A' Propedeutic Surgical Clinic, Aristotle's University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
HPB (Oxford). 2008;10(1):18-24. doi: 10.1080/13651820701854669.
The aim of this study was to report our 44-year experience (1963-2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center.
There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years.
Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. CONCLUSIONS. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.
本研究旨在报告我们在肝包虫病感染的治疗方面 44 年的经验（1963-2006 年）。这是对我们中心治疗的患者的人口统计学数据、临床表现、诊断方法、手术管理和长期结果进行回顾性分析。
共有 77 例手术治疗的感染性肝包虫囊肿患者。在同一时期，共 460 例肝包虫病患者接受了手术治疗。其中化脓性囊肿患者 27 例为男性，50 例为女性，平均年龄 54.5 岁。
75%的患者出现脓肿的临床表现。在本研究的早期病例中，诊断依据是临床症状、实验室检查，结合平片、肝闪烁扫描，而在后期病例中则依靠超声（US）、计算机断层扫描（CT）或磁共振成像（MRI）和内镜逆行胰胆管造影（ERCP）。采用腹部切口，偶尔采用胸腹部或胸腹联合切口。8 例患者行全囊内囊壁切除术，69 例患者行部分囊壁切除术和适当引流，在囊腔内留置一根或两根引流管。住院时间为 13-146 天，有 5 例再次手术。2 例严重化脓性囊肿合并其他医学问题的患者死亡。5 例患者疾病复发。结论：我们认为，在良好的围手术期抗生素和代谢支持下，感染性包虫囊肿必须完全排空并适当引流。应优先采用“保守”的手术方法。需要进一步研究来解决这种严重并发症的临床和治疗问题。
