腹腔镜下Trocar穿刺囊腔引流治疗肝囊型包虫病

Laparoscopic hydatid cyst punture drainage with Trocar for hepatic cystic echinococcosis

目的探索腹腔镜下Trocar穿刺囊腔引流治疗肝囊型包虫病的应用价值。方法回顾性分析2018年1月至2020年1月在青海大学附属医院行腹腔镜下Trocar穿刺囊腔引流治疗的20例肝囊型包虫病患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男12例,女8例;年龄10~68岁,中位年龄43岁。肝囊型包虫位于左叶7例,右叶13例;单发16例,多发4例;囊肿直径中位数为10.3(1.0~18.2)cm。腹腔镜直视下将5 mm一次性Trocar经腹壁直接穿刺包虫囊腔,置入普通吸引器吸出囊液,经Trocar进气孔注入20%高渗盐水,浸泡10 min,然后根据患者病灶采用不同手术。观察患者疗效。结果20例患者手术均获成功,无中转开腹。其中肝包虫内囊摘除术9例,内囊摘除+部分外囊剥离术6例,内囊摘除+部分外囊剥离+胆漏缝扎术4例,多发复杂囊肿切除术1例。术后出现胆漏2例,残腔积液2例,经过局部穿刺引流及抗感染治疗后痊愈。其余患者恢复顺利,3~7 d拔除引流管。术后住院时间7(3~12)d。随访3个月~1年,所有患者均未发生复发和腹腔种植。结论腹腔镜下Trocar穿刺囊腔引流治疗肝囊型包虫病可防止囊液渗漏,减少复发风险,疗效确切,安全易行。

Objective To evaluate the application value of laparoscopic hydatid cyst punture drainage with Trocar for hepatic cystic echinococcosis.Methods Clinical data of 20 patients with hepatic cystic echinococcosis treated with laparoscopic cyst punture drainage using disposable Trocar in Qinghai University Affiliated Hospital from January 2018 to January 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,12 patients were male and 8 female,aged from 10 to 68 years,with a median age of 43 years.The hydatid cysts of 7 cases were located in the left lobe and 13 in the right lobe.16 cases were with single lesion and 4 with multiple lesions.The median diameter of cysts was 10.3(1.0-18.2)cm.Under laparoscope,a 5-mm disposable Trocar was used to puncture the hydatid cysts through abdominal wall,and a common aspirator was inserted to discharge the cyst fluid for decompression.Hypertonic saline(20%)was injected through the Trocar inlet and soaked for 10 min.Different operations were performed on the patients according to different lesions.The operation results were observed.Results The operations were completed successfully in all the patients without conversion to open surgery.Excision of internal capsule was performed in 9 cases,excision of internal capsule+dissection of partial external capsule in 6 cases,excision of internal capsule+dissection of partial external capsule+suture of bile leakage in 4 cases,multiple cyst resection in 1 case.Bile leakage occurred in 2 cases and residual cavity effusion in 2 cases after operation,and they were cured after drainage and anti-infection treatments.The remaining patients were properly recovered,and the drainage tube was removed after 3-7 d.The length of postoperative hospital stay was 7(3-12)d.During the postoperative follow-up for 3 months to 1 year,no recurrence or implantation metastasis was reported.Conclusions Laparoscopic hydatid cyst punture drainage with Trocar for hepatic cystic echinococcosis is an effective,safe and convenient method,which can prevent the fluid leakage and reduce the recurrent risk.