单纯性肝囊肿的临床特点及手术疗效分析

发布时间：2018-01-21 10:42

本文关键词： 单纯性肝囊肿临床特点 CA19-9 腹腔镜肝囊肿开窗引流术　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:随影像学检查技术的提高以及人民群众查体意识的增强,单纯性肝囊肿的检出率呈逐年升高态势,在这部分患者中,有意向或已经接受外科手术治疗的比例也是呈逐年升高趋势,在为这些患者行常规检查时,我们发现部分患者血液中以及囊肿囊液中肿瘤标志物糖链抗原199(CA19-9)较正常范围(0-37u/L)升高。CA19-9升高与肝囊肿大小、数目及恶变的相关性目前尚不明确,值得进一步研究。目的:研究单纯性肝囊肿流行病学特点,及其手术治疗方式和效果,并研究肿瘤标志物CA19-9在肝囊肿血液、囊液中的表达特点及意义。方法:回顾性分析2009年1月至2017年1月期间于我院普外科住院并行手术治疗的190例病人的临床病例资料。该组病人共有男性病人69例,平均年龄58.38±10.80,女性病人121例,平均年龄58.86±11.38;有症状者91例(47.9%),分别是腹胀者49例,腹痛者32例,黄疸伴纳差者2例,恶心、呕吐者2例,发热者3例,腰背部疼痛者2例,腹部肿块者1例;合并其他肝胆疾病(如胆囊结石、胆囊息肉、肝血管瘤、慢性乙型病毒性肝炎等)者共34例(20.0%)单发肝囊肿167例(87.9%),其中4例位于肝尾状叶,94例位于右肝,69例位于左肝。肝多发囊肿为23例(12.1%),均累及全肝。结果:男性患者出现症状者26例(37.68%),女性患者出现症状者65例(53.72%),二者差异具有统计学意义(P=0.033);24例(12.63%)病人血液中CA19-9的值升高,并与患者年龄、囊肿大小、囊液量相关(P0.05);43例(95.56%)病人囊液中CA19-9的值升高,但与患者年龄、囊肿大小、囊液量均不存在相关性(P0.05);单发肝囊肿与多发肝囊肿患者血液及囊液中CA19-9水平并无统计学差异(P0.05)。SHC患者囊肿大小与患者其年龄密切相关(P=0.032);11例病人接受开腹肝部分切除术,平均手术时间为110.91±8.89min,术后平均住院日为7.55±1.30天;171例病人接受腹腔镜肝囊肿开窗引流术,平均手术时间为41.14±5.43min,术后平均住院日3.40±0.97天,其中8例(4.47%)中转开腹,二者平均手术时间以及平均住院日的差异具有显著统计学意义(P0.01);190例病人均获得随访,出院90天复查,开腹组均未发现复发,复发率0,腹腔镜组有10例(5.59%)出现影像学复发,1例(0.56%)出现原症状,二者的复发率的差异不具有统计学意义(P=0.403)。190例患者术后病理结果均为良性,血液及囊液中CA19-9的数值与病变的良恶性无相关性(P0.05)。结论:SHC好发于40岁以上人群,尤其是女性更为多见,且女性患者比男性患者更容易出现临床症状;血液中CA19-9的数值与患者年龄、囊肿大小、及囊液量呈正相关,囊液中CA19-9的数值则与上述各因素均无相关关系。血液或囊液中CA19-9水平与囊肿数目及无关,亦不能提示囊肿有恶变可能;腹腔镜肝囊肿开窗引流术操作简便、创伤较小、复发率较低,应做为单纯性肝囊肿外科治疗的首选方案。
[Abstract]:Background: with the improvement of imaging techniques and the enhancement of people's awareness of physical examination, the detection rate of simple hepatic cyst is increasing year by year, in this part of patients. The proportion of patients who intend or have received surgical treatment is also increasing year by year, when routine examinations are performed for these patients. We found that the tumor marker CA19-9 in the blood and cysts of some patients was higher than that in normal range (0-37u / L) .CA19-9 and the size of hepatic cysts. At present, the correlation between the number and malignant change is not clear, which is worthy of further study. Objective: to study the epidemiological characteristics of simple hepatic cysts, and the surgical treatment methods and results. And to study the tumor marker CA19-9 in the blood of hepatic cyst. Characteristics and significance of expression in cystic fluid. Methods:. The clinical data of 190 patients who were hospitalized and operated in general surgery from January 2009 to January 2017 in our hospital were analyzed retrospectively. There were 69 male patients in this group. The mean age was 58.38 卤10.80, and the average age was 58.86 卤11.38 in 121 female patients. There were 91 cases with symptoms, 49 cases with abdominal distension, 32 cases with abdominal pain, 2 cases with jaundice and anorexia, 2 cases with nausea and vomiting, 3 cases with fever and 2 cases with pain in the lower back. Abdominal mass in 1 case; Other liver and bile diseases (such as gallstone, polyp of gallbladder, hepatic hemangioma, chronic viral hepatitis B, etc.) included 34 cases with liver cyst, 167 cases with single hepatic cyst (87.9%). Four cases were located in caudate lobar of liver, 94 cases were located in right liver, 69 cases were located in left liver, 23 cases had multiple cysts in liver. Results: 26 cases of male patients had symptoms and 37.68% of them had symptoms, and 65 cases of female patients had symptoms (53.72%). The difference between them was statistically significant. The value of CA19-9 in the blood of 24 patients was increased, and it was related to the age, the size of cyst and the quantity of cystic fluid (P0.05). The value of CA19-9 in the cystic fluid of 43 patients was increased, but there was no correlation between CA19-9 and age, cysts size and cystic fluid volume (P 0.05). There was no significant difference in CA19-9 levels in blood and cysts between patients with single hepatic cyst and multiple hepatic cysts. The size of cysts in patients with single hepatic cysts and multiple hepatic cysts was closely related to their age. ; The average operative time was 110.91 卤8.89 min and the average hospitalization time was 7.55 卤1.30 days. 171 patients were treated with laparoscopic fenestration and drainage, the average operative time was 41.14 卤5.43 min, and the average hospital stay was 3.40 卤0.97 days. Among them, 8 cases (4.47%) were transferred to open operation. The average operation time and the average length of stay were significantly different between the two groups (P 0.01). All the 190 patients were followed up and re-examined 90 days after discharge. No recurrence was found in the open group and the recurrence rate was 0. In the laparoscopy group, 10 cases (5.59%) recurred in imaging. There was no significant difference in the recurrence rate between the two groups. There was no significant difference in the recurrence rate between the two groups. The postoperative pathological results were benign in all the 190 patients. There was no correlation between the value of CA19-9 in blood and cystic fluid and the benign and malignant lesions (P 0.05). Conclusion: CA19-9 is more common in people over 40 years old, especially in women. Female patients were more prone to clinical symptoms than male patients. The value of CA19-9 in blood was positively correlated with the patient's age, cyst size, and volume of cystic fluid. The value of CA19-9 in cystic fluid had no correlation with the above factors. The level of CA19-9 in blood or sac fluid was not related to the number and number of cysts, nor could it indicate the possibility of malignancy of cysts. Laparoscopic fenestration and drainage of hepatic cyst is simple, less trauma and lower recurrence rate. It should be the first choice for surgical treatment of simple hepatic cyst.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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