肝泡型棘球蚴病是由多房棘球绦虫幼虫寄生于宿主体内所引起的一种慢性人兽共患寄生虫病.根治性手术切除是肝泡型棘球蚴病首选的治疗方法.近年来,随着一些微创外科治疗方法在外科系统各领域的普及,微创外科技术逐渐开始应用于肝泡型棘球蚴病的临床治疗.本文就肝泡型棘球蚴病的微创外科治疗现状及进展进行综述.

ObjectiveTo investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. MethodsSurgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People’s Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. ResultsAll 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (1818%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

目的 探讨急性结石性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的危险因素.方法 通过青海省人民医院医院管理信息系统(hospital management information system,HIS)收集青海省人民医院普外科2018年1月至2019年12月急性结石性胆囊炎行LC患者的临床资料,探讨LC中转开腹的独立危险因素,行单因素分析和二元多因素Logistic回归分析影响因素.结果 共收集156例急性结石性胆囊炎患者基本资料及临床资料,其中完全行LC者共120例,由腹腔镜中转开腹手术胆囊切除术有36例,纳入研究影响因素中性别(χ2=0.414,P=0.520)、年龄(χ2=0.309,P=0.578),体质指数(χ2=0.001,P=0.977)、高血压病(χ2=1.256,P=0.262)差异均无显著性;胆囊壁厚度(χ2=15.230,P<0.001)、胆囊炎急性发作时间(χ2=6.984,P=0.008)、白细胞计数(Z=-2.533,P=0.011)、总胆红素水平(Z=-2.311,P=0.021)和纤维蛋白原(Z=-2.490,P=0.013)差异均有显著性.行二元多因素Logistic回归结果表明,胆囊壁厚度≥5mm、胆囊炎急性发作时间≥72h是急性结石性胆囊炎LC术中转开腹的独立危险因素.结论 LC术前准确把握手术适应证,术中规范、细致的操作可有效降低LC中转开腹率,而当患者术前超声提示胆囊壁显著增厚或胆囊炎急性发作时间较长应提前做好中转开腹的准备,以降低手术时间.