Scheuerlein Hubert, Rauchfuss Falk, Franke Julia, Jandt Karin, Dittmar Yves, Trebing Gudrun, Settmacher Utz
Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany.
BMC Surg. 2013 Sep 30;13:42. doi: 10.1186/1471-2482-13-42.
The optimal treatment of nonparasitic liver cysts is still a topic of debate. Only symptomatic cysts are being considered as requiring treatment. Aim of this study is to evaluate our experience with this disease over the past ten years with a structured follow-up program.
From January 2000 to August 2010, 56 consecutive patients with nonparasitic liver cysts were treated at our institution. We assessed morbidity, recurrence and complication rates, quality of life as well as pre- and post-operative sonographic status of the cysts and course of clinical symptoms.
In 84% of the patients surgery was started as a laparoscopic procedure. Conversion rate was 6.4%. Average diameter of deroofed cysts was 12 cm. Overall complication rate was 16% and overall recurrence rate 28.3% (8.7% recurrences at the surgical site, 19.6% new or enlarged cysts). One half of the patients were symptom-free after surgery and the other half had at least one persisting symptom post-operatively. In one half of these patients with persisting symptoms, symptoms were ameliorated by surgery. In the other half of patients the number of symptoms increased after surgery. Two thirds of the overall patients reported their post-operative health as being good or very good.
Surgical deroofing is the most effective treatment option for symptomatic liver cysts. Half of our patient population retained at least one symptom from a group of more than ten abdominal symptoms.Only the minority of these cases may be attributed to true recurrence, de-novo cysts or growing pre-existing cysts. The analysis of our cases suggests that the persistent symptoms in our patients may in part be due to the fact that the association between clinical complaints and the liver cysts was not sufficiently established. A more rigid patient selection should be implemented in order to achieve better results from the treatment of cysts. Because even large cysts are frequently asymptomatic, patient selection should not primarily be based on the cyst size only. The decision should be based strictly on the correlation between cyst / cyst location and symptoms / clinical complaints. In our opinion, further diagnostic procedures may be necessary in individual cases to clarify such a correlation.
非寄生虫性肝囊肿的最佳治疗方法仍是一个有争议的话题。只有有症状的囊肿才被认为需要治疗。本研究的目的是通过一个结构化的随访计划来评估我们在过去十年中对这种疾病的治疗经验。
从2000年1月至2010年8月，我们机构连续治疗了56例非寄生虫性肝囊肿患者。我们评估了发病率、复发率和并发症发生率、生活质量以及囊肿的术前和术后超声检查情况及临床症状的发展过程。
84%的患者手术起始为腹腔镜手术。中转率为6.4%。去顶囊肿的平均直径为12厘米。总体并发症发生率为16%，总体复发率为28.3%（手术部位复发率为8.7%，新囊肿或囊肿增大率为19.6%）。一半的患者术后无症状，另一半患者术后至少有一个持续症状。在这些有持续症状的患者中，一半患者的症状通过手术得到改善。另一半患者术后症状数量增加。三分之二的患者术后健康状况良好或非常好。
手术去顶是有症状肝囊肿最有效的治疗选择。我们一半的患者群体至少保留了一组十多种腹部症状中的一种症状。这些病例中只有少数可能归因于真正的复发、新发囊肿或原有囊肿增大。对我们病例的分析表明，我们患者的持续症状部分可能是由于临床症状与肝囊肿之间的关联未得到充分确立。为了在囊肿治疗中取得更好的效果，应实施更严格的患者选择标准。因为即使是大囊肿也常常无症状，患者选择不应仅主要基于囊肿大小。决策应严格基于囊肿/囊肿位置与症状/临床症状之间的相关性。我们认为，个别病例可能需要进一步的诊断程序来明确这种相关性。
