- 期刊
Laparoscopic Fenestration for Giant Liver Cyst
腹腔鏡開窗術以治療巨大肝囊腫
摘要
使用腹腔鏡開窗術以治療肝臟囊腫是較少報告，而且也是近年來治療方法上之進步，本科以此方法治療四位病例（一男三女），方法與腹腔鏡取膽囊術相似，只是在切除肝囊壁時，須先穿針入囊中吸出水液以防開窗術大量囊液流出而不利手術視野。一般肝囊壁是平滑微透明，其內面囊壁亦同，切除是須在腹腔鏡直視之下切除外露之囊壁，切除線須經止血完整後放置引流管。以這種方法有三例可以可以順利手術後第三天出院，但有一例因多發性囊腫而在多次開窗術中傷及左肝管分枝而發生膽汁從引流管流出，因此再開腹切除左肝葉第三及第四分葉之前部份之肝囊腫，術後一週後才順利出院。本法適應性為i）單一巨大為佳，ii ) 肝囊壁有一部份外露於肝表面，iii）囊腫與膽管系沒有交通。經此有限的經驗我們認為以腹腔鏡開窗術來治療肝臟巨大囊腫是一種簡單且有效的方法。
關鍵字
無資料並列摘要
Laparoscopic fenestration for treatment of the non-parasitic cyst of the liver has been rarely reported, but sporadic cases appeared elsewhere in the literature. Here we report four cases with symptomatic giant nonparasitic liver cysts which were treated by a laparoscopic fenestration procedure that allowed the successful removal of the cyst dome. Before starting to excise -the wall of the cyst, laparoscopic-qulded needle aspiration of the cyst fluid was done first in order to clean the visual field for laparoscopic intervention where possible. The cyst wall was usually slighty transparent and somewhat smooth in the external and internal surface of the cysts. It was necessary to lysis the omental adhesion sometime before starting to remove the dome of the cyst. The cyst wall of the exposed part could be removed first with heat-probe Instrument through laparoscopy. Those patients were discharged and revealed an uneventlul postoperative course in three cases but in one case we had to convert to the traditional laparostomy to perform resection of the multiple cystic lesions. Post-operative echo- graphic study showed that the giant cyst had collapsed. Therefore, we believe laparoscopic fenestration for the liver cyst is simple and effective, If the patient is a candidate who requires operation to remove the dome of the giant cyst.