Hepato-Pancreatico-Biliary and Liver Transplantation Units, Department of General Surgery, Hospital Italiano, Buenos Aires 1181, Argentina.
J Am Coll Surg. 2009 Dec;209(6):733-9. doi: 10.1016/j.jamcollsurg.2009.09.006.
The optimal management of nonparasitic hepatic cysts (NPHC) is a topic of debate. The purpose of this study was to evaluate our 17-year experience with NPHC.
From January 1990 to August 2007, 131 consecutive patients with NPHC were evaluated and treated at our institution. Seventy-eight patients (60%) had simple hepatic cysts (SHC). The remaining 53 (40%) had polycystic liver disease (PLD). Morbidity, mortality, and recurrence rates for each of the two groups were evaluated.
Thirty-seven patients underwent open deroofing (SHC, 24; PLD,13), 66 had laparoscopic deroofing (SHC, 46; PLD, 20), 19 had percutaneous drainage (SHC, 4; PLD, 15), 3 had major hepatic resections (PLD, 3), 4 had cystojejunostomy (SHC, 4), and 2 had combined hepatorenal transplantation (PLD, 2). Corresponding morbidity, mortality, and recurrence rates were, respectively: conventional deroofing: SHC, 29%, 0%, 8%; PLD, 8%, 0%, 0%; laparoscopic deroofing: SHC, 2%, 0%, 2%; PLD, 25%, 0%, 5%; percutaneous drainage: SHC, 0%, 0%, 75%; PLD, 0%, 0%, 20%; cystojejunostomy: SHC, 75%, 0%, 25%; major hepatic resections: PLD, 66%, 0%, 0%; and hepatorenal transplantation: PLD, 50%, 50%, 0%.
Laparoscopic deroofing provided complete relief of symptoms for both SHC and PLD. Percutaneous drainage was our procedure of choice for infected liver cysts and potentially for patients who cannot tolerate general anesthesia. Liver and liver-kidney transplantations were reserved for patients with end-stage PLD alone and in association with end-stage renal disease, respectively.
非寄生虫性肝囊肿（NPHC）的最佳治疗方法存在争议。本研究旨在评估我们 17 年的 NPHC 治疗经验。
1990 年 1 月至 2007 年 8 月，我们机构对 131 例连续 NPHC 患者进行了评估和治疗。78 例（60%）为单纯性肝囊肿（SHC）。其余 53 例（40%）为多囊肝病（PLD）。评估了两组患者的发病率、死亡率和复发率。
37 例行开腹去顶术（SHC24 例，PLD13 例），66 例行腹腔镜去顶术（SHC46 例，PLD20 例），19 例行经皮引流术（SHC4 例，PLD15 例），3 例行肝切除术（PLD3 例），4 例行胆肠吻合术（SHC4 例），2 例行肝肾联合移植术（PLD2 例）。相应的发病率、死亡率和复发率分别为：传统去顶术：SHC，29%，0%，8%；PLD，8%，0%，0%；腹腔镜去顶术：SHC，2%，0%，2%；PLD，25%，0%，5%；经皮引流术：SHC，0%，0%，75%；PLD，0%，0%，20%；胆肠吻合术：SHC，75%，0%，25%；肝切除术：PLD，66%，0%，0%；肝肾联合移植术：PLD，50%，50%，0%。
腹腔镜去顶术为 SHC 和 PLD 患者提供了完全缓解症状的效果。对于感染性肝囊肿和不能耐受全身麻醉的患者，经皮引流术是我们的首选治疗方法。肝和肝肾联合移植仅用于终末期 PLD 患者，或与终末期肾病相关时。
