Moumen M, el Fares F
Service de Chirurgie Viscérale, C.H.U. Ibnou Rochd, Casablanca, Maroc.
J Chir (Paris). 1991 Apr;128(4):188-92.
While reporting on 9 cases of bilio-bronchic fistulas of hydatic origin, and with the help of literature data the authors are underlying a number of points: Hidatic bilio-bronchic fistulas are rare and a serious condition responsible of lesions at 3 levels, hepatic, diaphragmatic, and pulmonary. The diagnosis gives no rise to any problem the biliptysia is the main symptom. The treatment is always surgical, the approach is the abdominal way that permits the hepato-bronchic deconnection and the treatment of the hydatic cyst and to ensure the liberty of the common bile duct and to realise an eventuly drainage of the common bile duct to close the fistulous diaphragmatic communication and permit an inter-hepatodiaphragmatic drainage. It's but in front of a preoperatory destruction of a pulmonary lobe or the absence of improval of a pulmonary state post operatively (irreversible bronchectasis, chronic pulmonary sepsis) that the thoracotomy is indicated. The prognosis is severe with an elevated rate of mortality of 12,2% in this series. Showing the necessity of the prenetion of such complication by operating on every hydatic cyst of hepatic dome.
在报告9例肝包虫源性胆支气管瘘病例时，借助文献资料，作者强调了以下几点：肝包虫性胆支气管瘘罕见且病情严重，可导致肝脏、膈肌和肺部三个层面的病变。诊断不存在任何问题，胆汁溢是主要症状。治疗始终采用手术方式，手术途径为经腹，这样可以实现肝支气管离断、治疗肝包虫囊肿、确保胆总管通畅，并最终实现胆总管引流，以封闭瘘性膈肌通道并进行肝膈间引流。但只有在术前肺叶已被破坏或术后肺部状况无改善（不可逆性支气管扩张、慢性肺脓毒症）的情况下才考虑开胸手术。本系列病例的预后严重，死亡率高达12.2%。这表明通过对肝顶部的每个肝包虫囊肿进行手术来预防此类并发症的必要性。
