肝脏囊性病变外科治疗的回顾性分析  

A Retrospective Analysis of the Surgical Therapy of Cystic Lesions in the Liver

作　　者：陈卫[1] 张生来[1] 王雪峰[1] 董平[1] 张勇[1] 全志伟[1] 

机构地区：[1]上海第二医科大学附属新华医院普外科,上海200092

出　　处：《中国临床医学》2004年第4期578-580,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :探讨肝脏囊性病变 (囊肿≥ 4cm)的外科治疗及预后。方法 :对 1983年～ 2 0 0 3年上海第二医科大学附属新华医院外科治疗的肝脏囊性病变的病因、外科治疗方法及预后进行回顾性分析。结果 :本组肝脏囊性病变 6 4例 ,其中单纯性肝囊肿5 7例 ,肝棘球蚴病 4例 ,肝胆管囊腺瘤 2例 ,肝胆管囊腺癌 1例。囊肿平均大小 10 .4cm。 16例单纯性肝囊肿行经皮囊肿穿刺抽液术 ,术后所有病人囊肿复发。 5 2例单纯性肝囊肿病人施行了手术治疗 ,方法有囊肿去顶术 (2 8例剖腹行囊肿去顶术 ,6例术后复发 ;18例腹腔镜辅助下手术 ,2例术后复发 ) ,囊肿切除术 2例 ,肝叶或肝部分切除术 4例。 4例肝棘球蚴病行包虫囊肿内囊摘除术 ,无复发。 2例肝胆管囊腺瘤和 1例肝胆管囊腺癌 ,均行肝叶切除术。结论 :巨大 (≥ 4cm)、有临床症状的单纯性肝囊肿行经皮囊肿穿刺抽液术均复发 ;囊肿去顶术复发率低 ,腹腔镜辅助下手术较剖腹手术创伤小。肝棘球蚴病行包虫囊肿内囊摘除术是有效的 ,复发率低。肝胆管囊腺瘤可能恶变 。Objective: To evaluate the surgical therapy and prognosis of cystic lesions (size of cyst≥4cm)of the liver. Methods: We performed a retrospective analysis of cause, surgical therapy and prognosis of patients diagnosed with hepatic cystic lesions in our hospital between 1983 and 2003. Results: 64 patients were identified. In 57 the lesions were simple cysts, in 4 echinococcal cysts, in 2 hepatobiliary cystadenomas, and in 1 hepatobiliary cystadenocarcinoma. Mean size was 10.4cm. Percutaneous aspiration of 16 simple cysts resulted in recurrence in 100% of the cases. 52 patients were treated surgically, either by wide unroofing (28 patients for open unroofing, recurrence occurred in 6 patients; laparoscopically in 18, recurrence occurred in 2 patients), or by resection(2 patients), or by segmentectomy or lobetomy(4 patients). 4 patients with echinococcal cysts were treated by open resection. There was no recurrence during a followup period. 2 patient of hepatobiliary cystadenomas and 1 patient of hepatobiliary cystadenocarcinoma were diagnosed, and treated by lobectomy. Conclusion:Large(≥4cm) symptomatic simple cysts invariably recur after percutaneous aspiration. Unroofing can be successfully undertaken with a low recurrence rate. The laparoscopic approach achieve a wide unroofing with debilitating incision. Open resection is a safe and effective treatment for echinococcal cysts. Early resection is probably the best choice for hepatobiliary cystadenomas because malignant transformation may occur.

关 键 词：肝脏囊性病变 外科治疗 预后 病因 影像学检查 

分 类 号：R735.7[医药卫生—肿瘤]