He Jun,Liu Dong,Liu Yanfang,et al.Clinical experiences of laparoscopic treatment of hepatic echinococcosis in children: a report of 26 cases[J].Journal of Clinical Pediatric Surgery,2018,17(09):703-706.
腹腔镜治疗小儿肝细粒棘球蚴病临床体会：附26例报告
- Title:
- Clinical experiences of laparoscopic treatment of hepatic echinococcosis in children: a report of 26 cases
- Keywords:
- Laparoscopy; Hepatic echinococcus disease; Children; Treatment
- 文献标志码:
- A
- 摘要:
- 目的 探讨腹腔镜治疗小儿肝细粒棘球蚴病的临床疗效及应用价值。方法 以本院2010年1月至2016年12月间采用腹腔镜治疗26例小儿肝细粒棘球蚴病患儿为研究对象。所有患儿均行腹腔镜探查，外缘性肝细粒棘球蚴囊肿采用“沿肝组织与囊肿间前卫间隙切除包虫外囊”治疗方案，内缘型肝细粒棘球蚴囊肿采用“内囊部分摘除术 + 外引流术”治疗方案。术后服用阿苯达唑片进行治疗，并针对患儿家属进行健康宣教。结果 手术均获成功，手术时间100 ~ 250min，平均（150 ± 43）min；出血量10 ~ 20 mL，平均（14 ± 3）mL；住院天数6 ~ 18 d，平均（10 ± 3）d。18例行腹腔镜下外囊切除术，4例行腹腔镜下部分内囊摘除术 + 外引流术，4例行腹腔镜下外囊切除 + 部分内囊摘除术 + 外引流术；2例术后出现残腔感染，4例术后出现残腔胆汁瘘。无1例发生肝细粒棘球蚴囊液溢出及过敏性休克，无1例手术死亡，随访半年无1例术后复发。结论 腹腔镜治疗小儿肝细粒棘球蚴病整体效果良好，尤其对于手术难度较小的小儿肝细粒棘球蚴病；对于手术难度较大的肝细粒棘球蚴病，“腹腔镜下部分内囊摘除术 + 外引流术”可能是一种较为理想的手术方案。
- Abstract:
- Objective To explore the clinical efficacy of laparoscopic treatment of children with hepatomegaly echinococcosis. Methods From January 2010 to December 2016, retrospective analysis was conducted for the clinical data of 26 children with hepatic hydatid disease. All children underwent laparoscopy. Ectopic hepatic cyst echinococcosis was treated by avant-garde clearance resection of hydatid capsule. And endochondral hepatic hydatid cyst was handled by partial excision plus drainage. And postoperative oral albendazole and health education were offered. Results All operations were successful. Average operative duration was (150±43)(100-250) min, average bleeding volume (14±3)(10-20) mL and average hospitalization stay (10±3)(6-18) days. Eighteen cases underwent laparoscopic external capsule resection while another 4 cases had laparoscopic partial cystectomy plus external drainage. Four cases underwent laparoscopic external capsule resection, partial removal of internal capsule plus external drainage. There were postoperative residual cavity infection (n=2) and residual bile fistula (n=4). No fluid overflow of hepatic hydatid cyst, anaphylactic shock or intraoperative mortality. During a 6-month follow-up period, there was no recurrence. Conclusion Both safe and feasible, laparoscopic treatment of pediatric hepatomegaly hydatid disease has great clinical values. For more complicated cases, laparoscopic partial en bloc resection plus external drainage is preferred.
参考文献/References:
1 罗剑平, 木合然木. 肝包虫囊肿126例临床分析[J].中国普通外科杂志, 2004,13(3):236-237.DOI:10.3969/j.issn.1005-6947.2004.03.023. Luo JP , Mu HRM. Clinical analysis of hepatic hydatid cysts:a report of 126 cases[J]. Chinese Journal of General Surgery, 2004,13(3):236- 237. DOI:10.3969/j.issn.1005-6947. 2004.03.023. 2 Kern P. Medical treatment of echinococcosis under the guidance of Good Clinical Practice (GCP/ICH).[J]. Parasitology International, 2006, 55(Suppl.):S273-S282. 3 张殷,王忠荣,潮敏,等.不同操作通道下腹腔镜经皮腹膜外环扎术治疗儿童鞘膜积液——两中心950例经验总结[J],临床小儿外科杂志, 2017, 1(2):146-147.DOI:10.3969/j.issn.1671-6353.2017.01.013. Zhang Y,Wang ZR,Chao M,et al. Laparoendoscopic percutaneous extraperitoneal closure using different approaches for various types of hydroceles in children[J].J Clin Ped Sur,2017,1(2):146-147.DOI:10.3969/j.issn.1671-6353.2017.01.013. 4 Hu M, Zhao G, Xu D, et al. Retroperitoneal laparoscopic hepatectomy:, a novel approach.[J]. Surg Laparosc Endosc Percutan Tech, 2011, 21(5):245-248.DOI:10.1097/SLE.0b013e31822de0ac. 5 Avgerinos ED, Pavlakis E, Stathoulopoulos A, et al. Clinical presentations and surgical management of liver hydatidosis: our 20 year experience.[J]. HPB, 2006, 8(3):189-193.DOI: 10.1080/13651820500539495. 6 巴桑顿珠，罗亦刚，黄磊.肝囊型包虫病内囊摘除术与外囊完整剥除术的对比研究[J].中华普通外科杂志,2013,28(7):526-528. DOI:10.3760/cma.j.issn.1007-631X.2013.07.012. Ba SDZ, Luo YG, Huang L. A comparative study on total cystectomy and internal cyst extirpation for hepatic cystic echinococcosis[J].Chinese Journal of General Surgery，2013，28(7): 526-528.DOI:10.3760/cma.j.issn.1007-631X.2013.07.012. 7 曹峻,赵晋明,温浩,等.腹腔镜下肝包虫外囊剥除联合胆囊切除术二例报告[J].中华肝胆外科杂志，2010,16(1):87-89.DOI:10.3760/cma.j.issn.1007-8118.2010.11.026. Cao J ,Zhao JM, Wen H, et al.Clearance of hepatic echinococcosis-hydatid cyst external cyst and cholecystectomy under laparoscope in 2 cases[J].Chinese Journal of HepatobiliarySurgery,2010,16(1):87-89.DOI:10.3760/cma.j.issn.1007-8118.2010.11.026. 8 中国医师协会外科医师分会包虫病外科专业委员会;肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015:14(4):253-264.DOI:10.3760/cma.j.issn.1673-9752.2015.04.001. Chinese College of Surgeons (CCS) of Chinese Medical Doctor Association, Expert Consensus on the Diagnosis and Treatment of Hepatic Cystic & Alveolar Echinococcosis (2015 Edition)[J]. Chinese Journal of Digestive Surgery, 2015:14(4):253-264.DOI:10.3760/cma.j.issn.1673-9752.2015.04.001. 9 唐群科,张瑛,刘睿年,等.肝泡型包虫病肝移植术后复发的诊断和治疗[ J] .中华消化外科杂志,2013,12(9) :715-716.DOI:10.3760/cma.j.issn.1673-9752.2013.09.020. Tang QK, Zhang Y, Liu RN,et al.Diagnosis and treatment of hepatic alveolar echinoeoccosis after liver transplantation[J], Chinese Journal of Digestive Surgery,2013,12(9) :715-716.DOI:10.3760/cma.j.issn.1673-9752.2013.09.020. 10 Gupta N,Javed A,Puri S,et al.Hepatic hydatid:PAIR,drain or resect?[J].Gastrointest Surg,2011,15(10):1829-1836.DOI: 10.1007/s11605-011-1649-9. 11 Akbulut S,Senol A,Sezgin A,et al. Radical vs conservative surgery for hydatid liver cysts: experience from single center.[J].World J Gastroenterol,2010,16(8):953-959. 12 米尔夏提?阿不都热西提,吐尔洪江?吐逊,邰沁文 ,等.腹腔镜肝包虫外囊摘除术治疗肝囊型包虫病的临床疗效[J]中华消化外科杂志，2014,6(9) :484-486.DOI:10.3760/cma.j.issn.1673-9752.2014.06.018. Mierxiati?ABDRXT,Tuerhongjiang?TX,Tai QW,et al.Clinical efficacy of laparoscopic pericystectomy in the treatment of hepatic cystic echinococcosis.[J],Chinese Journal of Digestive Surgery,2014,6(9) :484-486.DOI:10.3760/cma.j.issn.1673-9752.2014.06.018. 13 Tai QW, Tuxun T, Zhang JH, et al.The role of laparoscopy in the management of liver hydatid cyst: a single-center experience and world review of the literature[J]. Surg Laparosc Endosc Percutan Tech.2013,23(2):171-5.DOI:10.1097/SLE.0b013e31828a0b78. 14 常晓健,徐元龙,胡泽民,等.电视腹腔镜在肝脏外科的临床应用[J].腹腔镜外科杂志,2002，7（2）:126.DOI:10.3969/j.issn.1009-6612.2002.02.030. Chang XJ,Xu YL,Hu ZM,et al.Clinical application of television laparoscopy in liver surgery [J], Journal of Laparoscopic Surgery, 2002,7(2):126.DOI:10.3969/j.issn.1009-6612.2002.02.030. 15 邹海波,罗兰云,王冠,等.腹腔镜肝包虫外囊切除术治疗囊型肝包虫疗效分析[J].腹腔镜外科杂志,2016,21(5):340-342. Zou HB, Luo LY, Wang G, et al.Curative effects of hepatic cystic echinococcosis： laparoscopic hepatic hydatid ectocyst resection[J]. Journal of Laparoscopic Surgery, 2016,21(5):340-342. 16 Sharma D,Babu R,Borgharia S,et al. Laparoscopy for liver hydatid disease: where do we stand today?[J]Surg Laparosc Endosc Percutan Tech. 2009 19(6):419-423.DOI: 10.1097/SLE.0b013e3181c30ed1. 17 Nguyen KT,Gamblin TC,Geller DA.World review of laparoscopic liver resection-2,804 patients.[J].Ann Surg.2009,250(5):831-841. DOI: 10.1097/SLA.0b013e3181b0c4df. 18 谢金敏,高毅,师龙生,等.腹腔镜治疗肝包虫病附120例报告[J].中国普通外科杂志，2004,13（12）：892-894.DOI:10.3969/j.issn.1005-6947.2004.12.005. Xie JM, Gao Y,Shi LS,et al.Laparoscopic treatment of hepatic hydatid cysts:a report of 120 cases[J].Chinese Journal of General Surgery, 2004,13（12）：892-894.DOI:10.3969/j.issn.1005-6947.2004.12.005. 19 马尔旦?马合木提,邰沁文,吐尔干艾力?阿吉,等.肝脏囊型包虫病腹腔镜与开腹根治性手术治疗的疗效比较[J].中华普通外科杂志，2014,29（12）941-943.DOI：10.3760/cma.j.issn.1007-631X.2014.12.014. Maerdan ? MHMT, Tai QW, Tuerganaili ? AJ, et al.Laparoscopic vs conventional open resection of liver hydatid cyst[J].Chinese Journal of General Surgery, 2014，29（12）941-943.DOI：10.3760/cma.j.issn.1007-631X.2014.12.014. 20 Sozuer E,Akyuz M,Akbulut S.Open surgery for hepatic hydatid disease.Int Surg. 2014,99(6):764-769. DOI: 10.9738/INTSURG-D-14-00069.1.
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