Al-Bahrani Ahmed Z, Al-Maiyah Mohammed, Ammori Basil J, Al-Bahrani Zuhair R
Department of Surgery, Medical City Teaching Hospital, Baghdad, Iraq.
Hepatogastroenterology. 2007 Jan-Feb;54(73):214-7.
BACKGROUND/AIMS: Frank intrabiliary rupture (IBR) is a serious complication that occurs in 3-17% of patients. The aim of this study was to identify independent predictors of frank IBR of hepatic hydatid cysts (HHC).
Some 741 patients with HHC underwent surgery for HHC between 1965 and 2000. Patient and cyst characteristics were subjected to univariate and multivariate analysis to identify independent predictors of frank IBR.
Frank IBR was associated with significantly older age (median, 41 vs. 37 years,p =0.025), more male subjects (40% vs. 32%, p = 0.024), longer duration of symptoms (16 vs. 6 months, p < 0.001), larger cysts (median, 12 vs. 9cm, p < 0.001) and higher incidence of solitary (86% vs. 62%, p < 0.001), multivesicular (89% vs. 39%, p < 0.001), left lobar (38% vs. 13%, p < 0.001) and infected cysts (78% vs. 24%, p < 0.001). Multivariate analysis identified cyst size (> or =10 cm), cyst infection, multivesicular content, solitary cysts and location in the left lobe of liver as well as long duration of symptoms as independent predictors of frank IBR.
Patients with large (> or =10 cm), multivesicular, solitary, left lobar or infected HHC as well as those with prolonged history are at increased risk of frank IBR and should be offered early surgery.
背景/目的：肝内胆管破裂（IBR）是一种严重并发症，发生率为3%-17%。本研究旨在确定肝包虫囊肿（HHC）患者发生肝内胆管破裂的独立预测因素。
1965年至2000年间，741例HHC患者接受了HHC手术。对患者和囊肿特征进行单因素和多因素分析，以确定肝内胆管破裂的独立预测因素。
肝内胆管破裂与年龄较大（中位数41岁对37岁，p=0.025）、男性比例较高（40%对32%，p=0.024）、症状持续时间较长（16个月对6个月，p<0.001）、囊肿较大（中位数12cm对9cm，p<0.001）以及孤立性囊肿（86%对62%，p<0.001）、多房性囊肿（89%对39%，p<0.001）、左叶囊肿（38%对13%，p<0.001）和感染性囊肿（78%对24%，p<0.001）的发生率较高显著相关。多因素分析确定囊肿大小（≥10cm）、囊肿感染、多房性内容物、孤立性囊肿、位于肝左叶以及症状持续时间长是肝内胆管破裂的独立预测因素。
患有大（≥10cm）、多房性、孤立性、左叶或感染性HHC的患者以及病史较长的患者发生肝内胆管破裂的风险增加，应尽早进行手术。
