hepatic cystic echinococcosis(CE1).During the operation,there was no conversion to laparotomy.The operation time was(125.0±54.5)min,the intraoperative blood loss was(150.0±84.5)ml without blood transfusion,and the postoperative hospital stay was(6.5±2.5)d.There were no serious complications or deaths in the perioperative period,2 cases had microbile leakage,and recovered by themselves 5-10 days after the operation;the patients were followed up for 6-12 months,no loss of follow-up,no recurrence of liver and abdominal hydatid.Conclusions In the process of diagnosis and treatment of liver single cystic lesions,we should pay attention to the differential diagnosis of atypical CE1 hepatic cystic echinococcosis and simple liver cyst.The effective differential rate of abdominal spiral CT,hydatid immune experiment and abdominal ultrasound is low,which is easy to be misdiagnosed and missed.The high frequency probe of abdominal ultrasound can effectively find atypical CE1 hepatic cystic echinococcosis.Laparoscopic technique is not only an effective diagnosis method but also a treatment method.It is necessary to choose a reasonable operation method according to the patient's hydatidosis.Laparoscopic operation is safe and feasible in the treatment of hepatic cystic echinococcosis.