Bickel A, Daud G, Urbach D, Lefler E, Barasch E F, Eitan A
Department of Surgery, Western Galilee Hospital, Nahariya, Israel.
Surg Endosc. 1998 Aug;12(8):1073-7. doi: 10.1007/s004649900783.
In recent years attempts have been made to treat hydatid liver cysts laparoscopically. The purpose of this study was to evaluate different aspects of this approach and to examine whether a reasonable model could be developed.
Three different subjects were analyzed. In the first, physical aspects related to transmembrane pressures were analyzed to demonstrate that evacuation of the cyst under pneumoperitoneum does not carry increased risk of spillage, and may even offer an advantage when the proper technique is used. In the second subject, an isolated liver model of a goat was used to study several techniques for evacuating hydatid cysts without spillage. This was tested qualitatively by demonstrating scolices in the fluid medium around the isolated liver after surgical manipulations. In the third subject, the implication of the technique was evaluated in human patients.
According to basic physical assumptions, the following conclusions were reached: (1) The increase in intracystic pressure is equal to or less than the increase in intraperitoneal pressure after pneumoperitoneum. (2) Aspiration of parasitic cysts by laparoscopic needle through a large cannula under "vacuum" or by sealing the cannula and adhering it to the liver by cyanoacrylate or fibrin glue was found to be very safe. Simple needle aspiration failed to prevent spillage. (3) A new transparent cannula 18 mm in diameter with a beveled tip was designed that enables good accessibility to liver cysts and safe evacuation even of huge and complex cysts.
The novel technique to manage hydatid liver cysts, described in the study, is feasible, sensible, and safe. The isolated goat liver containing hydatid cysts can be used as a reliable animal model to test new techniques in the future.
近年来，人们尝试通过腹腔镜治疗肝包虫囊肿。本研究的目的是评估这种治疗方法的不同方面，并探讨是否可以建立一个合理的模型。
分析了三个不同的研究对象。第一个研究对象中，分析了与跨膜压力相关的物理因素，以证明气腹状态下囊肿排空不会增加囊液溢出的风险，并且如果使用适当的技术，甚至可能具有优势。第二个研究对象中，使用山羊的离体肝脏模型研究了几种无囊液溢出的肝包虫囊肿排空技术。通过手术操作后在离体肝脏周围的液体介质中发现头节来进行定性测试。第三个研究对象中，在人类患者中评估了该技术的意义。
根据基本物理假设，得出以下结论：（1）气腹后囊内压力的增加等于或小于腹腔内压力的增加。（2）发现在“真空”状态下通过大套管用腹腔镜针抽吸寄生囊肿，或通过用氰基丙烯酸酯或纤维蛋白胶密封套管并将其粘附于肝脏的方法非常安全。单纯的针吸未能防止囊液溢出。（3）设计了一种新型透明套管，直径为18毫米，尖端呈斜面，即使对于巨大和复杂的囊肿也能很好地接近肝囊肿并安全排空。
本研究中描述的处理肝包虫囊肿的新技术是可行、合理且安全的。含有肝包虫囊肿的山羊离体肝脏可作为未来测试新技术的可靠动物模型。
