Xu Song, Rao Min, Pu Yong, Zhou Junjing, Zhang Yong
Department of Hepatobiliary Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China.
Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, China.
Ann Palliat Med. 2020 Sep;9(5):3462-3471. doi: 10.21037/apm-20-1723.
Hepatic cysts in located posterior segments close to the diaphragm (IVa, VII, and VIII) reportedly have a high recurrence rate. Presently, laparoscopic omentoplasty is the accepted technique; developed from laparoscopic deroofing, which places a viable pedicle flap of omentum to prevent cyst closure. However, potential adhesions have made laparoscopic omentoplasty less favorable. In this paper, we report on an improved surgical technique involving lauromacrogol sclerosis directly under laparoscopic fenestration. We also review and evaluate the efficacy and feasibility of this refined surgical approach.
Data from 49 patients admitted to the Department of Hepatobiliary Surgery at the Affiliated Hospital of Jiangnan University from October 2015 to June 2020 with simple hepatic cysts located in the IVa, VII, and VIII segments were retrospectively analyzed. All patients were symptomatic before admission. They were separated into two groups based on the surgical approach they had received; refined laparoscopic lauromacrogol sclerotherapy or laparoscopic omentoplasty, and were compared and evaluated in terms of the postoperative cyst volume and quality of life.
No significant differences in sex, age, preoperative cyst volume, surgery duration, hospital stay, and bleeding volume were reported. There were no deaths or major complications in both groups. The postoperative cyst volume was significantly reduced in the laparoscopic lauromacrogol sclerotherapy group (2.48 cm) compared to the laparoscopic omentoplasty group (3.90 cm). This study evaluated both the immediate and medium-term results with a 3-12 months follow-up period for all patients. The cyst volume change in the laparoscopic lauromacrogol sclerotherapy group was found to be significantly greater than that of the laparoscopic omentoplasty group. The feedback regarding quality of life did not vary significantly between the two groups, except for general health and health change, where patients who received laparoscopic sclerotherapy responded with higher scores.
Our results indicate that laparoscopic lauromacrogol sclerotherapy surgery was safe and effective in patients with IVa, VII and VIII segment simple hepatic cysts.
据报道，位于靠近膈肌的肝后段（IVa、VII和VIII段）的肝囊肿复发率较高。目前，腹腔镜网膜成形术是公认的技术；它是由腹腔镜去顶术发展而来，即放置一块有活力的带蒂网膜瓣以防止囊肿闭合。然而，潜在的粘连使得腹腔镜网膜成形术的优势降低。在本文中，我们报告了一种改进的手术技术，即在腹腔镜开窗术下直接进行聚桂醇硬化治疗。我们还回顾并评估了这种改良手术方法的疗效和可行性。
回顾性分析2015年10月至2020年6月在江南大学附属医院肝胆外科收治的49例IVa、VII和VIII段单纯性肝囊肿患者的数据。所有患者入院前均有症状。根据所接受的手术方式将他们分为两组；改良腹腔镜聚桂醇硬化治疗组或腹腔镜网膜成形术组，并在术后囊肿体积和生活质量方面进行比较和评估。
两组在性别、年龄、术前囊肿体积、手术时间、住院时间和出血量方面均无显著差异。两组均无死亡或重大并发症。与腹腔镜网膜成形术组（3.90厘米）相比，腹腔镜聚桂醇硬化治疗组术后囊肿体积显著减小（2.48厘米）。本研究对所有患者进行了3至12个月的随访，评估了近期和中期结果。发现腹腔镜聚桂醇硬化治疗组的囊肿体积变化明显大于腹腔镜网膜成形术组。除了总体健康和健康变化方面，接受腹腔镜硬化治疗的患者得分较高外，两组在生活质量反馈方面没有显著差异。
我们的结果表明，腹腔镜聚桂醇硬化治疗手术对于IVa、VII和VIII段单纯性肝囊肿患者是安全有效的。
