腹腔镜开窗引流术与超声引导下穿刺硬化术治疗肝囊肿患者疗效研究*

doi:10.3969/j.issn.1672-5069.2022.03.035

摘要/Abstract

摘要： 目的比较观察采用腹腔镜开窗引流术与超声引导下穿刺硬化术治疗肝囊肿患者的疗效及对外周血心肌酶谱和血小板参数的影响。方法 2016年1月～2020年12月我院诊治的65例肝囊肿患者,其中31例接受腹腔镜开窗引流治疗,另34例采取超声引导下穿刺硬化治疗。常规检测血清肌酸磷酸激酶(CK)、肌激酶同工酶(CK-MB)和乳酸脱氢酶(LDH),使用全自动血球计数仪检测外周血血小板计数(PLT)、血小板压积(PCT)、血小板分布体积(PDW)和平均血小板体积(MPV)。结果术后3 d,两组血清心肌酶谱水平均显著升高,腹腔镜开窗引流组血清CK、CK-MB和LDH水平分别为(187.4±24.1)U/L、(25.8±8.3)U/L和(189.2±35.3)U/L,与超声引导穿刺硬化治疗组【分别为(188.1±27.2)U/L、(26.9±7.4)U/L和(188.3±33.5)U/L】比,无显著性差异(P>0.05);腹腔镜开窗引流组外周血PLT、PCT、PDW和MPV分别为(239.5±24.1)×10⁹/L、(0.1±0.1)%、(16.2±2.3)%和(10.5±3.6)fl,与超声引导下穿刺硬化治疗组【分别为(242.1±26.3)×10⁹/L、(0.1±0.1)%、(17.2±2.6)%和(9.8±3.1)fl】比,差异无统计学意义(P>0.05);超声引导下穿刺硬化治疗组发热、腹痛腹胀和呕吐发生率分别为8.8%、14.7%和20.6%,均显著低于腹腔镜开窗引流治疗组(分别为29.0%、41.9%和48.4%,P<0.05);在治疗后3个月,腹腔镜开窗引流术治疗组肝囊肿复发率为3.2%,显著低于超声引导下穿刺硬化术治疗组的20.6%(P<0.05)。结论采用腹腔镜开窗引流术或超声引导下穿刺硬化术治疗肝囊肿患者疗效相当,但前者治疗囊肿复发率低,后者简单易行,术后并发症发生率低。临床可根据当地医疗条件选择合适的治疗方法。

关键词: 肝囊肿, 腹腔镜开窗引流术, 超声引导下穿刺硬化术, 心肌酶谱, 疗效

Abstract: Objective The aim of this study was to compare the relapse of hepatic cysts (HC) after laparoscopic fenestration drainage (LFD) or ultrasound-guided puncture sclerotherapy (US-GPS) therapy in patients with HC, and the impact on serum myocardial enzymes and platelet parameters. Methods A total of 65 patients with HC were encountered in our hospital between January 2016 and December 2020, and 31 patients received LFD and 34 patients received US-GPS therapy. All patients were followed-up for three months. Serum creatine phosphokinase (CK), myokinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH)] were assayed, and peripheral blood platelet counts (PLT), thrombocytocrit (PCT), platelet distribution width (PDW) and mean platelet volume (MPV) were detected routinely. Results Three days after operation, serum myocardial enzymes increased compared to those at presentation, and there were no significant differences respect to serum CK, CK-MB and LDH levels [(187.4±24.1)U/L, (25.8±8.3)U/L and (189.2±35.3)U/L vs. (188.1±27.2)U/L, (26.9±7.4)U/L and (188.3±33.5)U/L] between patients with LFD- and with US-GPS-treated groups (P>0.05); the peripheral blood PLT, PCT, PDW and MPV in LFD-treated patients were (239.5±24.1)×10⁹/L, (0.1±0.1)%, (16.2±2.3)% and (10.5±3.6)fl, not significantly different compared to [(242.1±26.3)×10⁹/L, (0.1±0.1)%, (17.2±2.6)% and (9.8±3.1)fl] in US-GPS-treated patients (P>0.05); the incidences of fever, abdominal pain and distension, and vomiting in US-GPS-treated patients were 8.8%, 14.7% and 20.6%, all significantly lower than 29.0%, 41.9% and 48.4% (P<0.05) in LFD-treated patients; at the end of three month post-treatment, the relapse of HC in LFD-treated patients was 3.2%, significantly lower than 20.6%(P<0.05) in US-GPS-treated patients. Conclusion The efficacy of laparoscopic fenestration drainage is equivalent to that by ultrasound-guided puncture sclerotherapy in the treatment of patients with HC, with low recurrence of HC by the former, while with low complications by the latter, and the clinicians might make the decision appropriately.

Key words: Hepatic cyst, Laparoscopic fenestration drainage, Ultrasound-guided puncture sclerotherapy, Myocardial enzymes, Efficacy

李文强, 程春霞, 徐冬梅. 腹腔镜开窗引流术与超声引导下穿刺硬化术治疗肝囊肿患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(3): 443-446.

Li Wenqiang, Cheng Chunxia, Xu Dongmei. Relapse of hepatic cysts after laparoscopic fenestration drainage or ultrasound-guided puncture sclerotherapy therapy: a three-month followed-up[J]. Journal of Practical Hepatology, 2022, 25(3): 443-446.

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腹腔镜开窗引流术与超声引导下穿刺硬化术治疗肝囊肿患者疗效研究^*

Relapse of hepatic cysts after laparoscopic fenestration drainage or ultrasound-guided puncture sclerotherapy therapy: a three-month followed-up

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