Grubnik V, Iliashenko V, Bugridze Z, Grubnik Viqtor, Giuashvili Sh
Odessa National Medical University, Ukraine.
Georgian Med News. 2018 May(278):20-25.
The main goal of the research was to study echinococcosis liver cyst laparoscopic treatment's effectiveness. The retrospective analysis of liver echinococcosis cyst surgical treatment in the period from 2003 to 2013 years was conducted. 348 patients underwent surgical treatment, among them 283 patients - laparoscopic procedure, 65 - open surgery. Medial age was 42,3±7,9 years. Female - 214, male - 134. 249 patients underwent laparoscopic partial (conservative) cystectomy, 34 - laparoscopic radical cystectomy with liver resection, 3 (1%) - conversion. 47 patients underwent partial (conservative) cystectomy using open approach. 18 - radical cystectomy using either typical or atypical hemihepatectomy. A long term analysis of 226 (79,8%) patients in a period from 6 month to 7 years was conducted. Comparison of the results revealed the advantage of laparoscopic operations. It was manifested in less blood loss, duration of the procedure, pain syndrome, and a smaller number of bed-days. Infections of the residual cavity after open surgery were twice as much comparing to ones after laparoscopic surgery. Complications after open surgery were significantly higher than after laparoscopic procedures due to postoperative wound infections. After open surgery frequency of echinococcosis recurrence was higher than after laparoscopic one (8,5% vs 2,5%) (р<0,05). Nowadays it is possible to say that treatment of choice of noncomplicated liver echinococceal cysts is laparoscopic one. Correctly made laparoscopical procedure has a good long term results, few postoperative compications, less frequent recurrences and the excellent cosmetic effect. From the principles of radical surgical treatment's point of view laparoscopic approach is the same as an open surgery.
该研究的主要目的是探讨肝包虫囊肿腹腔镜治疗的有效性。对2003年至2013年期间肝包虫囊肿手术治疗进行回顾性分析。348例患者接受了手术治疗,其中283例行腹腔镜手术,65例行开放手术。平均年龄为42.3±7.9岁。女性214例,男性134例。249例患者行腹腔镜部分(保守)囊肿切除术,34例行腹腔镜根治性囊肿切除术并肝切除,3例(1%)中转开腹。47例患者采用开放手术行部分(保守)囊肿切除术。18例行根治性囊肿切除术,采用典型或非典型半肝切除术。对226例(79.8%)患者进行了为期6个月至7年的长期分析。结果比较显示腹腔镜手术具有优势。表现为出血量少、手术时间短、疼痛综合征轻、住院天数少。开放手术后残腔感染是腹腔镜手术后的两倍。由于术后伤口感染,开放手术后的并发症明显高于腹腔镜手术。开放手术后包虫病复发率高于腹腔镜手术(8.5%对2.5%)(p<0.05)。如今可以说,非复杂性肝包虫囊肿的首选治疗方法是腹腔镜手术。正确实施的腹腔镜手术具有良好的长期效果、术后并发症少、复发率低且美容效果极佳。从根治性手术治疗原则的角度来看,腹腔镜手术与开放手术相同。