Dziri C, Paquet J C, Hay J M, Fingerhut A, Msika S, Zeitoun G, Sastre B, Khalfallah T
Surgical Unit, Hôpital Charles Nicolle, Tunis, Tunisia.
J Am Coll Surg. 1999 Mar;188(3):281-9. doi: 10.1016/s1072-7515(98)00286-5.
Omentoplasty (OP) is thought to fill residual cavity, to assist healing of raw surfaces, and to promote resorption of serosal fluid and macrophagic migration in septic foci. Results published to date, whether retrospective or prospective, are not controlled and are discordant.
The authors investigated whether OP, either filling the residual cavity after unroofing, or covering the hepatic raw surface after pericystectomy, could reduce the rate or severity of deep abdominal complications (DAC) after surgical treatment of hydatid disease of the liver. Between January 1993 and December 1996, 115 consecutive patients (51 males and 64 females, mean age 42+/-16 years [range 10 to 80 years]) with previously unoperated uni- or multilocular hydatid disease of the liver, complicated or not, without other abdominal hydatid disease, were randomly allotted to OP (n = 58) or not (NO) (n = 57) after unroofing, total, or partial pericystectomy. Patients were divided into 2 strata according to the site of the cyst with respect to the diaphragm: a) posterosuperior segments II, VII, and VIII or b) anterior segments III, IV, V, and VI. Main outcomes measures included deep bleeding, hematoma, infection, or bile leakage. Subsidiary measures included wound complications, extraabdominal complications, duration of operation, and length of hospital stay.
Both groups were comparable regarding patient demographics, cyst characteristics, intraoperative procedures, search for bile leaks, and intraoperative transfusion requirements. On the other hand, more patients (86%) in NO had associated drainage of the abdominal cavity than in OP (64%) and the duration of operation was 9 minutes longer in OP, but neither of these differences was statistically significant. Less DAC occurred in OP (10%) than in NO (23%) (a posteriori gamma risk < 0.05) and fewer deep abdominal abscesses (0 versus 11%) (p < 0.03). Median duration of hospital stay, however, was similar.
OP decreases the rate of DAC and especially deep abdominal abscess after surgical treatment (unroofing or pericystectomy) for hydatid disease of the liver and should be recommended in this setting.
网膜成形术（OP）被认为可填充残留腔隙，辅助创面愈合，并促进浆液吸收及巨噬细胞向感染灶迁移。迄今为止发表的结果，无论是回顾性的还是前瞻性的，均未得到对照且存在分歧。
作者调查了OP，无论是在囊肿去顶后填充残留腔隙，还是在囊肿外膜切除后覆盖肝脏创面，是否能降低肝包虫病手术治疗后深部腹部并发症（DAC）的发生率或严重程度。在1993年1月至1996年12月期间，115例连续的患者（51例男性和64例女性，平均年龄42±16岁[范围10至80岁]），患有既往未手术的单发或多发肝包虫病，无论是否合并其他疾病，且无其他腹部包虫病，在囊肿去顶、完全或部分囊肿外膜切除后被随机分配至接受OP组（n = 58）或不接受OP组（NO）（n = 57）。根据囊肿相对于膈肌的位置，患者被分为2层：a）后上段II、VII和VIII或b）前段III、IV、V和VI。主要结局指标包括深部出血、血肿、感染或胆漏。次要指标包括伤口并发症、腹部外并发症、手术时间和住院时间。
两组在患者人口统计学、囊肿特征、术中操作、胆漏探查及术中输血需求方面具有可比性。另一方面，NO组中更多患者（86%）进行了腹腔引流，而OP组为64%，且OP组手术时间长9分钟，但这些差异均无统计学意义。OP组发生DAC的患者少于NO组（10%对23%）（事后伽马风险<0.05），深部腹部脓肿也更少（0对11%）（p < 0.03）。然而，中位住院时间相似。
OP可降低肝包虫病手术治疗（囊肿去顶或囊肿外膜切除）后DAC的发生率，尤其是深部腹部脓肿的发生率，在此情况下应推荐使用。
