Clinical efficacy of three-dimensional laparoscopic surgery in treatment of hepatic cystic echinococcosis.

Abstract

Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic surgery in treatment of hepatic cystic echinococcosis. Methods The retrospective cross-sectional study was conducted. The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People′s Hospital from March 2016 to July 2017 were collected. All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis. The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery. Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis+ residual cavity treatment, external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions. Observation indicators: (1) intraoperative situations: operation completion, surgical procedures, operation time, volume of intraoperative blood loss and blood transfusion; (2) postoperative recovery situations: time to initial anal exsufflation, time for initial fluid diet intake, time for out-of-bed activity, time of indwelling drainage-tube, wound healing, postoperative complications and duration of postoperative hospital stay; (3) follow-up: number of patients with follow-up, follow-up time, oral anti-echinococcosis medical therapy during follow-up, hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms, oral anti-echinococcosis medicine, hepatic echinococcosis recurrence and metastasis up to September 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Intraoperative situations: all the 40 patients underwent successful laparoscopic surgery, including 17 undergoing excision of internal capsule in hepatic echinococcosis+ residual cavity treatment, 15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy. Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision. Operation time and volume of intraoperative blood loss of 40 patients were respectively (100±28)minutes and (86±24)mL, without intraoperative blood transfusion. (2) Postoperative recovery situations: time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were (2.4±1.8)hours and (1.7±0.9)days. Forty patients had out-of-bed activity on the day of surgery. Of 40 patients, abdominal drainage-tubes of 39 were placed for 2-3 days; abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed. Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and (10.5±2.1)days. During hospitalization, 39 patients didn′t have bleeding, bile leakage, anaphylactic shock, intestinal adhesion and obstruction; 1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively. (3) Follow-up: all patients were followed up for 2-15 months, with a median time of 9 months. During the follow-up, 40 patients were not complicated with discomforts and received oral anti-echinococcosis medical therapy, without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis. Conclusion The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis, and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis, with good short-term outcomes. Key words: Echinococcosis, hepatic; Hepatic cystic echinococcosis; Minimally invasive surgery; Laparoscopy; Three-dimensional technology