Takayama Shoryu, Banba Takuya, Hyodo Takahumi
Department of Surgery, Haibara General Hospital, Hosoe 2887-1, Makinohara, Shizuoka 421-0421, Japan.
Department of Surgery, Haibara General Hospital, Hosoe 2887-1, Makinohara, Shizuoka 421-0421, Japan.
Int J Surg Case Rep. 2023 Oct 27;112:109001. doi: 10.1016/j.ijscr.2023.109001.
A large hepatic cyst cause abdominal bloating and other symptoms. Surgical deroofing or ethanol sclerosis has been reported as the treatment options. We have treated patients surgically. However, an experience with postoperative bile leakage prompted us to reexamine our treatment options. It has been reported that the cause of bile leakage is the connection between the hepatic cyst and the bile duct. Therefore, we planned to observe the lumen of the hepatic cyst by endoscopy to evaluate the bile duct connection.
An 82-year-old woman presented to our hospital for abdominal bloating. An abdominal computed tomography (CT) scan revealed a large hepatic cyst. Respiratory function was decreased due to diaphragmatic compression caused by the cyst. Endoscopic observation of the cyst was performed to evaluate the bile duct connection. There were no obvious abnormalities in her cyst. The patient was discharged 7 days after this procedure.
Laparoscopic deroofing is recommended for the treatment of a large hepatic cyst when a patient can take surgery. However, deroofing has the potential for postoperative bile leakage. Careful consideration should be given to the treatment approach for each patient. Ethanol sclerotherapy has the potential for recurrence, but in this case, we confirmed the absence of bile duct connection. The ethanol sclerosis was effective, and there was no postoperative bile leakage.
Endoscopic observation during puncture of the hepatic cyst allowed the evaluation of bile duct connection and search for malignant disease. Ethanol sclerotherapy was also effective.
巨大肝囊肿可导致腹胀及其他症状。据报道，手术去顶术或乙醇硬化治疗为可供选择的治疗方法。我们一直采用手术治疗患者。然而，术后胆漏的经历促使我们重新审视我们的治疗选择。据报道，胆漏的原因是肝囊肿与胆管之间存在连接。因此，我们计划通过内镜观察肝囊肿腔以评估胆管连接情况。
一名82岁女性因腹胀前来我院就诊。腹部计算机断层扫描（CT）显示一个巨大肝囊肿。由于囊肿导致膈肌受压，呼吸功能下降。对囊肿进行了内镜观察以评估胆管连接情况。其囊肿未发现明显异常。该患者在此次手术后7天出院。
对于能够接受手术的巨大肝囊肿患者，推荐行腹腔镜去顶术。然而，去顶术有术后胆漏的风险。应针对每位患者仔细考虑治疗方法。乙醇硬化疗法有复发的可能，但在本病例中，我们证实不存在胆管连接。乙醇硬化治疗有效，且无术后胆漏。
肝囊肿穿刺时进行内镜观察可评估胆管连接情况并排查恶性疾病。乙醇硬化治疗也有效。
