Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Research Center Named After Loginov A.S., shosse Entuziastov, 86, Moscow, 11123, Russia.
Department of Surgical Diseases No 1, Avicenna Tajik State Medical University, Kamongaron str., 3, Dushanbe, 734067, Tajikistan.
Surg Endosc. 2022 Feb;36(2):1224-1233. doi: 10.1007/s00464-021-08391-4. Epub 2021 Mar 1.
The diffusion of laparoscopic radical surgery for hydatid liver echinococcosis remains limited. There are no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed.
HPB center (Center 1) and general surgery hospital in an endemic area (Center 2) participated in a retrospective study. Radical surgery included total, subtotal pericystectomy, and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy.
The total number of patients who underwent surgery for liver hydatid cysts was 213. Laparoscopic cystectomy was performed in 106 (50%) patients. This number included 47 radical laparoscopic cystectomy (Center 1). Conservative laparoscopic procedures were used in 59 patients (Center 2). Finally, twenty-seven pairs of patients were matched. Immediate outcomes were better for radical treatment in terms of severe morbidity, length of hospital stay, and time of abdominal drainage before and after PSM. The mean follow-up length was 23 (4-66) and 29 (6-66) months and the recurrence rate was 2% and 5% in groups of radical and conservative treatment respectively. No differences were found in 1-, 3-, and 5-year disease free survival. After second PSM for recurrence, 20 pairs were matched with no relapse of disease.
Laparoscopic radical surgery leads to the better immediate outcomes and can be recommended as the preferred treatment option in a specialized HPB center. Conservative option is justified in general hospitals in endemic area for selected uncomplicated cysts.
腹腔镜根治性手术治疗肝包虫病的应用仍然有限。目前尚无关于肝包虫囊肿根治性和保守性腹腔镜手术即刻和长期结果的对比分析数据。本研究旨在比较肝包虫囊肿根治性和保守性腹腔镜手术后的即刻和长期结果。
HPB 中心（中心 1）和流行地区的普通外科医院（中心 2）参与了一项回顾性研究。根治性手术包括完整、次全包囊切除术和肝切除术。保守性手术包括单纯囊肿切除术和部分包囊切除术。
共对 213 例行肝包虫囊肿手术的患者进行了研究。腹腔镜囊肿切除术在 106 例（50%）患者中进行。这包括在中心 1 进行的 47 例根治性腹腔镜囊肿切除术。在中心 2 采用了 59 例保守性腹腔镜手术。最终，匹配了 27 对患者。在 PSM 后，在严重发病率、住院时间和腹部引流时间方面，根治性治疗的即刻结果更好。平均随访时间为 23（4-66）和 29（6-66）个月，根治性和保守性治疗组的复发率分别为 2%和 5%。在 1 年、3 年和 5 年无病生存率方面未发现差异。在因复发进行第二次 PSM 后，20 对匹配，疾病无复发。
腹腔镜根治性手术可获得更好的即刻结果，可推荐在专门的 HPB 中心作为首选治疗方法。在流行地区的普通外科医院，对于选择的简单囊肿，保守性治疗是合理的。
