Ozmen M Mahir, Coskun Faruk, Ziraman Ipek
Department of Surgery, Ankara Numune Teaching and Research Hospital, Ankara 06100, Turkey.
World J Surg. 2006 Sep;30(9):1722-8. doi: 10.1007/s00268-005-0726-1.
Hydatid disease is a common condition worldwide and continues to be a significant societal problem in many countries of all continents. Alhough other treatment options are also available, surgery remains the cornerstone of therapy for hepatic hydatid disease. Omentoplasty seems to be an efficient technique for managing the residual cavity, but it has some shortcomings and might be difficult in secondary cases. Therefore we describe a new technique using the falciform ligament as a flap instead of omentum for managing the residual cavity, as it is more anatomic and a better option for liver cysts.
From April 2004 to October 2005, a total of 20 patients (11 women) with a median age of 43 years (range 23-66 years) underwent partial cystectomy-falciformoplasty for hydatid liver disease. The falciform ligament was prepared as a flap in all patients during the initial step of the operation and, after partial cystectomy and evacuation of the cystic components, the flap was inserted into the cystic cavity and fixed with sutures. A single drain was inserted into the subhepatic area.
Cysts were located in the right lobe of the liver in 14 patients and mean diameter of the cyst was 10 cm (range 7-25 cm). The mean duration of the operation was 40 minutes (range 35-69 minutes), and the mean postoperative hospital stay was 4 days (range 3-7 days). None of the patients had any major complications. Only two patients had persistent drainage for 7 days, which stopped spontaneously. The median follow-up was 9 months (range 2-19 months). Patients underwent duplex ultrasonography (US) to check the viability of the flap and the residual cavity at 1 week, 1 month, and 3 months postoperatively. US did not reveal any collection, the cavities were fully collapsed, and blood flow to the falciform ligaments was seen to be viable.
Using the falciform ligament as a flap for management of the residual cavity is an easy, safe, effective new technique with few complications. It might be a good choice in patients with hydatid liver disease.
包虫病在全球范围内较为常见，在各大洲的许多国家仍然是一个重大的社会问题。尽管也有其他治疗选择，但手术仍是肝包虫病治疗的基石。网膜成形术似乎是处理残留腔隙的一种有效技术，但它有一些缺点，在二次手术病例中可能会有困难。因此，我们描述一种新技术，使用镰状韧带作为皮瓣而非网膜来处理残留腔隙，因为它更符合解剖结构，对于肝囊肿是更好的选择。
2004年4月至2005年10月，共有20例患者（11例女性）接受了肝包虫病部分囊肿切除术-镰状韧带成形术，中位年龄43岁（范围23 - 66岁）。在手术初始步骤中，所有患者的镰状韧带均被制备成皮瓣，在部分囊肿切除并清除囊内容物后，将皮瓣插入囊腔并用缝线固定。在肝下区域插入一根引流管。
14例患者的囊肿位于肝右叶，囊肿平均直径为10 cm（范围7 - 25 cm）。平均手术时间为40分钟（范围35 - 69分钟），平均术后住院时间为4天（范围3 - 7天）。所有患者均未出现任何严重并发症。仅2例患者持续引流7天，之后自行停止。中位随访时间为9个月（范围2 - 19个月）。患者在术后1周、1个月和3个月接受双功超声检查，以检查皮瓣和残留腔隙的存活情况。超声检查未发现任何积液，腔隙完全塌陷，可见镰状韧带的血流存活。
使用镰状韧带作为皮瓣处理残留腔隙是一种简单、安全、有效的新技术，并发症少。对于肝包虫病患者可能是一个不错的选择。
