Behrns K E, van Heerden J A
Section of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1991 Dec;66(12):1193-7. doi: 10.1016/s0025-6196(12)62469-0.
The use of conservative or radical surgical procedures in the management of hepatic echinococcosis is controversial. A review of data on 23 patients with hydatid cysts of the liver that were diagnosed between 1935 and 1990 at our institution was undertaken to determine the safety and efficacy of various surgical procedures. In eight patients (group 1), the cysts were treated conservatively by instillation of a scolicidal agent followed by evacuation of the cyst, drainage, or omentoplasty of the residual cyst cavity. Thirteen patients (group 2) underwent radical excision of the cyst by either pericystectomy or hepatic resection. In addition, two patients were treated by combined techniques. Scolicidal agents were used in 18 patients (78%) and apparently resulted in caustic biliary injury and death in 2 patients. Group 1 and group 2 patients had similar complication rates (62% and 54%, respectively) and mean hospital stay (24 and 23 days, respectively). Recurrent cysts, however, were detected in three of six patients who underwent a conservative surgical procedure and participated in follow-up, whereas no patients treated by a radical procedure had a recurrence. Because pericystectomy and hepatic resection resulted in a low rate of recurrence and eliminated the need for use of potentially toxic scolicidal agents, these procedures may be the preferred method for the surgical management of hepatic hydatid disease.
在肝包虫病的治疗中，采用保守或根治性手术方法存在争议。我们回顾了1935年至1990年间在本机构诊断的23例肝包虫囊肿患者的数据，以确定各种手术方法的安全性和有效性。8例患者（第1组）采用向囊肿内注入杀头节剂，随后排空囊肿、引流或对残留囊肿腔进行网膜成形术的保守治疗。13例患者（第2组）通过囊肿切除术或肝切除术进行囊肿根治性切除。此外，2例患者采用联合技术治疗。18例患者（78%）使用了杀头节剂，显然导致2例患者发生腐蚀性胆管损伤并死亡。第1组和第2组患者的并发症发生率相似（分别为62%和54%），平均住院时间也相似（分别为24天和23天）。然而，在接受保守性手术并参与随访的6例患者中，有3例检测到复发性囊肿，而接受根治性手术治疗的患者均无复发。由于囊肿切除术和肝切除术复发率低，且无需使用潜在有毒的杀头节剂，因此这些手术可能是肝包虫病手术治疗的首选方法。
