Lambruschi P G, Rudolf L E
Ann Surg. 1979 Jan;189(1):39-43. doi: 10.1097/00000658-197901000-00008.
A 20-year-old white male presented, complaining of abdominal fullness. His previous history was unremarkable except for the use of intravenous illicit drugs. Physical examination disclosed a mass filling the upper and lower right quadrants. We evaluated this mass through the use of barium contrast x-ray, sonography and angiography, and made the preoperative diagnosis of hepatic cystic disease. On operative exploration, a large thin-walled cyst was found on the right lobe of the liver and was shown to be free of communication with the biliary tree; 3,000 cc of chocolate colored fluid were aspirated from the cyst. Total removal of the cyst was achieved with careful dissection. The cavity was filled with omentum and closed with drainage. After a benign immediate postoperative course, the patient remains asymptomatic one year later. Although most reports from the literature describe unexpected intraoperative findings, we stress that symptomatic patients can and should be diagnosed prior to laparotomy, and that a thorough search be made for concomitant polycystic disease. Total extirpation of the cyst is the most desirable of the discussed treatments, when tempered by the age and physical condition of the patient. Thorough preoperative evaluation and awareness of different modalities of therapy allow for the correct choice of treatment.
一名20岁的白人男性前来就诊，主诉腹部胀满。除了使用静脉注射非法药物外，他既往史无异常。体格检查发现一个肿块占据右上腹和右下腹。我们通过钡剂造影X线、超声和血管造影对该肿块进行了评估，并做出了肝囊性疾病的术前诊断。手术探查时，在肝脏右叶发现一个大的薄壁囊肿，显示与胆管树无连通；从囊肿中抽出3000毫升巧克力色液体。通过仔细解剖实现了囊肿的完全切除。用大网膜填充腔隙并放置引流管关闭。术后早期过程良好，一年后患者仍无症状。尽管文献中的大多数报告描述了意外的术中发现，但我们强调有症状的患者能够且应该在剖腹手术前得到诊断，并且应彻底检查是否伴有多囊性疾病。在根据患者年龄和身体状况进行调整时，囊肿的完全切除是所讨论的治疗方法中最理想的。全面的术前评估和对不同治疗方式的了解有助于做出正确的治疗选择。
