Parajó Calvo A, García García M, Pérez Pombo S, Otero Gutiérrez E, Montero Gómez M
Servicio de Cirugía, Hospital Santa María Nai., Orense.
Rev Esp Enferm Dig. 1997 Apr;89(4):329-31.
We report the case of a 70-year-old woman with polycystic disease of the liver and kidney, complicated with rupture and hemorrhage of the hepatic cysts located in the right lobe. A laparoscopic approach was used. After identifying the polycystic mass, the cytologic examination of the aspirated hematic fluid and the intraoperative biopsy showed its benign nature. An hepatic fenestration was performed. Hemostasis was achieved by electrosurgical and argon probes. The postoperative course was satisfactory and radiological improvement was demonstrated on the CT scan 3 months later. Follow-up examination one year later has been uneventful. Fenestration is one of the less stressing surgical options in the adult polycystic liver disease when treatment is indicated. The laparoscopic approach may be used with safety to perform a similar technique in selected cases, establishing a communication between the cysts and the peritoneal cavity. Nevertheless, it may be difficult to reach deeply situated cysts and to differentiate them from vascular structures. Laparoscopic intraoperative ultrasonography might be of great value in these cases. Likewise, long term studies are needed to determine the benefits and the indications of the laparoscopic fenestration.
我们报告了一例70岁女性患者，患有肝肾多囊病，并发右叶肝囊肿破裂出血。采用了腹腔镜手术方法。在识别出多囊肿块后，对吸出的血液进行细胞学检查以及术中活检显示其为良性。进行了肝开窗术。通过电外科和氩气探头实现了止血。术后过程顺利，3个月后的CT扫描显示有影像学改善。一年后的随访检查无异常。当需要治疗时，开窗术是成人多囊肝病中创伤较小的手术选择之一。在某些选定病例中，腹腔镜手术方法可安全用于实施类似技术，在囊肿与腹腔之间建立通道。然而，可能难以触及深部囊肿并将其与血管结构区分开来。腹腔镜术中超声检查在这些病例中可能具有很大价值。同样，需要长期研究来确定腹腔镜开窗术的益处和适应证。
