腹腔镜治疗肝包虫病的争议。
Controversies in the laparoscopic treatment of hepatic hydatid disease.
机构信息
HPB Unit, Department of Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
出版信息
HPB (Oxford). 2004;6(4):213-21. doi: 10.1080/13651820410024003.
BACKGROUND
Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients.
METHODS
Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreatobiliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi.
RESULTS
Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (11.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and 11 years.
DISCUSSION
Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations.
背景
在选择合适的患者中，腹腔镜治疗肝包虫病是安全的。
方法
1980 年至 2003 年期间，在伊斯坦布尔大学医学院肝胆外科部治疗了 650 例肝包虫病患者。其中，1992 年至 2000 年期间有 60 例患者接受了腹腔镜治疗。一种特殊的抽吸磨碎装置用于排空囊内容物。根据 Gharbi 的超声分类，92%的囊肿处于 I、II 或 III 期。
结果
由于腹腔内粘连或位置困难的囊肿，有 8 例患者需要转为开腹手术。无与疾病或手术相关的死亡率。大多数并发症与腔感染（13.5%）和外胆管瘘（11.5%）有关，这些并发症是由囊肿与胆管树之间的沟通引起的。在 3.5 至 11 年的随访期间，有 2 例复发。
讨论
在选择合适的患者中，腹腔镜治疗肝包虫病是开放手术的替代方法。重要步骤是在不溢出的情况下排空囊肿内容物，用杀幼虫剂对囊肿腔进行消毒，并用经典的手术技术进行腔管理。我们专门设计的抽吸磨碎装置可安全地用于排空囊肿内容物而不会造成任何溢出。了解囊肿与胆管树的关系对于选择适合腹腔镜技术的患者至关重要。根据我们 650 例患者的经验，胆管沟通率高达 18%；其中一半可以在术前检测到。在其余病例中，胆管沟通通常在手术期间或之后发现。内镜逆行胰胆管造影（ERCP）和括约肌切开术有助于解决这个问题。由于肝包虫病是一种良性且有潜在复发的疾病，我们主张在腹腔镜和开放手术中使用保守技术。
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