Burgos R, Varela A, Castedo E, Roda J, Montero C G, Serrano S, Téllez G, Ugarte J
Department of Thoracic and Cardiovascular Surgery, Puerta de Hierro Clinic, Autonomous University of Madrid, Spain.
Eur J Cardiothorac Surg. 1999 Dec;16(6):628-34; discussion 634-5. doi: 10.1016/s1010-7940(99)00304-8.
We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol.
The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5 +/- 7.2 years (range: 4-70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (-30 cm H2O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti.
Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease.
The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.
我们回顾了1966年至1988年间在我们中心接受手术治疗的240例肺包虫囊肿患者，评估我们的手术技术（包括由D. 菲格拉教授设计的新型针吸装置）及术后治疗方案的效果。
大多数患者（60.4%）来自包虫病流行地区。手术时患者的平均年龄为31.5±7.2岁（范围：4 - 70岁）。在240例患者遇到的300个囊肿中，276个（92%）囊肿使用套管针抽吸装置进行针吸。其余24个囊肿通过不同的手术技术如囊肿摘除术、肺叶切除术、肺段切除术和非典型肺切除术完整切除。238例（86.2%）患者的残余腔通过囊肿外膜切除术并外翻至胸膜表面处理，38例（13.7%）通过缝合处理。所有病例均采用高负压吸引（-30 cm H₂O）。根据手术时间，患者按照贝赫蒂设计的方案接受甲苯达唑或阿苯达唑治疗。
通过对症状的临床评估及胸部X线平片，228例（95%）患者得到正确诊断。6例（2.5%）患者需要超声、计算机断层扫描和核磁共振等影像学检查，其余6例（2.5%）患者在术中或后续组织病理学检查中确诊。170例（70.8%）患者表现为单个肺囊肿，其余70例（29.2%）患者在一侧或双侧肺的一个或多个肺叶中发现多个囊肿。此外，45例（18.7%）患者有肝囊肿，25例（10.4%）患者在其他部位有囊肿。经过18年的随访，生存率为94.6%。在存活患者中，98.3%无肺包虫病，95.1%无包虫病。
这里使用的用于肺包虫囊肿针吸的套管针抽吸装置已证明其在预防囊肿破裂及其可能扩散方面的有效性。使用该装置可根除寄生虫并切除残余腔。
