Department of Thoracic Surgery, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey,
Surg Today. 2014 Jan;44(1):131-6. doi: 10.1007/s00595-012-0484-2. Epub 2013 Jan 20.
The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment.
The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (<10 cm) cysts and group 2 (n = 41) with giant (≥10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared.
In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2.
All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.
本研究旨在评估肺包虫囊肿大小与临床表现、手术入路和术后转归的关系。我们回顾了治疗大的肺包虫囊肿时遇到的问题，并强调了囊肿破裂和手术治疗延迟带来的风险。
回顾了 169 例肺包虫囊肿手术治疗患者的病历。根据囊肿大小将患者分为两组：组 1（n=128）为小囊肿（<10cm），组 2（n=41）为大囊肿（≥10cm）。分析比较了两组患者的症状、术前并发症、手术方式及术后并发症。
两组患者最常见的症状均为胸痛，其次分别为呼吸困难和咳嗽。两组患者术前与囊肿相关的实质或胸膜并发症无差异（p=0.80）。在大多数情况下，手术治疗为囊肿切开术、囊膜切除术和缝合术。9 例患者（7 例在组 1，2 例在组 2）行楔形切除术，1 例组 2患者行肺叶切除术。组 2行剥脱术的比例显著高于组 1（p=0.001）。组 1中有 16 例患者和组 2中有 10 例患者发生术后并发症（p=0.19）。两组均无围手术期死亡。两组患者的住院时间无差异（p=0.17）。组 1中 2 例复杂包虫囊肿患者在随访期间出现复发病例，而组 2中无复发病例。
一旦确诊肺包虫囊肿，应尽快手术治疗，以避免并发症。大多数此类病变，无论大小，均可通过保留最大肺实质的手术方法进行治疗，获得良好的结果。
