急诊腹腔镜手术治疗儿童肝囊型包虫病破裂的应用价值  

Application value of emergent laparoscopic surgery for rupture of hepatic cystic echinococcosis in children

作　　者：玉苏甫·阿克木[1] 阿布都赛米·阿布都热衣木[1] 秦双利 叶尔番 和军[1] 李凯[1] 刘东[1] 阿孜古丽[1] 周玲[1] 李水学[1] 克力木[1] Yusufu·Akemu;Abudusaimi·Abudureyimu;Qin Shuangli;Ye Erfan;He Jun;Li Kai;Liu Dong;Aziguli;Zhou Ling;Li Shuixue;Kelimu(Department of Pediatric Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院小儿外科,乌鲁木齐830001

出　　处：《中华肝脏外科手术学电子杂志》2020年第6期571-575,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨急诊腹腔镜手术治疗儿童肝囊型包虫病破裂的应用价值。方法回顾性分析2013年1月至2019年9月在新疆维吾尔自治区人民医院诊治的9例儿童肝囊型包虫病破裂患者临床资料。其中男6例,女3例;年龄4.0~10.0岁,中位年龄7.5岁。患者和(或)家属均签署知情同意书,符合医学伦理学规定。9例均出现过敏反应及过敏性休克症状。均行急诊腹腔镜手术清理及冲洗腹腔、囊腔,行内囊摘除、部分外内囊切除术及残腔处理等。术后口服阿苯达唑预防包虫病复发。观察患者手术及术后预后情况。结果所有患者均顺利完成腹腔镜手术,平均手术时间(70±32)min,术中出血量(6±3)ml。无手术死亡,术后无腹腔脓肿形成。术后胆漏2例,1例抗炎治疗5 d后治愈,1例残腔引流2周后自行治愈。术后随访3~15个月,腹腔、盆腔及肝脏未见包虫复发。结论急诊腹腔镜手术治疗儿童肝囊型包虫病破裂安全、有效、可行,具有术野清晰、创伤小、术后康复快、住院时间短等优点。Objective To evaluate the application value of emergent laparoscopic surgery in the treatment of rupture of hepatic cystic echinococcosis in children.Methods Clinical data of 9 children with rupture of hepatic cystic echinococcosis admitted to People's Hospital of Xinjiang Uygur Autonomous Region from January 2013 to September 2019 were retrospectively analyzed.Among them,6 children were male and 3 female,aged 4.0-10.0 years,with a median age of 7.5 years.The informed consents of the patients and/or family members were obtained and the local ethical committee approval was received.Allergic reaction and anaphylactic shock occurred in 9 cases.Emergent laparoscopic surgery was performed to clean and irrigate the abdominal cavity and capsular cavity,and internal capsular removal,partial external capsular resection and residual cavity treatments were performed.Albendazole was administered orally after operation to prevent the recurrence of hydatid disease.Intraoperative conditions and postoperative prognosis of patients were observed.Results All patients successfully completed laparoscopic surgery,with an average operation time of(70±32)min and intraoperative blood loss of(6±3)ml.No surgical death was reported and no abdominal abscess occurred after operation.Postoperative bile leakage occurred in 2 cases,1 of them was cured after anti-inflammatory treatment for 5 d and the other case healed after 2 weeks of residual cavity drainage.Patients were followed up for 3-15 months.No recurrence of hydatid disease was observed in the abdominal cavity,pelvic cavity and liver.Conclusions Emergent laparoscopic surgery is safe,effective and feasible for the rupture of hepatic cystic echinococcosis in children,which has advantages of clear surgical field,mild trauma,rapid postoperative recovery and short length of hospital stay.

关 键 词：棘球蚴病 肝 破裂 腹腔镜 过敏反应 

分 类 号：R726.5[医药卫生—儿科]