肝包虫病：15年的手术经验

Hepatic hydatid disease: surgical experience over 15 years.

作者信息

Agayev Rauf M, Agayev Beyukkishi A

机构信息

Department of Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan.

出版信息

Hepatogastroenterology. 2008 Jul-Aug;55(85):1373-9.

PMID:18795693

Abstract

BACKGROUND/AIMS: This study aimed to review the authors' surgical experience in hepatic hydatid disease over a 15-year period.

METHODOLOGY

The results of surgical treatment of 484 patients (37.2% male; 62.8% female) aged 5-82 years, with liver echinococcosis (LE), were analyzed.

RESULTS

Complications of the disease were evident in 226 (47%) patients. These were: cyst calcination, 34 (7%); bile ducts rupture, 128 (26.4%); cyst suppuration, 120 (24.8%); and abdominal cavity perforation, 6 (1.2%). In the diagnostics of liver echinococcosis and its complications, the most informative techniques were ultrasonography and CT. Surgical treatment included: echinococcectomy with complete liquidation of residual cavity (22.1%); echinococcectomy with suturing and external drainage of residual cavity (57.8%); external drainage of residual cavity (11.4%); pericystectomy (6.6%); and liver resection (2.1%). Postoperative complications developed in 118 (24.3%) patients; of these, specific complications occurred in 74 (15.3%) patients. Eight (1.6%) patients had lethal outcomes. The development of purulent biliary complications was connected with peculiarities of parasitic cysts, the character of preoperative complications of the hydatid cysts, and the type of operative intervention: in patients, who underwent echinococcectomy with complete liquidation of residual cavity these complications developed in 4% of cases, whereas the occurrence in patients who underwent operations with external drainage of residual cavity, was 15.2% (P < 0.01).

CONCLUSIONS

Laser irradiation is an essential aid in the prevention of specific complications: application during operation for processing a residual cavity and in the postoperative stage (transcutaneous irradiation of a zone of residual cavity projection or direct irradiation through a drainage tube) is effective. The laser processing of a residual cavity accelerates healing of the residual cavity by approximately 1/3 of the time, and reduces the number of purulent complications by almost 2.5, thereby reducing the patient's number of hospital stay days.

摘要

背景/目的：本研究旨在回顾作者在15年期间治疗肝包虫病的手术经验。

方法

分析了484例年龄在5至82岁之间的肝包虫病（LE）患者（男性占37.2%；女性占62.8%）的手术治疗结果。

结果

226例（47%）患者出现了疾病并发症。这些并发症包括：囊肿钙化，34例（7%）；胆管破裂，128例（26.4%）；囊肿化脓，120例（24.8%）；腹腔穿孔，6例（1.2%）。在肝包虫病及其并发症的诊断中，最具信息量的技术是超声检查和CT。手术治疗包括：彻底清除残腔的包虫切除术（22.1%）；缝合并外置引流残腔的包虫切除术（57.8%）；残腔外置引流（11.4%）；囊肿外膜切除术（6.6%）；肝切除术（2.1%）。118例（24.3%）患者出现了术后并发症；其中，74例（15.3%）患者出现了特异性并发症。8例（1.6%）患者死亡。化脓性胆道并发症的发生与寄生囊肿的特点、包虫囊肿术前并发症的性质以及手术干预类型有关：在接受彻底清除残腔的包虫切除术的患者中，这些并发症的发生率为4%，而在接受残腔外置引流手术的患者中，发生率为15.2%（P<0.01）。