Yang Hongqiang, Tang Jingxia, Peng Xinyu, Zhang Shijie, Sun Hong, Lv Hailong, Li Jiang, Chen Xiaoping
Center of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, 832000, China.
J Huazhong Univ Sci Technolog Med Sci. 2012 Apr;32(2):205-209. doi: 10.1007/s11596-012-0036-4. Epub 2012 Apr 20.
This study retrospectively reviewed 9 cases of complicated hepatic cystic hydatidosis with intrabiliary rupture who were surgically treated with pericystectomy in combination with Roux-en-Y hepaticojejunostomy in our hospital from 2004 to 2010. The clinical features, results of laboratory tests, B-mode ultrasonography and CT, post-operative recovery, days of hospital stay after the operation and post-operative complications were statistically analyzed and the patients were followed up. The subjects in our series included 7 males and 2 females, whose average age was 50.78±7.58 years. Before operation, 9 patients suffered from pain of the right upper quadrant and jaundice, which, in 4 cases (44.45%), were accompanied with fever and chills. Preoperative B-mode ultrosonography and CT showed that all the 9 patients had single hydatid cyst, with their diameter being 9.33±1.58 cm on average. The lesions involved segments V, VI in 6 cases, and segment IV in 3 cases. By WHO classification, 7 cases were classified as CE3 and 2 cases as CE4. They all had choledochectasia. The subjects underwent the surgery uneventfully. Intraoperatively, 2-4 biliary fistula orifices were found, with the average of the orifice being (0.79±0.20) cm. After the operation, one patient developed incision infection, one had pulmonary infection and one suffered from reflux cholangitis. No anastomotic leaks or peri-operative deaths took place and follow-up revealed no recurrence and implantative metastasis. We are led to conclude that pericystectomy in combination with Roux-en-Y hepaticojejunostomy can achieve satisfactory results for the treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture.
本研究回顾性分析了2004年至2010年在我院接受手术治疗的9例复杂性肝囊型包虫病伴胆道内破裂患者，手术方式为囊肿外引流术联合Roux-en-Y肝空肠吻合术。对患者的临床特征、实验室检查结果、B超及CT检查结果、术后恢复情况、术后住院天数及术后并发症进行统计学分析，并对患者进行随访。本研究系列中的患者包括7例男性和2例女性，平均年龄为50.78±7.58岁。术前，9例患者均有右上腹疼痛和黄疸，其中4例（44.45%）伴有发热和寒战。术前B超及CT检查显示，9例患者均为单发包虫囊肿，平均直径为9.33±1.58cm。病变累及Ⅴ、Ⅵ段6例，Ⅳ段3例。根据世界卫生组织分类，7例为CE3型，2例为CE4型。均有胆总管扩张。患者手术过程顺利。术中发现2～4个胆瘘口，瘘口平均直径为（0.79±0.20）cm。术后，1例患者发生切口感染，1例发生肺部感染，1例发生反流性胆管炎。未发生吻合口漏或围手术期死亡，随访未发现复发及种植转移。我们得出结论，囊肿外引流术联合Roux-en-Y肝空肠吻合术治疗复杂性肝囊型包虫病伴胆道内破裂可取得满意效果。
