本文關(guān)鍵詞： 單純性肝囊腫 臨床特點(diǎn) CA19-9 腹腔鏡肝囊腫開窗引流術(shù)　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:隨影像學(xué)檢查技術(shù)的提高以及人民群眾查體意識(shí)的增強(qiáng),單純性肝囊腫的檢出率呈逐年升高態(tài)勢,在這部分患者中,有意向或已經(jīng)接受外科手術(shù)治療的比例也是呈逐年升高趨勢,在為這些患者行常規(guī)檢查時(shí),我們發(fā)現(xiàn)部分患者血液中以及囊腫囊液中腫瘤標(biāo)志物糖鏈抗原199(CA19-9)較正常范圍(0-37u/L)升高。CA19-9升高與肝囊腫大小、數(shù)目及惡變的相關(guān)性目前尚不明確,值得進(jìn)一步研究。目的:研究單純性肝囊腫流行病學(xué)特點(diǎn),及其手術(shù)治療方式和效果,并研究腫瘤標(biāo)志物CA19-9在肝囊腫血液、囊液中的表達(dá)特點(diǎn)及意義。方法:回顧性分析2009年1月至2017年1月期間于我院普外科住院并行手術(shù)治療的190例病人的臨床病例資料。該組病人共有男性病人69例,平均年齡58.38±10.80,女性病人121例,平均年齡58.86±11.38;有癥狀者91例(47.9%),分別是腹脹者49例,腹痛者32例,黃疸伴納差者2例,惡心、嘔吐者2例,發(fā)熱者3例,腰背部疼痛者2例,腹部腫塊者1例;合并其他肝膽疾病(如膽囊結(jié)石、膽囊息肉、肝血管瘤、慢性乙型病毒性肝炎等)者共34例(20.0%)單發(fā)肝囊腫167例(87.9%),其中4例位于肝尾狀葉,94例位于右肝,69例位于左肝。肝多發(fā)囊腫為23例(12.1%),均累及全肝。結(jié)果:男性患者出現(xiàn)癥狀者26例(37.68%),女性患者出現(xiàn)癥狀者65例(53.72%),二者差異具有統(tǒng)計(jì)學(xué)意義(P=0.033);24例(12.63%)病人血液中CA19-9的值升高,并與患者年齡、囊腫大小、囊液量相關(guān)(P0.05);43例(95.56%)病人囊液中CA19-9的值升高,但與患者年齡、囊腫大小、囊液量均不存在相關(guān)性(P0.05);單發(fā)肝囊腫與多發(fā)肝囊腫患者血液及囊液中CA19-9水平并無統(tǒng)計(jì)學(xué)差異(P0.05)。SHC患者囊腫大小與患者其年齡密切相關(guān)(P=0.032);11例病人接受開腹肝部分切除術(shù),平均手術(shù)時(shí)間為110.91±8.89min,術(shù)后平均住院日為7.55±1.30天;171例病人接受腹腔鏡肝囊腫開窗引流術(shù),平均手術(shù)時(shí)間為41.14±5.43min,術(shù)后平均住院日3.40±0.97天,其中8例(4.47%)中轉(zhuǎn)開腹,二者平均手術(shù)時(shí)間以及平均住院日的差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01);190例病人均獲得隨訪,出院90天復(fù)查,開腹組均未發(fā)現(xiàn)復(fù)發(fā),復(fù)發(fā)率0,腹腔鏡組有10例(5.59%)出現(xiàn)影像學(xué)復(fù)發(fā),1例(0.56%)出現(xiàn)原癥狀,二者的復(fù)發(fā)率的差異不具有統(tǒng)計(jì)學(xué)意義(P=0.403)。190例患者術(shù)后病理結(jié)果均為良性,血液及囊液中CA19-9的數(shù)值與病變的良惡性無相關(guān)性(P0.05)。結(jié)論:SHC好發(fā)于40歲以上人群,尤其是女性更為多見,且女性患者比男性患者更容易出現(xiàn)臨床癥狀;血液中CA19-9的數(shù)值與患者年齡、囊腫大小、及囊液量呈正相關(guān),囊液中CA19-9的數(shù)值則與上述各因素均無相關(guān)關(guān)系。血液或囊液中CA19-9水平與囊腫數(shù)目及無關(guān),亦不能提示囊腫有惡變可能;腹腔鏡肝囊腫開窗引流術(shù)操作簡便、創(chuàng)傷較小、復(fù)發(fā)率較低,應(yīng)做為單純性肝囊腫外科治療的首選方案。
[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 鹵10.80, and the average age was 58.86 鹵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 鹵8.89 min and the average hospitalization time was 7.55 鹵1.30 days. 171 patients were treated with laparoscopic fenestration and drainage, the average operative time was 41.14 鹵5.43 min, and the average hospital stay was 3.40 鹵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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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