Pătraşcu Tr, Doran H, Brezean I, Marin I, Catrina E, Vîlcu Mihaela, Mihalache O
Clinica de Chirurgie I. Juvara, Spitalul Clinic Dr. I. Cantacuzino, Bucureşti.
Chirurgia (Bucur). 2007 Sep-Oct;102(5):531-6.
One of the most important problems of the surgical treatment of the hydatid disease of the liver is the remaining cavity of the cyst. Its evolution is mainly decided by the existence and the debit of a biliary fistula. During 10 years (1997-2006), 138 patients with 166 hydatid cysts of the liver were admitted and operated in our clinic. Among them, 57 cysts had a biliary fistula, found during the operation, while in 11 other patients the fistula became obvious 1 or 2 days after the procedure. The incidence of biliary fistulas (68 of 166 cases, which means 41%) is higher, due to the location of the cysts, mainly in the central parts of the liver. There were 44 (65%) low debit fistulas and 24 (35%) high debit fistulas. Our surgical attitude regarding the cavities with biliary fistulas has considerably changed; while between 1997-2000 an anastomosis with a Y or Omega jejunal loop was the most frequent technique, nowadays we use the external drainage of the cavity, associated to endoscopic sphincterotomy, for fistulas with large volumes (more than 300 ml/day) and/or persistent. Whenever it is possible, we practice the direct suture of the biliary fistula.
肝包虫病外科治疗最重要的问题之一是囊肿残留腔。其演变主要取决于胆瘘的存在及引流量。在10年（1997 - 2006年）间，我院收治并手术治疗了138例患有166个肝包虫囊肿的患者。其中，57个囊肿在手术中发现有胆瘘，另有11例患者在术后1或2天胆瘘变得明显。由于囊肿位置主要在肝脏中央部分，胆瘘发生率较高（166例中有68例，即41%）。有44例（65%）为低流量瘘，24例（35%）为高流量瘘。我们对有胆瘘的残腔的手术处理方式有了很大改变；在1997 - 2000年间，最常用的技术是与Y形或Ω形空肠袢吻合，如今对于大量（每天超过300毫升）和/或持续性瘘，我们采用残腔外引流并联合内镜括约肌切开术。只要有可能，我们就对胆瘘进行直接缝合。
