肝单房性包虫囊肿完整切除68例手术探讨

我院自 1995年 7月至 2 0 0 2年 1月行肝单房性包虫囊肿完整切除 6 8例 ,取得了较好的疗效 ,现报告如下。临床资料1.一般资料 :本组 6 8例中 ,男 4 3例 ,女 2 5例 ,年龄 16～ 5 2岁 ,平均 34岁 ;肝包虫囊肿位于肝右叶4 5例 ,位于肝左叶 2 3例 ;其中肝包虫囊肿切开内囊摘除术后复发 13例。2 .手术方式及结果 :手术均在气管插管全麻下进行 ,取右肋缘下斜切口或剑突下“人”字切口。充分游离肝周粘连和韧带 ,病变位于肝中叶周围者预置肝门阻断带 ,不行肝门阻断。经肝单房性包虫囊肿坚厚的外囊纤维层与正常肝组织薄膜间实施行肝包虫囊肿完整切除…     

脾包虫囊肿35例诊治报告

包虫囊肿病是西北地区常见病 ,最易发生在人体肝、肺部 ,发生在脾脏者少见。我院 1981年 2月至 2 0 0 1年 2月收治肝包虫囊肿 1893例 ,其中经手术治疗的脾包虫囊肿 35例 ,占 1 8%,现将诊治情况分析报告如下。临床资料1.一般资料 :本组中男 18例 ,女 17例。年龄 8～ 6 2岁 ,平均年龄 2 8岁。 35例均有与犬、羊密切接触史。 35例中单纯脾包虫囊肿 12例 ,占 34 3%。另 2 3例中 ,合并肝包虫 13例 ,合并肝、腹腔包虫 4例 ,合并肝、大网膜、腹腔、肠系膜包虫 2例 ,合并肝、肾、膀胱、大网膜包虫 1例 ,合并肝、盆腔、子宫、膀胱包虫 1例 ,合并肝…     

根治性肝包虫外囊剥除术27例报告

作者自2001年8月始实施肝包虫外囊剥除术共27例,均达到根治的效果,现报告如下。临床资料1.一般资料:本组27例中,男性11例,女性16例。年龄15~76岁,平均41岁。其中,15例为二次手术,4例为三次及以上手术。共计51个包虫囊肿,直径在2·5~22cm。其中6例病人10个囊肿分别突入左右胸腔。2.方法:以上病例均采用气管插管全麻,3例左肝外叶包虫囊肿(4个)取左侧肋缘下切口,3例左、右肝多发包虫囊肿(其中一例合并脾包虫)取上腹部“人”字形切口,其余均取上腹部正中切口并向右侧腰部之“L”型复合切口。于肝包虫外囊与肝实质交界处切开肝被膜,用电刀头仔细…     

肺包虫囊肿的诊治——附25例报告

我院自1986年5月至1999年6月共收住肺包虫囊肿25例,合并肝包虫6例。包虫囊肿破裂形成脓胸3例,脓气胸2例,均经开胸肺叶切除或囊肿摘除而治愈,作者体会:1.肺部发现囊肿,有疫区居住史,卡索尼试验阳性者应首先考虑包虫病;2.肺包虫合并膈下肝顶型肝包虫病例可一次开胸摘除肺、肝包虫囊肿;3.肺包虫囊肿破裂应立即开胸探查囊肿摘除,彻底清除坏死组织,用双氧水、盐水反复冲洗,无需行肺叶切除。     

应用腹腔镜治疗肝脏或腹腔包虫病54例临床分析

１９９２年５月至１９９７年１月我院经腹腔镜治疗肝脏或腹腔包虫５４例,报告如下。１．资料与方法：本组５４例,男３３例,女２１例,年龄１８～４５岁,诊断均经手术证实。单发肝包虫病４０例,多发９例（２个囊肿６例,３个囊肿３例）,单发肝包虫并单发腹腔包虫病５例;单子囊型３８例,多子囊型１６例,共摘除包虫囊肿７１个;位于右肝前叶３４例,右肝后叶前部３例,左肝外叶１２例,左右肝交界处５例;术中发现有胆漏９例,囊内感染坏死７例;腹腔或术区有明显粘连者８例。２．手术方法：采用ＳＴＯＲＺ腹腔镜及其配套设备。气管插…     

内囊搔刮术治疗巨大肝包虫囊肿五例

我院自1985年8月至1986年5月间,对难以做内囊摘除的巨大肝包虫囊肿5例,采用内囊搔刮术治疗,经8个月到1年6个月的随访,效果满意。现报道如下。临床资料本组5例均为巨大单发肝包虫囊肿。其中男2例,女3例。年龄26～60岁。病程(自发现右上腹肿     

学龄前儿童肝包虫病的诊断和治疗体会

肝包虫是由寄生在狗小肠内细粒棘球绦虫的虫卵被感染所致。小儿喜欢与狗玩耍的生活习惯致幼儿期受染。我院自 1978～ 2 0 0 0年对 93例学龄前儿童肝包虫外科手术治疗 ,现报告如下。1.临床资料 :本组 93例 ,男 65例 ,女 2 8例 ,男女之比为 2 3∶1,最小年龄2 5岁 ,最大年龄 6岁。腹部包块 83例 ,肝大 67例 ,破入胆道 4例 ,破入腹腔 3例 ,破入胸腔 1例 ,食欲不振 5 6例 ,黄疸 11例 ,压迫胆道 9例 ,压迫门脉 7例。Ｂ超 68例 ,ＣＴ 2 1例 ,确诊率10 0 %。Ｃａｓｏｎｉ实验 89例 ,阳性率64 %。合并腹腔包虫 9例 ,盆腔包虫 5例 ,脾包虫 3例。2 .…     

肝包虫囊肿胆道支气管瘘22例诊治体会

肝包虫囊肿破入胆道临床上并不少见。但肝包虫囊肿同时破入胆道和经右肺入支气管引起胆道支气管瘘较少见。我院自1985年1月至99年5月14年间共收治22例,总结如下1　临床资料1.1　一般资料本组22例,男14例,女8例,男女比为1.8∶1;年龄25～62岁,以43～55岁最多(87%),平均51岁。治愈19例,死亡3例,22例均有右上腹及右胸部胀痛、咳嗽,咯出淡黄色或胆汁样液体。16例咯出黄色粉皮样物,发冷发烧13例,梗阻性黄疸9例,休克6例,22例WBC计数均有升高,16例Hb轻度下降,肝功化验9例胆红质定量升高,13例转氨酶升高,5例白蛋白降低。B超检查:22例均在肝右叶顶部…     

腹腔镜治疗肝包虫病18例报道

病例资料肝包虫病通常采用手术治疗,但随着腔镜技术的发展,腹腔镜下肝包虫内囊摘除术逐步得到应用与开展。2008年6月至2011年2月期间,我院共对18例肝包虫病患者采用腹腔镜治疗,手术成功且疗效满意。其中男12例,女6例;年龄(38.2±3.6)岁(17～59岁)。18例患者均经手术确诊为肝包虫病,其中单发者12例,有2个囊肿者4例,有3个囊肿者1例,单发且并发单个腹腔包虫     

肝切除治疗单发多子囊肝包虫囊肿38例分析

我院自 1995年 7月至 1999年 12月行单发多子囊肝包虫囊肿肝切除 38例 ,取得了较好的效果。现报告如下。1　临床资料　　本组 38例 ,男性 2 2例 ,女性 16例。年龄 18～ 40岁 ,平均 2 9岁。肝包虫囊肿位于肝右叶 32例 ,位于肝左叶 6例。切除最大囊肿面积约 2 0ｃｍ× 14ｃｍ。　　手术方式 :本组均行手术切除。在常温下肝门间歇性阻断下 ,行肝局部切除 14例 ,各类肝段切除 18例 ,非规则性右半肝切除 1例 ,非规则性左半肝切除 2例 ,左外叶切除 3例。肝门血流阻断时间 :8～ 38ｍｉｎ ,平均 2 3ｍｉｎ ,其中阻断一次共 30例 ,最长阻断时间 2 8ｍ…     

Management of Retrohepatic Inferior Vena Cava Injury during Hepatectomy for Neoplasms

The aim of this article is to discuss the management of retrohepatic inferior vena cava injury during hepatectomy for neoplasms. Step-by-step hepatic vascular exclusion, digital compression, finger pinching, and surface-to-surface suturing were used in the management of retrohepatic inferior vena cava injury during hepatic resection in 16 cases: 12 patients underwent exclusion of the hepatic artery and portal vein by portal triad clamping (PTC) only; 3 underwent PTC and exclusion of the infrahepatic inferior vena cava (IVC); and 1 underwent PTC together with exclusion of the suprahepatic and infrahepatic IVC. In all cases, bleeding stopped immediately after the management described, with no intraoperative deaths and no postoperative bleeding. The median follow-up was 42.5 months (range 19–60 months) for all patients, and the 5-year survival rate of all patients with malignant tumors was 28.57%. One died of lung metastasis 19 months after operation, one with spontaneous rupture of a hepatocellular carcinoma 19 months after operation, and eight others from recurrence or metastasis 21, 23, 24, 27, 30, 35, 50, or 54 months after operation, respectively. Two patients had a recurrence 4 years and 4 years 6 months after the initial operation, respectively. The recurrent tumors of the liver were resected. The other patients are currently alive without recurrence or metastasis. The techniques described are safe, simple, practical, time-saving, and effective for controlling massive bleeding arising from injury to the retrohepatic inferior vena cava during hepatic resection.     

Replacement of the vena cava with aortic graft for living donor liver transplantation in budd-Chiari syndrome associated with hydatid cyst surgery: a case report

A 12-year-old girl, operated because of a hydatid cyst of the liver, with Budd-Chiari syndrome was evaluated for postoperative development of ascites and paraumbilical varicose veins. A vena caval stent was placed for the relief of inferior vena caval obstruction. The patient was admitted because of progressive deterioration in ascites and liver functions. Imaging techniques showed degeneration adjacent to the right hepatic vein in liver segments 7 to 8, a partially calcified 5-cm hydatid cyst, and a thrombosis in the inferior vena cava was that addressed with a 10-cm metal stent. A living donor segments 2 to 3 liver transplantation was obtained from the patient's mother. After completion of the donor operation without complications, the vena caval stent was removed following the recipient hepatectomy. Suprarenal flow continued after resection of the fibrotic vena cava and placement of a cadaveric cryopreserved aortic graft for the vena cava, anastomosed between the suprarenal and subdiaphragmatic segments of the vena cava. An end-to-side anastomosis was performed between the left hepatic vein of the donor liver and the aortic graft. There was no complication and the patient was discharged on postoperative day 19. Follow-up Doppler ultrasonography showed the aortic vena caval graft to be open, along with the hepatic/portal vein and hepatic artery. This case demonstrated that operations for liver hydatid cyst surgeries can iatrogenically induce Budd-Chiari syndrome; a cryopreserved aortic graft can be an alternative to ensure the continuity of the vena cava in living donor liver transplantation.     

Surgical Treatment of Liver Echinococcosis — the Role of Laparoscopy

Background: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.

Methods: A prospective study of 21 patients operated on in a 5-year period (1999–2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.

Results: There was no mortality after 5–65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.014.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).

Conclusion: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparo-scopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.     

肝包虫外膜内完整摘除术30例报告

目的：评价一种根治性治疗肝包虫病的新术式--肝包虫外膜内完整摘除术。方法：从1999年至今，对30例患者共45个肝包虫囊肿进行了“肝包虫外膜内完整摘除术”。结果：手术均获成功，未发生肝包虫外囊破裂囊液溢出，每个囊肿剥除平均失血量20ml，无手术死亡。21例患者获术后半年至2年随访，无复发、残腔形成及其他并症。结论：肝包虫外膜内完整摘除术具有并发症少、创伤小、操作简单、根治性治疗肝包虫病等优点。     

Banked depopulated vena caval homograft: a new strategy to restore caval continuity

This study reports one case of primary inferior vena cava (IVC) leiomyosarcoma. A 67-year-old woman was referred to the authors' clinic for evaluation. She presented complaining of epigastric and right upper abdominal quadrant pain. Contrast-enhanced abdominal computed tomography scan revealed a 5.2 × 6.4 cm heterogeneously enhancing mass involving the anteromedial aspect of the IVC, below the renal vein (segment I), deforming the duodenum. There was a partial intraluminal extension in the IVC. Laparotomic resection was performed, with total en bloc excision of the lower IVC tumor. The caval continuity was restored with concomitant interposition of a banked depopulated vena cava homograft. Histological findings showed leiomyosarcoma originating from IVC. The postoperative course was uneventful: Neither recurrence nor metastasis was evident at 4 years postsurgery.     

选择性肝血流阻断技术在肝肿瘤切除术中的应用

目的 探讨选择性肝静脉血流阻断术(SHVE)在复杂肝肿瘤切除术中的有效性和安全性.方法 在246例复杂肝肿瘤切除手术中采用选择性肝血流阻断技术,统计分析患者术前一般情况、术中情况、病理诊断、术后并发症等.结果 从2000年1月～2007年7月,在复杂肝肿瘤切除手术中246例肿瘤采用了选择性肝血流阻断技术.根据肝血流阻断方法的不同,完全SHVE(阻断第一肝门和所有主肝静脉,Total SHVE)145例,部分SHVE中阻断第一肝门和右肝静脉54例,阻断第一肝门和左中肝静脉47例.3例因术中发现瘤体侵犯下腔静脉壁而改为全肝血流阻断.结果 显示血流阻断过程中患者均保持血流动力学稳定,仅外周循环阻力和肺循环阻力轻度升高.术后患者无死亡发生,总并发症率为24.8%,平均住院天数为9.6 d.结论 选择性肝血流阻断技术是一种安全、有效的血流阻断技术,尤其适合用于位于第二肝门未侵犯下腔静脉的肿瘤切除.     

Extension incision for renal carcinoma including invaded vena cava and right lobe of liver.

We report on a thirty-five-year-old woman with renal cell carcinoma who successfully underwent right radical nephrectomy and extended right hepatic lobectomy with resection and reconstruction of inferior vena cava (IVC). A temporary bypass was placed between the infrarenal IVC and right atrium using a heparin-coated synthetic tube. The tumor was resected en bloc including right kidney, adrenal gland, hepatic lobe, and IVC. The IVC was reconstructed using an expanded polytetrafluoroethylene (EPTFE) graft. Her postoperative course was uneventful with no signs of recurrence four years after surgery.     

Surgical treatment for colorectal liver metastases involving the paracaval portion of the caudate lobe

BACKGROUND: Hepatic neoplasms in the paracaval portion of the caudate lobe (S1r) are usually difficult to treat surgically because such neoplasms often invade the hepatic veins and/or inferior vena cava (IVC). We reevaluated resected cases of colorectal liver metastases involving S1r to confirm the significance of aggressive surgical treatments. METHODS: Between July 1977 and December 2002, 95 consecutive patients with colorectal liver metastases underwent hepatic resection. Seven patients with liver metastases involving the S1r underwent resection. RESULTS: The surgical procedures for liver metastases comprised 3 isolated caudate lobectomies, 2 right hepatectomies, and 2 right hepatic trisectionectomies with caudate lobectomy. Combined resections included partial resection of the hepatic vein in 2 patients, wedge resection of the IVC in 3, and segmental resection of the IVC in 1. Six of the 7 patients with S1r metastasis had recurrent disease in liver and/or lung. A second hepatectomy was carried out in 4 patients and a partial lung resection in 2 patients. Four of the 7 patients survived more than 5 years, but 2 of them died of recurrent disease at 61 and 95 months after initial hepatectomy. The remaining 2 patients are alive 72 and 118 months without any sign of recurrence. The median survival time of the 7 patients was 60 months. CONCLUSION: Liver metastases involving the S1r could be resected radically with en bloc resection of the major hepatic veins and/or the inferior vena cava. An aggressive surgical approach with combined resection of the adjacent major vessels may offer a better chance of long-term survival in selected patients with caudate lobe metastasis from colorectal cancer.     

The use of hypothermia and circulatory arrest to control intraoperative bleeding from the inferior vena cava

Bleeding from the suprahepatic inferior vena cava (IVC) was encountered in a patient undergoing repeat liver resection for the fourth time due to a recurrence of colorectal liver metastases. Bleeding was observed from an IVC tear above the liver and it was not possible to control it with traditional clamping procedures including total vascular exclusion (a suprahepatic clamp). Hypothermia, cardioplegia, and circulatory arrest were all required to control the bleeding. The inferior vena cava was reconstructed with a pericardial patch. The patient recovered well and was discharged on the 14th postoperative day.     

Anesthetic management of a hydatid cyst adhering to the inferior vena cava

A patient with a hepatic hydatid cyst with fistula formation to inferior vena cava is reported. To carry out the resection, the cyst was isolated from systemic circulation by means of cardiopulmonary bypass. Inferior vena cava was cannulated through the right atrium until the implantation area of the cyst (above the hepatic veins) was surpassed. Bypass was carried out in 25 minutes by means of cannulation of the ascending aorta, without clamping the aorta, myocardial protection or hypothermia. Postoperative analgesia was achieved with a lumbar epidural catheter. Measures to prevent anaphylactic shock are recommended, an anesthetic technique based on the prevention of hypersensitivity reactions and a careful surgical technique to prevent hydatid dissemination.