Tor M, Atasalihi A, Altuntas N, Sulu E, Senol T, Kir A, Baran R
Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Department of Pulmonary Medicine, Istanbul, Turkey.
Respiration. 2000;67(5):539-42. doi: 10.1159/000067470.
Echinococcus disease is endemic in sheep-and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Turkey.
To determine the presentation, approach to surgical treatment and outcome of hydatid disease in an endemic region.
From January 1989 to December 1998 288 patients, aged between 1 and 71 years with a mean age of 31 years (134 female, 154 male), were operated on for pulmonary hydatidosis. Clinical charts of the patients were reviewed retrospectively in a tertiary referral hospital.
Of 288 patients, 30 patients were asymptomatic, the rest (89%) were symptomatic, cough and chest pain being the most common symptoms. Fifty-three patients (18%) had associated liver hydatid cysts. Bilateral lung hydatid cysts were present in 18 patients (6%). Recurrent hydatid cysts were observed in 33 patients (11%). Seventy-seven patients (27%) presented with complicated hydatid cysts. Postoperative morbidity was observed in 3 patients [bronchopleural fistula (2), infection of the cyst space (1)] and postoperative mortality in 1 patient who presented with hydatid lung disease associated with liver and brain cysts. In the remaining 98. 6%, no complications were noted.
In conclusion, hydatidosis is still an important public health problem in Turkey and in an endemic country such as Turkey hydatid lung disease should be considered initially in a patient presenting with a corresponding chest roentgenogram and a compatible epidemiologic history. Surgery is indicated in all symptomatic and/or enlarging or infected cysts. When necessary lobectomy or wedge resection can be the procedure of choice. Single-stage combined resection is preferred in hydatid lung disease with associated liver hydatid cysts. Total postoperative complication and mortality rate is low and we recommend a close follow-up of the operated cases to diagnose postoperative recurrence early in its course.
棘球蚴病在世界各地的牛羊养殖地区呈地方性流行。在包括土耳其在内的地中海地区，其患病率也很高。
确定地方性流行地区包虫病的临床表现、手术治疗方法及预后。
1989年1月至1998年12月，对288例年龄在1至71岁之间、平均年龄31岁（女性134例，男性154例）的肺包虫病患者进行了手术治疗。在一家三级转诊医院对患者的临床病历进行了回顾性分析。
288例患者中，30例无症状，其余（89%）有症状，咳嗽和胸痛是最常见的症状。53例患者（18%）伴有肝包虫囊肿。18例患者（6%）双侧肺有包虫囊肿。33例患者（11%）观察到复发性包虫囊肿。77例患者（27%）表现为复杂性包虫囊肿。3例患者出现术后并发症[支气管胸膜瘘（2例）、囊肿腔感染（1例）]，1例合并肝和脑囊肿的包虫肺病患者术后死亡。其余98.6%未发现并发症。
总之，包虫病在土耳其仍然是一个重要的公共卫生问题，在像土耳其这样的地方性流行国家，对于胸部X线片表现相应且有相符流行病学史的患者，应首先考虑包虫肺病。所有有症状和/或增大或感染的囊肿均需手术治疗。必要时，肺叶切除术或楔形切除术可为首选术式。对于合并肝包虫囊肿的包虫肺病，首选一期联合切除术。术后总并发症和死亡率较低，我们建议对手术病例进行密切随访，以便在病程早期诊断术后复发。
