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Abstract：
Hydatid disease is endemic in certain geographical areas where animal breeding is common, frequently challenging the medical services in these regions. Hydatid cysts most often affect the liver, with damage to other organs accounting for around one-third of the total cases. The alternative to interventional or pharmacological approaches is surgical treatment, available in variants such as laparoscopy, laparoscopy with special instruments for hydatid disease, or open surgery. This article aims to analyze the outcomes of these three types of surgical approaches, considering preoperative indications, operative techniques and efficiency, and immediate and long-term postoperative results. A total of 149 patients from two different surgical units were analyzed over a period of seven years. It was observed that males were more affected by this pathology (53.02%), with the majority of patients coming from rural areas (62.42%). The distribution by surgical procedure type showed that 50.34% were operated on using open surgery, 33.56% by means of a laparoscopic approach with the usual instruments, and 16.11% by means of a laparoscopic approach with special instruments. The laparoscopic procedure with special instruments presented a lower rate of conversion to open surgery compared to the usual laparoscopic approach (p = 0.014). The analysis of the average operative duration revealed statistically significant differences between the three types of surgical techniques (p < 0.05), noting that interventions with specialized instruments had the shortest duration, while open surgery had the longest operative time (72.5 ± 27.23 min vs. 154 ± 52.04 min). In terms of intraoperative complications, they were documented in 8.34% of cases for the group operated on with special instruments, in 12.24% of cases for the standard laparoscopy group, and in 16% of cases for the open surgery group. Maximal cystectomy was the preferred method for resolving these cysts using minimally invasive surgery (p < 0.001), while Lagrot pericystectomy was preferred in the open approach (p < 0.001). The most frequent postoperative complication was biliary fistula (24.16%), encountered in varying percentages across each technique but without significant statistical difference (p > 0.05). Open surgery was associated with a longer length of hospitalization compared to minimally invasive procedures (p < 0.05), a higher number of late postoperative complications (p = 0.002), and a significantly higher number of recurrences (p < 0.001) compared to the other two techniques. The present study highlights the effectiveness of minimally invasive surgery for hydatid cysts as a safe alternative with fewer complications and superior results compared to open surgery. Additionally, it provides a comparative analysis of these surgical approaches (special instruments, standard laparoscopy, and open surgery) to hydatid disease for the first time. Under the circumstances where pharmacological treatment is recommended as a supportive measure before and after procedures, and using medication alone as the primary treatment option shows only modest efficacy, there is a necessity to consider invasive treatment methods. Percutaneous procedures represent the least invasive form of treatment, yielding results comparable to surgery in terms of efficacy. However, their effectiveness is influenced by factors such as the cyst\'s stage of development, its location, and the challenges in achieving complete intra-procedural isolation. Laparoscopy, particularly when using specialized instruments tailored to the tactical and technical demands of managing hydatid disease, serves to address the limitations of percutaneous methods. Open surgery\'s role is increasingly restricted, primarily serving as a fallback option in laparoscopic procedures or in cases complicated by hydatid disease. In conclusion, despite the rising popularity of percutaneous methods, surgery remains a viable therapeutic option for treating hydatid disease. Minimally invasive surgical interventions are increasingly versatile and yield comparable outcomes, further solidifying the role of surgery in its management.
摘要：
包虫病在某些动物繁殖普遍的地理区域流行，经常挑战这些地区的医疗服务。包虫囊肿最常影响肝脏，对其他器官的损害约占总病例的三分之一。介入或药理学方法的替代方法是手术治疗，可用于腹腔镜检查等变体，包虫病用特殊器械进行腹腔镜检查，或者开腹手术.本文旨在分析这三种手术方式的效果，考虑到术前适应症，手术技术和效率，以及术后的即时和长期结果。在7年的时间里，共分析了来自两个不同外科单元的149名患者。观察到男性受此病理影响更大（53.02％），大多数患者来自农村地区（62.42%）。按手术类型划分的分布显示，50.34%的患者采用开放手术，33.56％通过腹腔镜方法与通常的器械，通过使用特殊器械的腹腔镜方法，占16.11％。与通常的腹腔镜方法相比，使用特殊器械的腹腔镜手术的转化率较低（p=0.014）。对平均手术时间的分析显示，三种手术技术之间的差异具有统计学意义（p<0.05），注意到使用专门工具进行干预的持续时间最短，而开放手术的手术时间最长（72.5±27.23minvs.154±52.04分钟）。在术中并发症方面,在使用特殊仪器进行手术的组中，有8.34%的病例被记录下来，在12.24%的病例中，标准腹腔镜组，和16％的病例为开放手术组。最大膀胱切除术是使用微创手术解决这些囊肿的首选方法（p<0.001），而Lagrot包膜切除术在开放入路中更受欢迎(p<0.001)。术后最常见的并发症是胆瘘（24.16%），在每种技术中遇到不同的百分比，但没有显著的统计学差异(p>0.05)。与微创手术相比，开放手术的住院时间更长（p<0.05）。术后晚期并发症较多（p=0.002），与其他两种技术相比，复发次数明显更高（p<0.001）。本研究强调了微创手术治疗包虫囊肿的有效性，是一种安全的替代方法，与开放手术相比，并发症少，效果更好。此外,它提供了这些手术方法的比较分析(特殊器械，标准腹腔镜检查，和开放手术）首次针对包虫病。在建议在手术前后进行药物治疗作为支持措施的情况下，单独使用药物作为主要治疗选择仅显示出适度的疗效，有必要考虑侵入性治疗方法。经皮手术是侵入性最小的治疗形式，在疗效方面产生与手术相当的结果。然而,它们的有效性受到诸如囊肿的发育阶段等因素的影响，它的位置,以及实现完全程序内隔离的挑战。腹腔镜检查,特别是当使用针对包虫病管理的战术和技术需求而定制的专门仪器时，用于解决经皮方法的局限性。开放手术的作用日益受到限制,主要作为腹腔镜手术或包虫病并发病例的后备选择。总之,尽管经皮方法越来越受欢迎，手术仍然是治疗包虫病的可行治疗选择。微创手术干预越来越通用，并产生可比的结果，进一步巩固手术在其管理中的作用。
