Kurul Ismail Cüneyt, Topcu Salih, Altinok Tamer, Yazici Ulkü, Tastepe Irfan, Kaya Sadi, Cetin Güven
Department of Thoracic Surgery, Atatürk Center for Chest Disease and Thoracic Surgery, Ankara, Turkey.
J Thorac Cardiovasc Surg. 2002 Dec;124(6):1212-5. doi: 10.1067/mtc.2002.127314.
Hydatid disease is endemic in many countries throughout the world. Although we do not have exact figures, the disease is prevalent in Turkey. A considerable number of patients have additional liver cysts as well. In this study we reviewed our experience with hydatid disease of the lung and liver and discussed the principles of treatment.
From 1971 to 1999, 2509 patients with pulmonary hydatidosis were referred to us, and 485 of them had concomitant liver cysts. Of these, 405 patients had cysts located on the dome of the liver, and they were operated on with phrenotomy through a right thoracotomy. Eighty patients who were found to have concomitant liver cysts in the lower part of the liver were referred to general surgery for a laparotomy.
Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. In case of multiple cysts in the liver, needle aspiration was preferred. Twelve major complications, including excessive biliary drainage and bronchobiliary fistula, occurred in these patients.
We believe that management of pulmonary and hepatic cysts simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation. Needle aspiration can be applied only for liver cysts. It is absolutely contraindicated in lung hydatid cysts.
包虫病在世界上许多国家呈地方性流行。虽然我们没有确切数据，但该病在土耳其较为普遍。相当一部分患者还伴有肝囊肿。在本研究中，我们回顾了我们在肺和肝包虫病方面的经验，并讨论了治疗原则。
1971年至1999年，2509例肺包虫病患者转诊至我院，其中485例伴有肝囊肿。其中，405例患者的囊肿位于肝顶部，通过右胸切开术经膈切开术进行手术。80例在肝下部发现伴有肝囊肿的患者转诊至普通外科进行剖腹手术。
肺内包虫囊肿通过囊肿切开术和囊腔缝合处理。对于肝囊肿，囊肿切开术和用缝线翻转囊腔是首选的手术方法，并留置引流管。如果肝脏有多个囊肿，首选穿刺抽吸。这些患者发生了12例主要并发症，包括胆汁引流过多和支气管胆管瘘。
我们认为，通过胸径路同时处理肺和肝囊肿很方便，应鼓励患者采用，因为这样可避免二次手术。穿刺抽吸仅适用于肝囊肿。绝对禁止用于肺包虫囊肿。
