腹腔镜肝包虫外囊摘除术治疗肝囊型包虫病的临床疗效

摘要

目的 探讨腹腔镜肝包虫外囊摘除术的临床疗效.方法 回顾性分析2005年5月至2010年12月新疆医科大学第一附属医院收治的21例肝囊型包虫病患者行腹腔镜肝包虫外囊摘除术的临床资料.所有患者术前1周口服阿苯达唑[10 mg/(kg· d)].术后采用门诊复查、电话等方式进行随访,随访时间截至2012年6月.对中转开腹率、手术时问、术中出血量、术后住院时间、术后并发症和包虫病复发等指标进行分析.结果 根据WHO包虫病非正式工作小组包虫病分型,21例肝囊型包虫病患者包虫为CE1型.其中8例患者囊肿位于肝Ⅱ～Ⅲ段,13例患者囊肿位于肝Ⅳ～Ⅵ段.囊肿直径为3 ～ 12 cm,平均直径为7 cm.手术时间为(76±23) min,术中出血量为(110±35) mL,术后住院时间为(4±1)d.术中无输血、中转开腹患者.术后1例患者出现少量胆汁漏并于术后10 d自行痊愈.所有患者随访15～60个月,中位随访时间为18个月.无一例患者复发.结论 腹腔镜肝包虫外囊摘除术安全、可行,近、远期疗效好.%Objective To investigate the clinical safety and prognosis of laparoscopic pericystectomy in the treatment of hepatic cystic echinococcosis.Methods The clinical data of 21 patients with hepatic cystic echinococcosis who received laparoscopic pericystectomy at the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed.Albendazole [10 mg/(kg · d)] was administered orally to all the patients 1 week before operation.All the patients were followed up via outpatient examination and phone call till June 2012.The rate of transfer to the open surgery operation time,volume of blood loss,duration of postoperative hospital stay,incidence of postoperative complication and recurrence rate were analyzed.Results According to the standard issued by the Informal Working Group on Echinococcosis,all the 21 patients were with type CE1 hepatic cystic echinococcosis.The cysts were in hepatic segments Ⅱ-Ⅲin 8 patients,and in hepatic scgmcnts Ⅳ-Ⅵ in 13 patients.The diameters of the cysts ranged between 3-12 cm,and the mean diameter was 7 cm.The operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were (76 ±23) minutes,(110 ± 35) mL and (4 ± 1) days.There were no patients who received blood transfusion or be transferred to open surgery.Bile leakage was occurred in 1 patient and was cured spontaneously at postoperative day 10.All the patients were followed up for 15-60 months,and the median time of follow up was 1 g months.No recurrence was observed.Conclusion Laparoscopic pericystectomy is safe and feasible for the treatment of hepatic cystic echinococcosis.