Cirenei A, Bertoldi I
Department of Surgery, University of Rome La Sapienza, Italy.
World J Surg. 2001 Jan;25(1):87-92. doi: 10.1007/s002680020368.
Hydatid disease (echinococcosis) remains a complex worldwide problem in rural areas. Medical treatment does not definitively cure hydatid cysts, and surgical management aims to eliminate the parasite, favoring rapid disappearance of the residual cavity, preventing complications and recurrence, and shortening the hospital stay. In this consecutive series, 298 patients with liver hydatidosis were treated surgically by the authors from 1950 to 1987 in various hospitals in Rome, Italy. Surgery comprised conservative methods (marsupialization and partial cystopericystectomy) and radical methods (total pericystectomy and liver resection). Liver resection was used only if unavoidable. Complications were exudate from the residual cystic cavity, cholerrhagia, and nonspecific incisional fistula. In the entire series, morbidity was 8.7% of which 12.6% was seen with conservative methods and 5.5% with radical methods (p < 0.05); mortality was 3.6%, of which 5.9% was seen with conservative methods and 1.8% with radical methods (p = NS). Over the 37 years, as medical science and complementary therapies progressed, the use of conservative operations diminished and radical treatments increased. Long-term follow-up showed that hydatid disease relapsed more frequently in patients who underwent conservative or subtotally radical treatment than in those who underwent radical surgery: eight patients (11.2%) versus one (0.9%) (p < 0.01). Hence surgical treatment that removes all of the pericyst and preservation of the nonpathologic liver are important.
包虫病（棘球蚴病）在全球农村地区仍然是一个复杂的问题。药物治疗无法彻底治愈包虫囊肿，手术治疗旨在清除寄生虫，促进残余腔隙快速消失，预防并发症和复发，并缩短住院时间。在这个连续系列研究中，1950年至1987年期间，作者在意大利罗马的多家医院对298例肝包虫病患者进行了手术治疗。手术包括保守方法（袋形缝合术和部分囊肿外囊切除术）和根治方法（完全外囊切除术和肝切除术）。仅在不可避免的情况下才使用肝切除术。并发症包括残余囊肿腔渗出、胆漏和非特异性切口瘘。在整个系列中，发病率为8.7%，其中保守方法组为12.6%，根治方法组为5.5%（p<0.05）；死亡率为3.6%，其中保守方法组为5.9%，根治方法组为1.8%（p=无显著性差异）。在这37年中，随着医学科学和辅助治疗的进步，保守手术的使用减少，根治性治疗增加。长期随访显示，接受保守或次全根治性治疗的患者比接受根治性手术的患者包虫病复发更频繁：分别为8例（11.2%）和1例（0.9%）（p<0.01）。因此，切除所有外囊并保留无病变肝脏的手术治疗很重要。
