Sinha R, Sharma N
Department of Surgery, MLB Medical College, Jhansi, UP India.
JSLS. 2001 Jul-Sep;5(3):237-40.
The conventional surgical procedures for managing abdominal hydatids, including those of the liver, have a very high morbidity rate in terms of hospital stay and wound complications. Less invasive procedures may thus be logical alternatives.
We enrolled 58 patients in the study. Using guided ultrasound aspiration followed by instillation of 15% saline, we were able to manage 16 patients as outpatients. In the remaining 42 patients, saline instillation was combined with laparoscopic aided percutaneous evacuation combined with partial pericystectomy. Omental packing was added in four patients. A pericystic drain tube was left in every patient managed laparoscopically.
In the aspiration group, two sittings were required in 12 patients and more than two sittings (3 x) in two patients. Laparoscopic parameters showed an average IV infusion time of 12.3 hrs, drain removal time of 3.2 days, and discharge time of 3.2 days. Short-term complications included prolonged tube drainage for six days in one patient, intracystic bile collection in two, and intracystic pus in four patients. The aspiration group did not have any complications. Conversion to open evacuation was done in one patient. Fifty-four months of follow-up has been recurrence free.
Minimally invasive management, including aspiration and laparoscopic intervention, appear to be viable alternatives to open surgery because they result in less morbidity.
包括肝脏包虫病在内的腹部包虫病的传统外科手术，在住院时间和伤口并发症方面发病率极高。因此，侵入性较小的手术可能是合理的替代方案。
我们招募了58名患者进行该研究。通过超声引导下穿刺抽吸，然后注入15%的盐水，我们成功将16名患者作为门诊患者进行治疗。在其余42名患者中，盐水注入与腹腔镜辅助经皮抽液并结合部分包囊切除术相结合。4名患者增加了网膜填塞。每个接受腹腔镜治疗的患者都留置了一根包囊引流管。
在抽吸组中，12名患者需要进行两次治疗，2名患者需要进行两次以上（3次）治疗。腹腔镜手术参数显示，平均静脉输液时间为12.3小时，引流管拔除时间为3.2天，出院时间为3.2天。短期并发症包括1名患者引流管引流延长6天，2名患者囊内胆汁积聚，4名患者囊内积脓。抽吸组没有任何并发症。1名患者转为开放引流。随访54个月无复发。
包括抽吸和腹腔镜干预在内的微创治疗似乎是开放手术的可行替代方案，因为它们导致的发病率较低。
