腹腔镜肝包虫外囊切除术治疗囊型肝包虫病疗效分析  

Curative effects of hepatic cystic echinococcosis: laparoscopic hepatic hydatid ectocyst resection

作　　者：邹海波[1] 罗兰云[1] 王冠[1] 薛华[1] 骆乐[1] 姚豫桐[1] 向光明[1] 黄孝伦[1] 

机构地区：[1]四川省医学科学院.四川省人民医院,四川成都610072

出　　处：《腹腔镜外科杂志》2016年第5期340-343,共4页Journal of Laparoscopic Surgery

基　　金：四川省省级重大疾病防控基金资助项目(编号:2015-49号CZ93-02)

摘　　要：目的：探讨腹腔镜肝包虫外囊切除术治疗囊型包虫病的临床疗效及应用价值。方法：2012年1月至2015年4月为22例肝囊型包虫病患者行腹腔镜手术,术前充分评估,静滴100 mg氢化可的松注射液,以防止过敏。沿肝组织与囊肿间纤维间隙切除包虫外囊,并妥善夹闭所遇血管及胆管。注意隔离囊液,标本装袋取出,高渗盐水浸泡术野防止复发及播散转移。术后予以抗寄生虫药物治疗及健康宣教。结果：全组手术均获成功,成功率100%,无一例中转开腹,无围手术期死亡病例。2例术中囊肿破裂,但获妥善处理,无过敏反应发生。手术时间50~230 min,平均（115±63）min;出血量50~600 ml,平均（230±155）ml;住院5~16 d,平均（7.2±2.6）d。1例术后出现胆漏,经治疗1周后痊愈。随访2~35个月,未见肝脏及腹腔包虫病复发。1例右肺下叶新发病灶。结论：对囊肿位置表浅、腹腔镜下易于暴露操作、直径小于10 cm的囊型包虫病,在有腹腔镜肝切除技术基础、有囊型包虫病处理经验的医院,腹腔镜下肝包虫外囊切除术安全、可行,可作为首选术式。Objective： To investigate the curative effects and applications of laparoscopic hepatic hydatid ectocyst resection in the treatment of hepatic cystic echinococcosis. Methods： Twenty-two patients with hepatic cystic echinococcosis,treated from Jan. 2012 to Apr. 2015,accepted laparoscopic hepatic hydatid ectocyst resection. Before surgery,the conditions of patients were assessed sufficiently,and the patients were given intravenous drip infusion of 100 mg hydrocortisone to prevent allergies. With the ultrasonic knife,hepatic hydatid ectocyst was excised along the fabric space between hepatic tissue and cyst,and the blood vessels and bile ducts were properly clipped. The hepatic hydatid fluid should be paid attention and the specimen should be taken out with a bag. Surgical site was immersed with hypertonic saline to prevent the relapse and dispersed metastasis of hepatic cystic echinococcosis in surgery. The patients accepted the treatment of anti-parasitic medicine and health education after operation. Results： The success rate was 100%. No conversion to laparotomy or perioperative death occurred. The operation time was（ 115 ± 63） min（ range,50-230 min）,the amount of blood loss was（ 230 ± 155） ml（ range,50-600 ml）,the length of hospital stay was（ 7. 2 ± 2. 6） d（ range,5-16 d）. 2 cases of cyst ruptured,but no allergic reaction occurred after proper treatment. 1 case of bile leakage was cured with one-week treatment after operation. No recurrence or relapse of liver and abdominal echinococcosis was found during 2 to 35 months’ following-up for the patients. 1 patient with hepatic cystic echinococcosis occurred new lesions in inferior lobe of right lung. Conclusions： The laparoscopic hepatic hydatid ectocyst resection is safe and feasible and can be adopted as the first selected method when the hospitals have the laparoscopic liver resection skills and rich experiences of curing hepatic cystic echinococcosis and the cyst is located at a shallow position,easy to expose and less than

关 键 词：棘球蚴病 肝 外囊切除术 腹腔镜检查 治疗结果 

分 类 号：R657.3[医药卫生—外科学]