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,200092

出　　处：《临床外科杂志》2004年第S1期12-13,共2页Journal of Clinical Surgery

摘　　要：目的　提高肝脏囊性病变 (囊肿≥ 4cm )的外科治疗水平。方法　对 1983～ 2 0 0 3年我院外科治疗肝脏囊性病变的病因、外科治疗方式及预后进行回顾性分析。结果　本组肝脏囊性病变病人 64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。囊肿平均直径为 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 ,其中 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 ,应早期手术切除。Objective To evaluate the surgical therapy and prognosis of cystic lesions(size of cyst≥4 cm)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 10.4 cm.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(≥4 cm) 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 

分 类 号：R657.3[医药卫生—外科学]