腹腔镜下肝泡型包虫病切除术：单中心经验。
Laparoscopic resection of hepatic alveolar echinococcosis: A single-center experience.
机构信息
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
出版信息
PLoS Negl Trop Dis. 2022 Sep 6;16(9):e0010708. doi: 10.1371/journal.pntd.0010708. eCollection 2022 Sep.
INTRODUCTION
Alveolar echinococcosis (AE) remains a very rare disease requiring complete radical resection for curative treatment. While open approaches are common, safety and efficacy of laparoscopic resections remain unknown.
METHODS
This is a single-center, retrospective cohort study with patients undergoing liver resection for hepatic AE at the Department of Visceral Surgery and Medicine, Bern University Hospital from December 2002 to December 2020. Postoperative outcomes of patients following laparoscopic hepatectomy (LH) for hepatic AE were compared with those of patients undergoing open hepatectomy (OH).
RESULTS
A total of 93 patients underwent liver resection for hepatic AE. Laparoscopic hepatectomy was performed in 23 patients and open hepatectomy in 70 patients. While there were no significant differences in terms of gender, age and diagnostic tools, the majority of patients of the LH cohort were PNM stage 1 (78%) in contrast to only 39% in the OH cohort (p = 0.002). Patients undergoing laparoscopic hepatectomy were treated by minor liver resections in 91% and in 9% by major liver resections in comparison to the open hepatectomy cohort with 61% major liver resections and 39% minor resections. Laparoscopic hepatectomy was associated with shorter mean operation time (127 minutes vs. 242 minutes, p <0.001), lower major complication rate (0% vs. 11%, p = 0.322) and shorter mean length of hospital stay (4 days vs. 13 days, p <0.001). Patients with LH had a distinct, but not significant lower recurrence rate (0% vs. 4%, p = 0.210) during a mean follow-up of 55 months compared with a follow-up of 76 months in the OH cohort. After subgroup analysis of PNM stage 1 patients, similar results are seen with persistent shorter mean operation time (120 minutes vs. 223 minutes, p <0.001), lower major complication rate (0% vs. 8%, p = 0.759) and shorter length of hospital stay (4 days vs. 12 days, p <0.001).
CONCLUSION
Laparoscopy appears as a feasible and safe approach for patients with PNM stage 1 alveolar echinococcosis without impact on early disease recurrence.
介绍
泡型包虫病（AE）仍然是一种非常罕见的疾病，需要完全根治性切除才能达到治疗效果。虽然开放方法很常见，但腹腔镜切除术的安全性和疗效仍不清楚。
方法
这是一项单中心、回顾性队列研究，纳入了 2002 年 12 月至 2020 年 12 月期间在伯尔尼大学医院内脏外科和医学系接受肝切除术治疗肝泡型包虫病的患者。比较了腹腔镜肝切除术（LH）治疗肝泡型包虫病患者与开放性肝切除术（OH）治疗患者的术后结果。
结果
共有 93 例患者因肝泡型包虫病接受肝切除术。23 例患者接受腹腔镜肝切除术，70 例患者接受开放性肝切除术。尽管两组患者在性别、年龄和诊断工具方面无显著差异，但 LH 组的大多数患者为 PNM 分期 1 期（78%），而 OH 组仅为 39%（p=0.002）。行腹腔镜肝切除术的患者中，91%行小范围肝切除术，9%行大范围肝切除术，而行开放性肝切除术的患者中，61%行大范围肝切除术，39%行小范围肝切除术。腹腔镜肝切除术的平均手术时间较短（127 分钟比 242 分钟，p<0.001），主要并发症发生率较低（0%比 11%，p=0.322），平均住院时间较短（4 天比 13 天，p<0.001）。在平均 55 个月的随访中，LH 组的复发率明显较低（0%比 4%，p=0.210），而 OH 组的随访时间为 76 个月。在 PNM 分期 1 期患者的亚组分析中，也观察到相似的结果，包括持续的平均手术时间较短（120 分钟比 223 分钟，p<0.001）、主要并发症发生率较低（0%比 8%，p=0.759）和较短的住院时间（4 天比 12 天，p<0.001）。
结论
腹腔镜手术对于 PNM 分期 1 期泡型包虫病患者是一种可行且安全的方法，不会影响早期疾病复发。
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