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腹腔镜治疗多发性肝、网膜、肠系膜、腹膜及圆韧带包虫囊肿——1例罕见病例报告及系统文献综述

Laparoscopic Management of Multiple Liver, Omental, Mesenteric, Peritoneal, and Round Ligament Hydatid Cysts-A Rare Report of a Case and a Systematic Literature Review.

作者信息

Mihetiu Alin, Bratu Dan Georgian, Tanasescu Ciprian, Vintilă Bogdan Ioan, Sandu Alexandra, Sandu Mariana, Serban Dragos, Sabau Dan, Hasegan Adrian

机构信息

County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania.

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania.

出版信息

J Pers Med. 2024 Feb 14;14(2):205. doi: 10.3390/jpm14020205.

Abstract

Hydatid cyst disease is a parasitic ailment with an endemic nature, predominantly affecting geographical areas with a tradition in animal husbandry. The most common localization of hydatid disease is in the liver (60%), followed by the lungs, with other organ localizations comprising less than 10%. The surgical approach to this condition can be carried out through open surgery or laparoscopy. The coexistence of hepatic and intraperitoneal hydatidosis often leads to the preference for open surgery. We performed a literature review aiming to retrieve data regarding demographic characteristics, clinical features, preoperative management, and surgical approach concerning these unusual localizations of hydatid disease. It was observed that the mesenteric localization frequently presented with acute abdominal pain ( = 0.038) and that the open approach was preferred in 85.71% of cases. Furthermore, an interdependence was identified between the localization of the cysts and the type of surgical approach ( = 0.001), with mesenteric localizations being approached through laparotomy and excision ( = 0.037), while omental localizations, due to the easier approach, benefited from laparoscopy with excision in 14.29% of cases. Overall, the laparoscopic approach was less frequently used, but its utilization resulted in a lower number of complications and faster recovery. Additionally, we present a rare case of hepatic and intra-abdominal hydatidosis, resolved exclusively through a laparoscopic approach, including a review of the literature for these uncommon localizations of hydatid disease. A 45-year-old patient diagnosed with multiple hydatid cysts, both hepatic and intraperitoneal, underwent surgical intervention with exploratory laparoscopy. Laparoscopic excision of peritoneal, epiploic, mesenteric cysts, and round ligament, along with laparoscopic inactivation, evacuation, and pericystectomy of hepatic hydatid cysts, was performed. The patient's recovery was uneventful, and she was reevaluated at 3 and 9 months without signs of recurrence. The association of hepatic hydatid cysts with multiple intra-abdominal localizations is not commonly encountered. The treatment of choice is surgical and is predominantly conducted through open surgery. The presented case is unique due to the exclusive laparoscopic approach in the management of mixed hepatic and intra-abdominal hydatidosis.

摘要

包虫囊肿病是一种具有地方性的寄生虫病,主要影响有畜牧业传统的地理区域。包虫病最常见的发病部位是肝脏(60%),其次是肺部,其他器官发病部位占比不到10%。这种疾病的手术治疗可以通过开放手术或腹腔镜手术进行。肝内和腹腔内包虫病并存时,通常倾向于采用开放手术。我们进行了一项文献综述,旨在获取有关包虫病这些不寻常发病部位的人口统计学特征、临床特征、术前管理和手术方法的数据。据观察,肠系膜发病部位常表现为急性腹痛(P = 0.038),85.71%的病例首选开放手术。此外,还发现囊肿发病部位与手术方法类型之间存在相关性(P = 0.001),肠系膜发病部位通过剖腹手术和切除进行治疗(P = 0.037),而网膜发病部位由于手术操作更容易,14.29%的病例通过腹腔镜切除受益。总体而言,腹腔镜手术的使用频率较低,但其应用导致并发症数量减少且恢复更快。此外,我们还介绍了一例罕见的肝内和腹腔内包虫病病例,仅通过腹腔镜手术治愈,包括对包虫病这些不常见发病部位的文献综述。一名45岁患者被诊断为肝内和腹腔内多发包虫囊肿,接受了探索性腹腔镜手术干预。进行了腹腔镜下切除腹膜、网膜、肠系膜囊肿和圆韧带,以及腹腔镜下灭活、排空肝包虫囊肿并进行囊肿外膜切除术。患者恢复顺利,在3个月和9个月时进行复查,无复发迹象。肝包虫囊肿与多个腹腔内发病部位并存的情况并不常见。首选的治疗方法是手术,主要通过开放手术进行。本病例独特之处在于在混合性肝内和腹腔内包虫病的治疗中仅采用了腹腔镜手术方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd81/10890065/3890407b4700/jpm-14-00205-g001.jpg

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