Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.     

The surgical management of congenital liver cysts

BACKGROUND: Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome. METHODS: Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2. RESULTS: There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression. CONCLUSIONS: When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.     

Endoscopic treatment of quadrigeminal cistern arachnoid cysts.

Five patients with arachnoid cysts of the quadrigeminal cistern treated by endoscopic fenestration are reported and another eleven well-documented cases from the literature are reviewed. Among the five personal cases four were children and one was adult; the cyst fenestration was performed from the lateral ventricle in three cases and from the third ventricle in two. In four patients the endoscopic treatment resulted in clinical remission, whereas a two-month-old baby later required a shunt. The lateral ventricle-cystostomy and the third ventricle-cystostomy (according to the cyst extent) are the best endoscopic procedures, whereas the cyst fenestration through a suboccipital supracerebellar approach is no longer used. The rate of cured or improved patients after endoscopic surgery (14/16 or 87.5%) was rather similar to that of a group of twenty patients treated by traditional surgery (craniotomy and cyst excision and/or shunt) (85%). These data confirm that endoscopic fenestration of quadrigeminal cistern cysts must be performed as the first procedure because it is less invasive and avoids shunt dependency.     

腹腔镜下肝肾囊肿开窗去顶术的临床应用

目的:探讨腹腔镜治疗肝肾囊肿的方法和效果。方法: 1994至2004年于腹腔镜下为68例肝肾囊肿患者行开窗去顶术,其中肝囊肿56例,肾囊肿12例,并注入无水酒精灌洗残留粘膜。结果: 68例手术全部成功,无中转开腹。手术时间30~70min,随访时间6个月~10年, 1例复发。结论:腹腔镜治疗肝肾囊肿安全可行,在严格掌握适应证的条件下值得推广应用。     

Role of fenestration and resection for symptomatic solitary liver cysts

BACKGROUND: Symptomatic liver cysts can be managed surgically by fenestration or by hepatic resection. The present study was designed to investigate the current role of each surgical technique in the management of this benign condition. METHODS: Forty consecutive patients with symptomatic liver cyst (non-parasitic and non-malignant) surgically treated by fenestration or resection were identified from a prospectively collected database. An analysis of primary outcome measures including operative parameters, morbidity and mortality rates, length of postoperative stay and recurrence rates in months was carried out. RESULTS: The laparoscopic fenestration group had the best perioperative outcome. At median follow up of 20 months, there were no recurrences in the resection group but recurrence occurred in 6/27 (22%) in the fenestration group. Four of these recurrences were asymptomatic and were managed conservatively while two symptomatic recurrences required a resection. CONCLUSION: Laparoscopic fenestration is the best treatment for symptomatic liver cysts as the primary operation. It is associated with the lowest blood loss, lowest morbidity and shortest hospital stay. Liver resection is best reserved for recurrent symptomatic cysts and cystic lesions suspicious of tumours where it can be safely performed and associated with a zero recurrence rate.     

Sclerosant therapy as first-line treatment for solitary liver cysts

AIM: The aim was to determine the outcome from percutaneous sclerosing treatment of solitary non-parasitic hepatic cysts. METHODS: The results of treatment of patients with symptomatic solitary non-parasitic hepatic cysts treated between 1995 and 2000 were reviewed. RESULTS: There were 23 women and one man with a median (range) age of 59 (34-79) years. The median (range) diameter of the cysts was 10 (5-24) cm. Five patients were treated by laparoscopic fenestration ab initio as they also required a cholecystectomy because of gallstones. The remaining 19 patients underwent percutaneous sclerotherapy. In one just aspiration was successful without further treatment. In six contrast leaked from the cyst and five of these had laparoscopic fenestration. Twelve patients had sclerosant treatment with good results at a median (range) follow-up of 35 (6-60) months in 10 patients. Good results were also obtained in 10 of the 12 patients who had fenestration.     

Intracranial arachnoid cysts in children

The clinical and radiographic findings, surgical treatment, and outcome in 16 pediatric patients with intracranial arachnoid cysts are reviewed. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imaging scans were diagnostic in all cases. Of the nine cysts treated primarily or secondarily by craniotomy for fenestration and drainage into the basilar cisterns, five recurred. Cyst-peritoneal shunting led to diminished cyst size and clinical improvement in all seven cases in which it was used as the initial treatment and in all four cases in which fenestration had been unsuccessful. The results in this series show that cyst-peritoneal shunting is the treatment of choice for most intracranial arachnoid cysts in children.     

Endoscopic treatment of para- and intraventricular cerebrospinal fluid cysts.

This study has been made to define the role of endoscopy and the most appropriate approach and technique of endoscopic fenestration of paraventricular and intraventricular CSF cysts according to the cyst size and location. Twenty-two patients with intraventricular (13 cases) and paraventricular (9 cases) CSF cysts, operated upon by endoscopic technique in three Italian neurosurgical centers, are reviewed. Paraventricular hemispheric cysts have been treated by endoscopic fenestration from the cyst to the lateral ventricle. Midline intraventricular cysts (2 of the septum pellucidum and 4 of the velum interpositum) underwent fenestration from the right lateral ventricle to the cyst, with fenestration in both lateral ventricles in one case. Cysts of the choroid plexus have been fenestrated from the homolateral enlarged ventricle (4 cases) or from the contralateral compressed ventricle (2 cases). Twenty patients (more than 90%) were definitively cured by the endoscopic procedure, whereas only 2 patients required a shunt or a direct approach. We think that the endoscopic fenestration must be considered the treatment of choice of intraventricular and paraventricular CSF cysts.     

Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting

The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the child shunt-independent. The cases of 40 pediatric patients with arachnoid cysts treated between 1978 and 1989 are reported. Five children with mild symptoms and small cysts that remained stable on follow-up studies have not required surgical intervention. Of 15 patients with cysts initially treated by fenestration, 10 (67%) showed no clinical or radiographic improvement postoperatively and have undergone cyst-peritoneal (eight patients) or ventriculoperitoneal (VP) shunting (one patient), or revision of a VP shunt placed for hydrocephalus before cyst fenestration (one patient). Two other patients with existing VP shunts required no further procedures. Thus, only three (20%) of 15 patients initially treated by fenestration remain shunt-independent after a median follow-up period of 8 years. The 20 other patients were initially treated by cysts shunting and all improved postoperatively; shunt revision has been necessary in six (30%) of these 20 patients because of cysts recurrence. Cyst location influenced the success of shunt treatment; none of the seven middle cranial fossa cysts treated by shunting have required revision, but results with cysts in other locations were less favorable. In all locations, though, shunting was more successful than fenestration. It is concluded that cyst-peritoneal or cyst-VP shunting is the procedure of choice for arachnoid cysts in most locations, including those in the middle cranial fossa.     

Surgical therapy of symptomatic arachnoid cysts - an outcome analysis

BACKGROUND: Arachnoid cysts may present with various symptoms and in different locations. Optimal treatment is still controversial, although cyst fenestration or shunt insertion are recognized as standard procedures. In this retrospective analysis the authors sought to determine which factors influence the outcome after surgery of symptomatic arachnoid cysts. METHODS: 37 patients (24 male, 13 female, mean age 40.2 years) were treated within a ten year period in our institution. Mean follow-up was 39 months; follow-up was done on an ambulatory basis. For analysis patient charts were reviewed and cranial CT scans or MR investigations were examined to determine pre- and postoperative cyst volumes. Clinical outcome was graded into four subgroups using a scale based on the patients self-rating of success. Different factors were studied concerning their influence on outcome. FINDINGS: Fenestration was performed in 28 cases, cysto-peritoneal or cysto-atrial shunting in 9 cases. A favourable outcome (subgroups 3 and 4) was achieved in 19 of 28 patients (fenestration) and in 6 of 9 patients (shunting), respectively. Mean reduction of the cyst volumes was 58% after fenestration and 74% after shunting revealing both methods to be effective. Degree of cyst volume reduction correlated significantly with clinical outcome. Patients with infratentorial cysts had more often a favourable outcome. Headache as the only symptom did not influence outcome. CONCLUSIONS: Surgery of symptomatic arachnoid cysts resulted in favourable outcome in two thirds of the patients. Both standard procedures, fenestration and shunting, are equally effective for treatment. Factors that influence outcome are the rate of volume reduction and cyst location.     

肝囊肿158例临床治疗分析

目的：比较硬化治疗、腹腔镜和剖腹开窗引流术治疗肝囊肿的疗效及其优缺点,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月行剖腹开窗术（42例,剖腹组）、腹腔镜下开窗术（52例,腔镜组）及硬化治疗（64例,硬化组）的肝囊肿患者的临床资料,并对手术时间、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。结果：158例均顺利实施手术,无手术死亡病例。手术时间和出血量剖腹组明显高于腔镜组;住院时间剖腹组明显长于其他2组,硬化组短于其他2组（P〈0.05）;术后并发症3组间差异无统计学意义（P〉0.05）;住院费用腔镜组与剖腹组差异无统计学意义（P〉0.05）,硬化组低于其他2组（P〈0.05）;复发率硬化组高于其他2组（P〈0.05）,但剖腹组与腹腔镜组差异差异无统计学意义（P〉0.05）。结论：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因素综合评估,选择最佳治疗方案。     

Suprasellar arachnoid cysts: endoscopy versus microsurgical cyst excision and shunting

The aim of this study is to define the indications to endoscopy versus other surgical procedures in the management of suprasellar arachnoid cysts from a personal series and an extensive literature review. Five symptomatic patients (two children and three adults) with suprasellar arachnoid cysts were treated by endoscopic fenestration in our neurosurgical unit. The endoscopic procedure consisted of ventricle-cyst-cisternostomy in three cases and ventricle-cystostomy in two. Four patients were cured after the endoscopic procedure alone, whereas another with rhinoliquorrhoea later required a craniotomy. The literature review includes 102 patients treated by endoscopic fenestration and 74 treated by other procedures, including microsurgical cyst resection through craniotomy (38 cases), shunt of the cyst (21 cases) and percutaneous ventricle-cystostomy (15 cases). Among the reviewed cases, the rate of cure or improvement was 90% (92 among 102 cases including ours) after endoscopy and 81% (60 among 74 cases) after other surgical procedures. The results of this study suggest that endoscopic ventricle-cyst cisternostomy is the best treatment for suprasellar arachnoid cysts, because it is less invasive, provides the best results and avoids shunt dependency in most cases.     

中颅窝蛛网膜囊肿的神经内镜手术治疗

目的 探讨中颅窝蛛网膜囊肿神经内镜手术的治疗经验并评估其治疗效果.方法 回顾2004年1月至2009年6月使用神经内镜行囊肿-脑池造瘘治疗中颅窝蛛网膜囊肿32例,其中男性21例,女性11例,年龄6个月～39岁,平均年龄8.4岁,包括5例幼儿患者,年龄2～5岁.分析病例的临床资料,包括临床症状、影像学表现、手术适应证、手术技巧、手术并发症以及临床及影像学随访结果 .结果 患者术后随访时间8～72个月,术前有症状的27例患者中,症状消失8例、改善17例、无变化2例,临床症状好转率为92.6%.5例术前无症状的幼儿患者,术后随访无新症状出现.囊肿消失4例,缩小20例,无明显变化8例.术后颅内感染及切口脑脊液漏各1例.无症状硬脑膜下积液4例.并发症发生率为18.8%.结论 神经内镜手术损伤小、效果好,可以作为中颅窝蛛网膜囊肿的首选治疗方法 .     

三种开窗引流术治疗老年先天性肝囊肿的回顾性对比研究

目的比较腹腔镜开窗网膜移植术、腹腔镜单纯开窗术和开腹单纯开窗术三种方法治疗年龄60岁及以上先天性肝囊肿的近远期疗效。方法回顾性分析74例老年先天性肝囊肿患者的临床资料,其中网膜组（腹腔镜开窗网膜移植术）25例,单纯组（腹腔镜单纯开窗术）28例,开腹组（开腹单纯开窗术）21例,比较三组的手术时间、术中失血量、禁食时间、下床活动时间、术后引流量、术后白细胞计数、住院时间、术后并发症发生率和复发率等。结果单纯组手术时间较网膜组、开腹组缩短（P〈0．05）。开腹组术中失血量、禁食时间、下床活动时间、术后白细胞计数、住院时间较腹腔镜组增多（P均〈0．05）。网膜组术后引流量和总并发症发生率较单纯组、开腹组减少（P均〈0．05）,但三组术后近期并发症发生率如术后出血、胸腔积液、肺部感染、腹水、胆漏等以及复发率、再手术率差异无统计学意义（P〉0．05）。结论针对老年先天性肝囊肿患者,腹腔镜开窗网膜移植术在减少术后引流量、降低总体并发症发生率上更具优势,腹腔镜单纯开窗术可缩短手术时间。     

Endoscopic treatment of prepontine arachnoid cysts

Prepontine (or suprasellar) arachnoid cysts are uncommon in clinical practice and experience in their management may therefore be limited. Symptomatic cysts usually present with features of hydrocephalus due to obstruction of the third ventricle and aqueduct, and occlusion or partial obstruction of both foramina of Monro. Several treatment techniques have been used including stereotactic aspiration, microsurgical excision and shunting, but the best method of treatment remains unclear and the role of endoscopy is not yet established. We report our experience in a series of seven patients who had endoscopic treatment for prepontine arachnoid cysts; five were children under 15 years old who presented with delayed development and/or enlarged heads. The two adult patients, both of whom had insertion of shunts as children, presented with headache and vomiting due to shunt blockage. All patients improved following endoscopic cyst fenestration. There was no operative morbidity and there have been no relapses to date. Endoscopic fenestration of prepontine arachnoid cysts appears to be an effective method of treatment.     

口腔颌面部囊肿开窗减压术的临床疗效及美学效果

探讨对口腔颌面部囊肿患者实施开窗减压术的临床效果。方法 选取2023年5月-11月于 本院行手术治疗的50例口腔颌面部囊肿患者为研究对象,依据手术方案不同分为对照组和观察组,每组 25例。对照组给予常规切开治疗,观察组给予开窗减压术治疗,比较两组临床指标、临床疗效、治疗满 意度及并发症发生情况。结果 观察组手术时间、术中出血量及住院时长均优于对照组（P ＜0.05）;观察 组治疗总有效率为96.00%,高于对照组的72.00%（P ＜0.05）;观察组治疗满意度为96.00%,高于对照组的 76.00%（P ＜0.05）;观察组并发症发生率为4.00%,低于对照组的24.00%（P ＜0.05）。结论 开窗减压术 可有效缩短口腔颌面部囊肿患者的手术时间及住院时长,减少术中出血量,治疗效果优于常规切开治疗方 案,有利于降低相关并发症的发生几率,提高患者满意度。     

Endoscopic fenestration of symptomatic septum pellucidum cysts: three case reports with discussion on the approaches and technique.

OBJECTIVES: We describe three patients with symptomatic septum pellucidum cysts treated by endoscopic fenestration and discuss the different endoscopic approaches to these cysts. CLINICAL PRESENTATION: The patients are an 8-year-old boy, a 7-year-old boy and a 21-year-old woman; this last also had a right frontal cavernous angioma and a pituitary microadenoma. All patients presented with headache, associated with vomiting in two and behavioral changes in one. In all cases magnetic resonance showed a septum pellucidum cyst. INTERVENTION: Two patients were operated upon by posterior approach through a right occipital burr hole and underwent fenestration from the right occipital horn to the cyst, with a second fenestration from the cyst to the left lateral ventricle in one. Another patient underwent microsurgical removal of a right frontal cavernoma and endoscopic cyst fenestration with both lateral ventricles through a right frontal craniotomy. Postoperatively, headache and vomiting resolved in all cases and behaviour changes improved in one. CONCLUSIONS: Endoscopic fenestration is the treatment of choice for septum pellucidum cysts, where it results in immediate relief of the mass effect of the cyst and in the remission of the associated symptoms. We suggest a posterior approach through a right occipital burr hole. It allows one to easily cannulate the occipital horn, which is usually larger than the frontal one, thus avoiding the risk of damaging the vascular and neural structures surrounding the foramen of Monro. Besides, the endoscopic trajectory is in our opinion more direct. The two-window technique, with fenestration of the cyst into both lateral ventricles, improves the chances of long-term patency.     

Surgical therapy of symptomatic arachnoid cysts – an outcome analysis

Summary. Background. Arachnoid cysts may present with various symptoms and in different locations. Optimal treatment is still controversial, although cyst fenestration or shunt insertion are recognized as standard procedures. In this retrospective analysis the authors sought to determine which factors influence the outcome after surgery of symptomatic arachnoid cysts.Methods. 37 patients (24 male, 13 female, mean age 40.2 years) were treated within a ten year period in our institution. Mean follow-up was 39 months; follow-up was done on an ambulatory basis. For analysis patient charts were reviewed and cranial CT scans or MR investigations were examined to determine pre- and postoperative cyst volumes. Clinical outcome was graded into four subgroups using a scale based on the patients self-rating of success. Different factors were studied concerning their influence on outcome.Findings. Fenestration was performed in 28 cases, cysto-peritoneal or cysto-atrial shunting in 9 cases. A favourable outcome (subgroups 3 and 4) was achieved in 19 of 28 patients (fenestration) and in 6 of 9 patients (shunting), respectively. Mean reduction of the cyst volumes was 58% after fenestration and 74% after shunting revealing both methods to be effective. Degree of cyst volume reduction correlated significantly with clinical outcome. Patients with infratentorial cysts had more often a favourable outcome. Headache as the only symptom did not influence outcome.Conclusions. Surgery of symptomatic arachnoid cysts resulted in favourable outcome in two thirds of the patients. Both standard procedures, fenestration and shunting, are equally effective for treatment. Factors that influence outcome are the rate of volume reduction and cyst location.     

Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration

OBJECTIVE: The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to provide a baseline for comparisons of the efficacies of other treatment modalities. METHODS: A retrospective review of data for 50 children who underwent keyhole craniotomy for fenestration of temporal arachnoid cysts between 1994 and 2001 was performed after institutional review board approval. During that period, the first-line treatment for all symptomatic middle fossa arachnoid cysts was microcraniotomy for fenestration. Microsurgical dissection to create communications between the cyst cavity and basal cisterns was the goal. All patient records were reviewed and numerous variables related to presentation, cyst size and classification, treatment, cyst resolution, symptom resolution, follow-up periods, and cyst outcomes were recorded. RESULTS: Fifty temporal arachnoid cysts in 50 treated patients were identified. The average age at the time of surgery was 68 +/- 57.2 months. The follow-up periods averaged 36 months. There were 34 male and 16 female patients in the series. Twenty-six cysts were on the left side. Indications for surgery included intractable headaches (45%), increasing cyst size (21%), seizures (25%), and hemiparesis (8%). The symptoms most likely to improve were hemiparesis (100%) and abducens nerve palsies. Headaches (67%) and seizure disorders (50%) were less likely to improve. Nine patients exhibited progressive increases in cyst size in serial imaging studies. Those patients were monitored for a mean of 40 +/- 23 months before intervention. In the entire series, 82% of patients demonstrated decreases in cyst size in serial imaging studies. Of those patients, 18% demonstrated complete cyst effacement. Overall, 83% of patients with Grade II cysts and 75% of patients with Grade III cysts exhibited evidence of decreases in cyst size in long-term monitoring. Two patients required shunting after craniotomy (4%). Hospital stays averaged 3.4 days. Total surgical times averaged 115 minutes. No significant blood loss occurred (5-50 ml). Complications included spontaneously resolving pseudomeningocele (10%), transient Cranial Nerve III palsy (6%), cerebrospinal fluid leak (6%), subdural hematoma (4%), and wound infection (2%). CONCLUSION: A microsurgical keyhole approach to arachnoid cyst fenestration is a safe effective method for treating middle fossa cysts. This procedure can be performed with minimal morbidity via a minicraniotomy. Compared with an endoscopic approach, better control of hemostasis can be obtained, because of the ability to use bipolar forceps and other standard instruments. The operative time and length of hospital stay were not excessively increased.     

成人多囊肝病28例诊治探讨

目的 研究探讨多囊肝病（ＡＰＬＤ）的临床特征和有效的治疗方法。方法 ２８例ＡＰＬＤ经开窗术，肝叶，段切除术，部分病例联合肾囊肿开窗术等外科治疗。结果 经纺前检查及手术证实２８例ＡＰＬＤ合并多囊肾病（ＰＫＤ）２４例，４例合并胰腺囊肿，合并脾脏和卵巢囊肿各２例。妇女均有生育史，最多达８次，结论 ＡＰＬＤ以弥漫性肝囊肿致肝脏损害为特点，经内科治疗无显效，外科手术治疗获得一定效果。