Kilani T, El Hammami S, Horchani H, Ben Miled-Mrad K, Hantous S, Mestiri I, Sellami M
Department of Thoracic and Cardiovascular Surgery, A. Mami Hospital, Tunisia.
World J Surg. 2001 Jan;25(1):40-5. doi: 10.1007/s002680020006.
Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.
由细粒棘球绦虫引起的包虫病是地中海国家的一种地方性寄生虫病。最常见的解剖部位是肝脏和肺。位于肝圆顶的包虫囊肿胸腔内破裂是一种严重的并发症，会导致胸膜、肺实质和支气管受损。1984年1月至1997年12月，我们对40例肝包虫囊肿胸腔内破裂患者进行了手术。胸部X线片显示半侧胸腔底部有大小不一的阴影。所有病例均进行了肝脏和胸部超声检查。40例中有30例在术前确诊为肝囊肿胸腔内破裂。所有患者均行后外侧开胸术。这种经胸入路便于进行粘连松解以及治疗胸膜病变、肺部病变和肝囊肿。膈肌间隙的处理很容易完成。我们进行了15例肺叶切除术、10例楔形切除术、16例胸膜剥脱术，1例患者仅对大量胸膜肺和肝脓性包虫病灶进行了引流。26例患者术后病程平稳，但14例患者出现并发症，其中3例死亡。治疗方法取决于超声检查结果。我们认为超声检查是评估胆道、肝脏、膈肌和胸膜肺病变的最佳检查方法。当存在胸腔内积液时，必须进行开胸术，如果胆道安全则足够。当需要进行胆管引流时，必须采用腹部入路，对于直接破入支气管的情况可能也足够。
