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目的探讨有并发症的非寄生虫性肝囊肿的诊治。方法回顾性分析2002年1月—2007年11月收治的21例有并发症的非寄生虫性肝囊肿的诊治经验。结果男5例,女16例;年龄25～83岁。7例为单发囊肿,囊肿直径8～30cm;14例为多发囊肿,最大的单个囊肿直径为7～21cm。合并胆囊结石2例,合并胆总管结石、肝内胆管结石2例,合并多囊肾7例。曾行囊肿穿刺治疗12例,囊肿切开引流2例,肝囊肿开窗术后复发4例。并发感染14例,并发胆瘘11例,并发陈旧性出血9例,囊肿破裂并弥漫性腹膜炎2例;囊肿压迫致黄疸4例,下肢水肿1例。单发肝囊肿行左半肝切除联合胆囊切除术1例,囊肿切除2例,囊肿开窗4例;多发肝囊肿行肝部分切除术联合肝囊肿开窗3例,多发肝囊肿开窗11例。并行关闭胆瘘8例,胆总管探查4例;12例残留囊壁黏膜以氩气刀烧灼破坏。术后无手术并发症。21例恢复良好。结论有并发症的非寄生虫性肝囊肿可行肝囊肿开窗术,如有胆瘘,应予关闭;足够大的开窗面积、残留囊壁分泌功能的破坏是防止复发的关键。氩气刀处理残留囊壁安全、高效。巨大肝囊肿穿刺治疗应慎重。术前B超检查有助于诊断囊肿合并感染。
Objective To investigate the diagnosis and treatment of non-parasitic hepatic cysts with complications. Methods The diagnosis and treatment of 21 non-parasitic hepatic cysts with complications were retrospectively analyzed from January 2002 to November 2007. Results of 5 males and 16 females; aged 25 to 83 years. 7 cases of single cyst, the cyst diameter of 8 ~ 30cm; 14 cases of multiple cysts, the largest single cyst diameter of 7 ~ 21cm. 2 cases of gallbladder stones combined with common bile duct stones, intrahepatic bile duct stones in 2 cases, 7 cases of polycystic kidney disease. There were 12 cases of cyst puncture, cyst incision and drainage in 2 cases, hepatic cyst recurrence after fenestration in 4 cases. Complication of infection in 14 cases, complicated by biliary fistula in 11 cases, 9 cases of old bleeding, ruptured cysts and diffuse peritonitis in 2 cases; 4 cases of cyst compression caused jaundice, lower extremity edema in 1 case. One case of single hepatic cyst with left hepatectomy combined with cholecystectomy in 1 case, cyst excision in 2 cases, cyst fenestration in 4 cases; multiple hepatic cyst partial hepatectomy combined with hepatic cyst fenestration in 3 cases, multiple hepatic cysts open in 11 cases . 8 cases of biliary fistula were closed in parallel, 4 cases of common bile duct exploration, and 12 cases of residual wall mucosa were destroyed by argon knife burn. No postoperative complications. 21 cases recovered well. Conclusion Complications of non-parasitic hepatic cyst fecal hepatic cyst fenestration, if biliary fistula, should be closed; large enough window area, residual cystic wall secretion is the key to preventing recurrence. Argon gas treatment residual wall safe and efficient. Huge liver cyst puncture should be careful. B-ultrasound preoperative diagnosis of cyst infection.