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題名 | 非寄生蟲性肝囊腫外科治療之經驗 |
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作 者 | 李威震; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 25:5 民81.09-10 |
頁次 | 頁1325-1331 |
分類號 | 416.246 |
關鍵詞 | 非寄生蟲性肝囊腫; 外科治療; |
語文 | 中文(Chinese) |
中文摘要 | 長庚紀念醫院從1977年元月至1991年三月,共24位非寄生蟲性肝囊腫病患(男性5位,女性19位),接受26次的手術,包括開窗術11例,開窗術併肝切除5例,囊腫切除3例,外引流5例,及抽取2例。因手術引起併發症而死亡的有2例(7.7%),第一次手術後,先天性囊腫可追踪病例,復發率為16.7%。手術前的主要症狀為腹部腫塊(56%),腹部疼痛(52%),及腹部腫脹(32%)。手術前肝功能核查,除了10例(38.5%)鹼性磷酸酶輕微升高及33.3%病例白蛋白較低外,其餘大部分都正常。目前利用腹部超音波及腹部電腦斷層檢查,幾乎都可在手術前確定診斷。依我們的經驗,非寄生蟲性肝囊腫的治療原則為:(1)沒有症狀的囊腫,不需要特別治療。(2)有症狀的先天性囊腫,若囊腫內沒有受到感染,可以做開窗術,或開窗術併肝切除,若受到感染,則只做外引流。(3)若囊腫內含有膽汁,可以做開窗術,但必須配合功能良好的外引流。(4)若懷疑是腫瘤性肝囊腫,應該做愛腫切除。(5)若囊腫內為血液,似外傷性,但不能確定有明確的外傷病史,建議做囊腫切除。(6)倘若病患不適合手術,或因其他疾病,來日已不多,才考慮抽取以減輕症狀,否則不要做抽取。 |
英文摘要 | Non-parasitic liver cysts can be classified as congenital and acquired. Congenital cysts include simple cyst and polycystic cysts. Acquired cysts can be divided into traumatic, inflammatory, and neoplasma degenerative ones furtherly. Since January, 1977, to March, 1991, there were 24 patients with liver cystic diseases, including 9 simple cyst (88.9% female), 11 polycystic liver disease (81.8% female) and 4 acquired liver cyst ( 50% female), to receive 26 surgical procedures (11 fenestration, 5 fenestration with resection, 3 total excision, 5 external drainage, and 2 aspiration) at Chang Gung Memorial Hospital. The recurrent rate of congenital cysts was 16.7% and the mortality rate, related to operations, was 7.7%. Abdominal mass (56%), abdominal vague pain (52%) and abdominal distention were the most common clinical presentations. Liver function tests were almost within normal limits preoperatively except the mild elevation of alkaline-phosphatase in 38.5% of cases and hypoalbuminemia in 33.3% of cases. Abdominal ultrasonography and computed tomography of abdomen were the most valuable diagnostic studies. Our current principles of surgical procedures for non-parasitic liver cyst diseases are: (1)Surgical treatment is not necessary for non-symptomatic patients. (2) If there is purulent material within cysts, external drainage is the surgical procedure only. (3) If the cysts contain bile-stain fluid, fenestration can be performed with a good functional external drain. (4) Fenestration with or without resection is a simple and effective procedure, resulting in a good outcome, for congenital liver cysts. (5) Total excision is the most reliable procedure for acquired liver cystic disease. (6) Aspiration has 100% recurrent rate. But, it can be performed for high risk or life-span limited symptomatic patients. |
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