Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China.
Surg Laparosc Endosc Percutan Tech. 2020 Aug 5;31(1):44-50. doi: 10.1097/SLE.0000000000000822.
Total cystectomy is a challenging procedure in patients with complicated liver hydatid cysts (HCs). This study aimed to evaluate the feasibility and safety of laparoscopic total cystectomy in patients with complicated liver HCs.
Prospectively collected clinical data of 50 consecutive patients, who underwent laparoscopic procedures for complicated liver HCs between January 2017 and January 2019, were retrospectively analyzed. One hundred patients who underwent open procedures were compared with the laparoscopic group in terms of perioperative outcomes during the 1-year follow-up period.
Conversion to open surgery occurred in 1 (2%) case. The number of single and multiple lesions and the size of HCs were similar between the 2 groups (P>0.05). Sixty-six percent of patients underwent total cystectomy, 10% subtotal cystectomy, and 24% hepatectomy in the laparoscopic group (P>0.05). Decompression and hepatic inflow occlusion were performed in high-risk cases. No differences were noted in average blood loss volume, and transfusion rate between the 2 groups. Postoperative recovery in the laparoscopic group was significantly shorter than that in the open group. There was no difference in the incidence of postoperative complications between the laparoscopic and open groups. No recurrence or death was observed in either group during this period.
Laparoscopic total cystectomy was a curative and safe surgical approach to the treatment of complicated HC with favorable mid-term outcomes. Subtotal cystectomy combined with decompression is the preferred option for patients with high surgical risk(s). However, long-term outcomes need to be validated in prospective studies with larger sample sizes and prolonged follow-up.
对于合并复杂肝脏包虫囊肿（HC）的患者，全囊切除术是一项具有挑战性的操作。本研究旨在评估腹腔镜全囊切除术治疗合并复杂肝脏 HC 的可行性和安全性。
回顾性分析了 2017 年 1 月至 2019 年 1 月期间 50 例连续接受腹腔镜手术的合并复杂肝脏 HC 患者的前瞻性收集的临床资料。在 1 年的随访期间，将这 50 例患者与 100 例接受开放手术的患者进行了比较，比较了围手术期结果。
1 例（2%）患者转为开放手术。两组患者的单发和多发病变数量以及 HC 大小相似（P>0.05）。腹腔镜组中 66%的患者行全囊切除术，10%行次全囊切除术，24%行肝切除术（P>0.05）。高危病例行减压和肝血流阻断。两组间平均出血量和输血率无差异。腹腔镜组术后恢复明显短于开放组。腹腔镜组和开放组术后并发症发生率无差异。两组患者在随访期间均无复发或死亡。
腹腔镜全囊切除术是治疗合并复杂 HC 的一种有疗效且安全的手术方法，具有良好的中期结果。对于高手术风险的患者，次全囊切除术联合减压是首选。然而，需要前瞻性研究更大样本量和更长随访时间来验证长期结果。
