Senthilnathan P, Inamdar Swati, Nalankilli V P, Vijay Anand, Rajapandian S, Parthsarathi R, Raj Praveen, Palanivelu C
HPB Department, GEM Hospital and Research Center, Pankaja Mill Road, Ramnathpuram, Coimbatore, 641045, Tamil Nadu, India,
Surg Endosc. 2014 Oct;28(10):2832-9. doi: 10.1007/s00464-014-3570-2. Epub 2014 Jun 6.
Incidence of hepatic hydatid disease is increasing due to globalization. Surgery is the gold standard treatment. Laparoscopy has gained enough evidence regarding its safety and efficacy. Complete evacuation of hydatid contents without spillage remains a challenge. We aimed to determine long-term results of hepatic hydatid disease managed laparoscopically using palanivelu hydatid system (PHS) at our institution.
One hundred and five patients underwent laparoscopic surgical management using the PHS at our institute from May 1997 to May 2013. Clinical presentations, surgical strategy, postoperative morbidity, and long-term recurrence rate were evaluated.
Of the 105 patients, 76 were male and 29 female with a mean age of 32 years (range 14-71 years). The most common presentation was abdominal pain in 61 patients (58%). Sixteen patients had multiple cysts of which nine had involvement of both lobes. Seventy-seven (73.3%) cysts were uncomplicated. Nineteen (18.09%) had a cyst-biliary communication, two were ruptured cysts, and seven were recurrent cysts. All patients underwent successful laparoscopic management where conservative surgery was performed in 94 patients and radical surgery in 11 patients. Post-operative morbidity was seen in 18 (17.14 %) patients, which included deep cavity infection in two cases, post-operative bile leak in 13 cases, and duodenal injury in one case without any mortality. Mean long-term follow-up was 36 months (range 6 months-5 years) with recurrence in two cases.
Our long-term results with PHS showed good outcomes in the laparoscopic management of hepatic hydatid disease with conservative surgery as the preferred approach reserving radical surgery only in selected cases.
由于全球化，肝包虫病的发病率正在上升。手术是金标准治疗方法。腹腔镜手术在安全性和有效性方面已获得足够的证据。在不发生囊液外溢的情况下完全清除包虫内容物仍然是一项挑战。我们旨在确定在我们机构使用帕拉尼韦卢包虫系统（PHS）进行腹腔镜治疗肝包虫病的长期结果。
1997年5月至2013年5月，我们机构有105例患者接受了使用PHS的腹腔镜手术治疗。对临床表现、手术策略、术后发病率和长期复发率进行了评估。
105例患者中，男性76例，女性29例，平均年龄32岁（范围14 - 71岁）。最常见的表现是61例患者（58%）出现腹痛。16例患者有多个囊肿，其中9例双侧肝叶均受累。77个（73.3%）囊肿为单纯性囊肿。19个（18.09%）囊肿与胆管相通，2个为破裂囊肿，7个为复发性囊肿。所有患者均成功接受了腹腔镜治疗，其中94例患者接受了保守手术，11例患者接受了根治性手术。18例（17.14%）患者出现术后并发症，包括2例深部腔隙感染、13例术后胆漏和1例十二指肠损伤，无死亡病例。平均长期随访时间为36个月（范围6个月 - 5年），2例复发。
我们使用PHS的长期结果表明，在腹腔镜治疗肝包虫病方面取得了良好的效果，保守手术为首选方法，仅在特定病例中采用根治性手术。
