Kabiri H, Chafik A, al Aziz S, el Maslout A, Benosman A
Service de chirurgie thoracique, CHU Ibn Sina, Rabat, Maroc.
Ann Chir. 2000 Sep;125(7):654-9. doi: 10.1016/s0003-3944(00)00256-x.
The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy.
From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases.
There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up.
Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.
本研究旨在报告经胸廓切开术治疗包虫病所致胆支气管瘘和胆胸膜支气管瘘的手术结果。
1990年至1998年，在同一中心观察了63例患者。72%的病例以胆汁咳出为主要症状。诊断基于胸部X线摄影和腹部超声检查；这两项检查均显示了囊肿、胸腔积液、膈肌破裂和胆道病变。所有患者均接受一期胸廓切开术治疗。手术包括胸部的肺切除术（肺叶切除术和/或肺段切除术）（n = 47）和纤维板剥脱术（n = 16），腹部的囊肿顶部切除术（n = 61）或部分囊肿外膜切除术（n = 12），以及在肝膈离断后对所有病例的膈肌缺损进行缝合。4例患者需要额外进行剖腹手术。
有8例死亡（12.7%）：1例术中因出血死亡，7例术后死亡，主要与肺部并发症有关。术后并发症发生率为14.3%，主要为呼吸系统并发症。随访一年，临床和影像学结果良好。
包虫囊肿所致的胆支气管瘘和胆胸膜支气管瘘较为罕见，但病情严重。它们会导致腹部、膈肌和胸部三个层面的病变。围手术期死亡率较高。胸廓切开术是对所有三个层面进行手术治疗的最佳方法。
