肝囊肿的临床治疗：附137例分析
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摘要
目的：比较超声引导下囊肿穿刺引流及硬化剂注入术、腹腔镜开窗引流术和开腹开窗引流术治疗肝囊肿的疗效,分析其优缺点、适应证和禁忌证,探寻外科治疗肝囊肿的合理方法。
方法：回顾性分析2006年2月-2009年6月间于山东大学齐鲁医院住院治疗的肝囊肿病例共137例,分别行剖腹开窗术(21例)、腹腔镜下开窗术(52例)及超声引导下囊肿穿刺硬化剂注入置管引流术(64例)。通过对手术时间、术中出血量、住院时间、住院费用、手术并发症及复发率进行对比分析,比较三种术式的优缺点。
结果：52例患者在腹腔镜下完成肝囊肿开窗术,无中转剖腹病例,无手术死亡,术后2例出现胸腔积液,1例胆漏,1例腹水,经保守治疗后痊愈,3例复发。21例行剖腹肝囊肿开窗术,无手术死亡,术后1例出现胸腔积液,1例腹水,2例复发。64例行超声引导下经皮穿刺囊肿抽液及硬化剂注入术,无手术死亡,6例术后出现酒醉症状,2例术后引流管脱落,10例在术后2-6个月内复发。手术时间和出血量剖腹组明显高于腔镜组,P<0.05；住院时间剖腹组明显长于其他两组,P<0.05,硬化组短于其他两组,P<0.05；术后并发症三组间无明显统计学差异,P>0.05；住院费用腹腔镜组与剖腹组无统计学差异,P>0.05,硬化组低于其他两组,P<0.05；复发率硬化组高于其他两组,P<0.05,但剖腹组与腹腔镜组无统计学差异,p>0.05。
结论：临床常用的3种治疗肝囊肿的方法各有优缺点,对于需要外科治疗的肝囊肿,要严格把握手术适应证及禁忌证,结合囊肿的部位、大小、形态、囊液的性状、肝功能以及全身情况等综合评估,选择最佳治疗方案。
Objective:To compare laparoscopic fenestration, laparotomy fenestration and ultrasound-guided puncture drainage with Alcohol injection and sclerosing in the treatment for liver cyst and explore their advantages, disadvantages, indications and contraindications, to find a reasonable way of surgical treatment of hepatic cyst.
Methods:Review a total of 137 cases of liver cyst hospitalized at the Shandong University Qilu Hospital right from February 2006 to June 2009, were treated by laparotomy fenestration (21 cases), laparoscopic fenestration (52 cases), and puncture drainage with Alcohol injection and sclerosing (64 cases). The operative time, blood loss, hospitalization time, hospitalization costs, surgical complications and recurrence rate were analyzed to compare the advantages and disadvantages of three surgical methods.
Results:52 patients received laparoscopic fenestration, no conversion to laparotomy patients, no operative mortality, postoperative pleural effusion in 2 cases,1 case of bile leak,1 case of ascites, recovered after conservative treatment, three cases of recurrence.21 received laparotomy fenestration, no mortality,1 patient developed postoperative pleural effusion,1 case of ascites, and 2 cases of recurrence.64 receved ultrasound-guided puncture drainage with Alcohol injection and sclerosing, no operative mortality,6 patients had symptoms of intoxication,2 cases of postoperative drainage loss,10 cases recurrence in 2-6 months after surgery. Operative time and blood loss were significantly higher than the endoscopic and laparotomy group, P <0.05; hospitalization time of laparotomy group was longer than the other two groups, P<0.05, sclerosis group was shorter than the other two groups, P<0.05; postoperative complications of three groups had no significant statistical difference, P> 0.05; hospitalization costs of laparoscopy and laparotomy was no significant difference, P> 0.05, sclerosis group was less than other groups, P<0.05; recurrence rate of sclerosis group was higher than in the other two groups P<0.05, but the laparotomy group and the laparoscopic group had no significant difference, P> 0.05.
Conclusion:The three kinds of commonly used clinical treatment for hepatic cyst methods have respective advantages and disadvantages. With liver cysts needed surgical treatment, we must strictly control the surgical indications and contraindications, comprehensively evaluate the location, size, shape of cyst, cyst fluid properties, liver functions, and the body situation, and choose the best treatment.
方法：回顾性分析2006年2月-2009年6月间于山东大学齐鲁医院住院治疗的肝囊肿病例共137例,分别行剖腹开窗术(21例)、腹腔镜下开窗术(52例)及超声引导下囊肿穿刺硬化剂注入置管引流术(64例)。通过对手术时间、术中出血量、住院时间、住院费用、手术并发症及复发率进行对比分析,比较三种术式的优缺点。
结果：52例患者在腹腔镜下完成肝囊肿开窗术,无中转剖腹病例,无手术死亡,术后2例出现胸腔积液,1例胆漏,1例腹水,经保守治疗后痊愈,3例复发。21例行剖腹肝囊肿开窗术,无手术死亡,术后1例出现胸腔积液,1例腹水,2例复发。64例行超声引导下经皮穿刺囊肿抽液及硬化剂注入术,无手术死亡,6例术后出现酒醉症状,2例术后引流管脱落,10例在术后2-6个月内复发。手术时间和出血量剖腹组明显高于腔镜组,P<0.05；住院时间剖腹组明显长于其他两组,P<0.05,硬化组短于其他两组,P<0.05；术后并发症三组间无明显统计学差异,P>0.05；住院费用腹腔镜组与剖腹组无统计学差异,P>0.05,硬化组低于其他两组,P<0.05；复发率硬化组高于其他两组,P<0.05,但剖腹组与腹腔镜组无统计学差异,p>0.05。
结论：临床常用的3种治疗肝囊肿的方法各有优缺点,对于需要外科治疗的肝囊肿,要严格把握手术适应证及禁忌证,结合囊肿的部位、大小、形态、囊液的性状、肝功能以及全身情况等综合评估,选择最佳治疗方案。
Objective:To compare laparoscopic fenestration, laparotomy fenestration and ultrasound-guided puncture drainage with Alcohol injection and sclerosing in the treatment for liver cyst and explore their advantages, disadvantages, indications and contraindications, to find a reasonable way of surgical treatment of hepatic cyst.
Methods:Review a total of 137 cases of liver cyst hospitalized at the Shandong University Qilu Hospital right from February 2006 to June 2009, were treated by laparotomy fenestration (21 cases), laparoscopic fenestration (52 cases), and puncture drainage with Alcohol injection and sclerosing (64 cases). The operative time, blood loss, hospitalization time, hospitalization costs, surgical complications and recurrence rate were analyzed to compare the advantages and disadvantages of three surgical methods.
Results:52 patients received laparoscopic fenestration, no conversion to laparotomy patients, no operative mortality, postoperative pleural effusion in 2 cases,1 case of bile leak,1 case of ascites, recovered after conservative treatment, three cases of recurrence.21 received laparotomy fenestration, no mortality,1 patient developed postoperative pleural effusion,1 case of ascites, and 2 cases of recurrence.64 receved ultrasound-guided puncture drainage with Alcohol injection and sclerosing, no operative mortality,6 patients had symptoms of intoxication,2 cases of postoperative drainage loss,10 cases recurrence in 2-6 months after surgery. Operative time and blood loss were significantly higher than the endoscopic and laparotomy group, P <0.05; hospitalization time of laparotomy group was longer than the other two groups, P<0.05, sclerosis group was shorter than the other two groups, P<0.05; postoperative complications of three groups had no significant statistical difference, P> 0.05; hospitalization costs of laparoscopy and laparotomy was no significant difference, P> 0.05, sclerosis group was less than other groups, P<0.05; recurrence rate of sclerosis group was higher than in the other two groups P<0.05, but the laparotomy group and the laparoscopic group had no significant difference, P> 0.05.
Conclusion:The three kinds of commonly used clinical treatment for hepatic cyst methods have respective advantages and disadvantages. With liver cysts needed surgical treatment, we must strictly control the surgical indications and contraindications, comprehensively evaluate the location, size, shape of cyst, cyst fluid properties, liver functions, and the body situation, and choose the best treatment.
引文
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63.崔屹,叶远红.超声引导下治疗非寄生虫性肝囊肿141例疗效分析.医学影像学杂志,2001,11：329-330.
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66.钱林学,贵玉,冯彦红.单纯性肝囊肿酒精硬化治疗的进展.世界华人消化杂志.2007,31：3253-3256.
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