腹腔镜治疗肝包虫病术中关键技术探讨

目的探讨腹腔镜肝包虫内囊摘除术关键技术要点.方法对56例肝包虫病患者行腹腔镜肝包虫内囊摘除术,术中常规采用3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查.结果56例均获成功,无一例中转开腹,手术时间45～150 min,平均60 min,术中出血量10～120 ml,平均70 ml.无并发症.56例随访1～12年,平均2年6个月,无肝包虫复发.结论3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查处理技术的应用是手术成功的关键.

On key techniques of laparoscopic treatment for hepatic echinococcosis

Objective To discuss key techniques of laparoscopic resection of hydatid liver cysts. MethodsLaparoscopic resection of hydatid cysts was performed in 56 patients with hepatic echinococcosis.Under laparoscopic visualization,wicks with 3% dioxide hydrogen were routinely used for avoiding the contamination of the peritoneal cavity related with the spillage.A specially-designed puncture-aspiration cannula was employed to irrigate and evacuate all the contents of the cysts.Then the cysts were sterilized by the injection of 20% hypertonic saline solution.Afterwards,the residual cystic cavity was explored.Results The laparoscopic operation was successfully completed in all the 56 patients,without conversions to open surgery.The operation time was 45~150 min(mean,60 min).The intraoperative blood loss was 10~120 ml(mean,70 ml).No complications occurred.Follow-up observations for 1~12 years(mean,2 years and 6 months) in the 56 patients found no recurrence of hepatic echinococcosis.Conclusions Application of 3% dioxide hydrogen wicks for preventing the contamination,specially-designed puncture-aspiration cannula for irrigation,injection of 20% hypertonic saline solution for sterilization,and residual cystic cavity exploration are crucial to good surgical outcomes.