Daali M, Hssaida R
Service de Chirurgie générale, Hôpital Militaire Avicenne, Marrakech, Maroc.
Presse Med. 2000 Jun 17;29(21):1166-9.
The aim of this study was to analyse the epidemiological, diagnostic and therapeutic aspects of muscle hydatidosis.
This retrospective study included a series of 15 patients with hydatic muscular cysts operated on in our service over an eight year period. Five cysts were superficial and ten were deep. Patients were predominantly young adults (10 cases); M/F sex ratio was 2/1. Clinical signs included atypical pain, particularly for the deep localizations, and tumoral formations, particularly for superficial localizations. Diagnosis of muscle hydatidosis was made in some patients seen for complications or systematic search for another localization. A second hepatic localization was found in 5 cases and a splenic localization in one. Sonography provided the diagnosis in all cases although the exact localization could not be determined. A CT scan was performed in half the cases. Localizations included the diaphragm 7 cases, psoas 3 cases, and buttock, triceps, sartorius, anterior tibial and intercostal muscles 1 case each.
Surgical treatment was the same for all abdominal localizations, although different access routes were used. Partial pericystostomy was the basic procedure and gave excellent results. One case was complicated by a crural nerve lesion that recovered spontaneously. Recurrence in the diaphragm occurred in two cases and was successfully treated surgically two years later. One patient died due to acute liver failure subsequent to multiple cysts which had destroyed the entire liver.
本研究旨在分析肌肉包虫病的流行病学、诊断及治疗方面。
本回顾性研究纳入了我院在8年期间手术治疗的15例患有包虫性肌肉囊肿的患者。5例囊肿位于浅表,10例位于深部。患者以青壮年为主(10例);男女比例为2:1。临床症状包括非典型疼痛,特别是深部囊肿的情况,以及肿瘤样肿物,特别是浅表囊肿的情况。部分患者因并发症就诊或系统性检查其他部位时被诊断为肌肉包虫病。5例患者发现有肝脏的其他部位存在包虫病,1例有脾脏包虫病。所有病例均通过超声检查做出诊断,但无法确定确切位置。半数病例进行了CT扫描。囊肿所在部位包括:膈肌7例,腰大肌3例,臀部、肱三头肌、缝匠肌、胫前肌及肋间肌各1例。
所有腹部囊肿的手术治疗方式相同,但采用了不同的入路。部分囊肿开窗引流术是基本手术方式,效果良好。1例患者并发股神经损伤,后自行恢复。2例膈肌部位的囊肿复发,2年后手术成功治愈。1例患者因多个囊肿破坏整个肝脏导致急性肝衰竭死亡。