Yan Jinghao,Zhou Ling,Li Shuixue.Experience and efficacy analysis of endoscopic treatment of 35 children with hepatic cystic hydatid disease[J].Journal of Clinical Pediatric Surgery,2023,22(01):32-36.[doi:10.3760/cma.j.cn101785-202205004-007]
小儿肝囊性细粒棘球蚴病的腔镜治疗
- Title:
- Experience and efficacy analysis of endoscopic treatment of 35 children with hepatic cystic hydatid disease
- Keywords:
- Laparoscopes; Echinococcosis; Internal Capsule; External Capsule; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨腹腔镜下肝细粒棘球蚴囊性包虫外囊切除术或次全切除术+内囊摘除术治疗小儿肝囊性细粒棘球蚴病的临床疗效及应用价值。方法 回顾性分析新疆维吾尔自治区人民医院2010年1月至2021年6月采用腹腔镜手术治疗的35例肝囊性细粒棘球蚴病患儿临床资料,男21例,女14例;年龄(8.9±3.0)(5~12)岁。主要临床表现为腹痛伴呕吐或腹痛伴腹膜炎体征;26例术前口服阿苯达唑片。35例术后口服阿苯达唑片。35例均采用4孔法顺利完成腹腔镜手术,其中26例行腹腔镜肝细粒棘球蚴囊性包虫外囊切除术,9例行腹腔镜肝细粒棘球蚴囊性包虫外囊次全切除术+内囊摘除术。收集所有患儿术中、术后临床资料及疗效情况。结果 35例术中均采用10%氯化钠溶液浸泡的纱布保护穿刺点,手术均顺利,手术时间(132±14.2)(118-159)min,住院时间(16±1.9)(14-20)d。7例(7/35,20%)出现手术相关并发症,其中4例为残腔胆漏,3例为残腔感染,均经保守治疗治愈。35例术中无一例发生肝细粒棘球蚴囊液溢出及过敏性休克。术后随访12~24个月,无一例复发。结论 在采用10%氯化钠溶液浸泡纱布保护穿刺点的前提下,实施腹腔镜肝细粒棘球蚴囊性包虫外囊切除术或次全切除术+内囊摘除术治疗小儿肝细粒棘球蚴囊性包虫病安全、有效;在肝细粒棘球蚴囊性包虫病囊肿破裂的情况下,行急诊腹腔镜下肝细粒棘球蚴囊肿外囊次全切除术+内囊摘除术同样可行。
- Abstract:
- ObjectiveTo explore the clinical efficacy and application value of laparoscopic hepatic cystic hydatid excision or subtotal external resection +internal encapsulation for hepatic cystic hydatid in children.MethodsFrom January 2010 to June 2021,clinical data were retrospectively reviewed for 35 children with hepatic hydatid disease undergoing laparoscopy.There were 21 boys and 14 girls with an average age of (8.9±3.0) years.The major manifestations were abdominal pain with vomiting or abdominal pain with signs of peritonitis.Surgical apparoach was laparoscopic hepatic echinococcosis cystic hydatid exocystectomy or subtotal resection plus internal capsule removal.ResultsAll of them underwent 4-hole laparoscopy successfully.Laparoscopic hepatic echinococcosis cystectomy (n=26) and laparoscopic hepatic echinococcosis granulosus cystectomy (n=9) were performed with an average operative duration (132±14.2) min and an average hospital stay (16±1.9) days.Seven cases (20%) had surgery-related complications,including residual cavity infection (n=3) and residual cavity bile leakage (n=4).All cases were cured and discharged after conservative measures.There was no hepatic hydatid cyst fluid overflow and anaphylactic shock during operation.ConclusionLaparoscopic hepatic hydatid cyst excision or subtotal resection plus internal capsule excision is both safe and effective for hepatic hydatid cyst in children with hydatid cyst.For ruptured cystic echinococcosis of hepatic hydatid cyst,emergency laparoscopic subtotal external cystectomy plus internal cystectomy of hepatic hydatid cyst is equally feasible.
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备注/Memo
收稿日期:2022-05-02。
基金项目:新疆维吾尔自治区科技援疆项目(2020E0287);新疆维吾尔自治区自然基金项目(2020D01A89)
通讯作者:李水学,Email:lishuixue@sina.com