Bouchikh M, Ouadnouni Y, Smahi M, Msougar Y, Lakranbi M, Achir A, Caidi M, Harrak L, El Aziz S, Benosman A
Service de Chirurgie thoracique, CHU Ibn Sina, Rabat, Maroc.
Rev Mal Respir. 2008 Nov;25(9):1110-4. doi: 10.1016/s0761-8425(08)74981-7.
Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH).
Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol.
The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%.
Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.
肺外胸内包虫囊肿较为罕见，但可能是多发的，尤其是在继发性播散期间。为了阐明这种播散的起源，我们报告了我们在治疗多发性胸外肺包虫病（MTEH）方面的经验。
1995年1月至2004年12月，我科对41例MTEH患者进行了手术。胸部X线片和计算机断层扫描是主要的诊断手段。治疗方法是完整切除囊肿。手术入路为后外侧开胸（右侧29例，左侧8例，双侧3例），1例采用正中胸骨切开术。所有患者均接受阿苯达唑辅助药物治疗。
6例（15%）MTEH继发于血行播散，7例（17%）继发于肺包虫囊肿，28例（68%）继发于肝包虫囊肿。这些患者中有75%曾因肝囊肿接受过手术干预，88%有膈肌受累。我们的患者中无死亡病例，但复发率为12%。
继发性胸外肺包虫病通常见于因肝包虫囊肿接受手术的患者。手术时必须采取必要的预防措施，以避免任何胸内播散。
