Reyes Ríos P Y, Aranda García M J, Sánchez Morote J M, Roqués Serradilla J L, Ruiz Pruneda R, Trujillo Ascanio A
Cir Pediatr. 2013 Oct;26(4):198-202.
The aim of this review is to present our experience in minimally invasive surgical procedures as treatment of hepatic and pulmonary hydatidosis in the last five years.
Retrospective review of patients with pulmonary and hepatic hydatid cysts treated in our hospital between 2008-2012 with minimally invasive surgery.
We identified 4 cases, all of them Moroccan origin, the mean age was 6.7 years. Only one patient with hepatic cyst and three with hepatopulmonary cysts. All of them were treated with albendazole before surgery. Laparoscopy and/or thoracoscopy was performed and, in one case a transdiaphragmatic approach was used, as a way to reach a posterior hepatic injury unapproachable by laparoscopy. The technique used was the sterilization of the contents of the cyst with hypertonic saline solution, cyst opening and cystic membrane removal. We didn't do capitonage or pericystectomy. The resolution rate of residual cavities of the cysts was 100% and there was no recurrence or intraoperative complications.
In children surgical treatment can be performed using endoscopic techniques with the same safety and efficacy as open surgery. Treatment with albendazole before surgery is helpful in preventing recurrences and as unique treatment in small lesions. Surgery must be as sparing as possible avoiding unnecessary liver or lung resections. Treatment of the residual cavity seems unnecessary. The thoracoscopic transdiaphragmatic approach should be considered as an alternative treatment, for those liver lesions in posterior segments, which are intractable with laparoscopy.
本综述的目的是介绍我们在过去五年中采用微创手术治疗肝和肺包虫病的经验。
回顾性分析2008年至2012年在我院接受微创手术治疗的肺和肝包虫囊肿患者。
我们确定了4例患者，均为摩洛哥裔，平均年龄为6.7岁。仅1例肝囊肿患者，3例肝肺囊肿患者。所有患者术前均接受阿苯达唑治疗。进行了腹腔镜检查和/或胸腔镜检查，其中1例采用经膈入路，以处理腹腔镜无法触及的肝后部损伤。所采用的技术是用高渗盐溶液对囊肿内容物进行消毒、打开囊肿并去除囊膜。我们未进行缝合或囊肿切除术。囊肿残余腔的闭合率为100%，无复发或术中并发症。
在儿童中，可采用内镜技术进行手术治疗，其安全性和有效性与开放手术相同。术前使用阿苯达唑治疗有助于预防复发，并可作为小病灶的唯一治疗方法。手术必须尽可能保守，避免不必要的肝或肺切除。似乎无需处理残余腔。对于腹腔镜难以处理的肝后段病变，应考虑采用胸腔镜经膈入路作为替代治疗方法。
