PDF(Pubmed)
Abstract：
Background and objective While hydatid disease is associated with a high prevalence only in certain endemic areas, it can be encountered in any geographical region. The characteristics of this parasitic disease, and its implications during development, such as the risk of seeding, and the complications caused by cyst rupture, means that its therapeutic management should adhere to strict principles and may sometimes require approaches specially tailed for this type of pathology. In this study, we aimed to provide a comparative analysis of conventional laparoscopic techniques vs. treatment with specialized instrumentation in these patients. Methods Our study involved a retrospective evaluation of a cohort comprising 41 patients diagnosed with hepatic hydatid cysts, who underwent procedures with both conventional laparoscopic techniques and specialized instrumentation tailored for this particular pathology. Furthermore, we conducted a comprehensive review of the literature examining alternative types of laparoscopic instrumentation specifically crafted for the management of hydatid cysts. This review employed an extensive search utilizing PubMed and Google Scholar databases. Results The examination of cases within our study revealed a high prevalence of hydatid disease among male patients (63.41%) and a predominance of instances originating from rural regions necessitating emergent admissions (p<0.05). Notably, in 58.54% of cases, surgical interventions employed specialized instrumentation, with a notable discrepancy in conversion rates to open surgery favoring the standard approach: 12.2% vs. 2.44% (p=0.025). Additionally, the laparoscopic approach was associated with prolonged surgical durations compared to the dedicated technique (p=0.002), besides a higher incidence of postoperative complications (12.2% vs 7.32%). Furthermore, patients undergoing laparoscopic procedures with standard instrumentation experienced lengthier hospital stays (p=0.002). Our comprehensive review of the literature identified six distinct surgical methodologies utilizing specifically tailored instrumentation for addressing hydatid cysts. Analysis of these findings underscored a preference for single localizations and selective cases. Postoperative complication rates ranged from 6.66% to 22.22%, with conversion rates to open surgery reaching up to 23.33%, and recurrence rates observed to be as high as 7.81%. Conclusions The patented approach, which uses special trocars that provide stable anchorage and allow a safe puncture-aspiration, reaspiration, and fragmentation processes, has superior characteristics compared to the laparoscopic approach with standard instrumentation. Comparative analysis with other similar procedures described in the literature has shown similar results regarding the frequency of complications, with our technique being superior in terms of approaching multiple cysts and recurrence rate. It has been successfully applied even in unselected cases.
摘要：
背景和目的虽然包虫病仅在某些流行地区与高患病率相关，它可以在任何地理区域遇到。这种寄生虫病的特点,以及它在发展过程中的影响，例如播种的风险，以及囊肿破裂引起的并发症，意味着其治疗管理应遵守严格的原则，有时可能需要专门针对此类病理的方法。在这项研究中,我们旨在提供常规腹腔镜技术与在这些患者中使用专门的仪器进行治疗。方法我们的研究涉及对一个队列的回顾性评估，该队列包括41例诊断为肝包虫囊肿的患者，他们接受了常规腹腔镜技术和针对这种特殊病理量身定制的专门仪器的手术。此外，我们对文献进行了全面回顾，研究了专门用于治疗包虫囊肿的腹腔镜器械的替代类型。这篇评论利用PubMed和GoogleScholar数据库进行了广泛的搜索。结果我们研究中的病例检查显示，男性患者中包虫病的患病率很高（63.41％），并且主要来自农村地区的病例需要紧急入院（p<0.05）。值得注意的是,在58.54%的病例中，采用专门仪器的外科手术，有利于标准方法的开放手术转化率存在显著差异：12.2%与2.44%(p=0.025)。此外,与专用技术相比，腹腔镜方法与延长的手术持续时间相关（p=0.002），术后并发症发生率较高(12.2%vs7.32%)。此外，接受标准器械腹腔镜手术的患者住院时间延长(p=0.002).我们对文献的全面回顾确定了六种不同的手术方法，利用专门定制的器械解决包虫囊肿。对这些发现的分析强调了对单一本地化和选择性病例的偏好。术后并发症发生率为6.66%～22.22%,开放手术的转化率高达23.33%，复发率高达7.81％。结论专利方法，它使用特殊的套管针，提供稳定的锚固并允许安全的穿刺抽吸，再呼吸,和碎片化进程，与标准器械的腹腔镜方法相比，具有优越的特点。与文献中描述的其他类似程序的比较分析显示，关于并发症发生频率的类似结果。我们的技术在接近多个囊肿和复发率方面更优越。即使在未选定的情况下，它也已成功应用。
