Hasdıraz Leyla, Onal Omer, Oguzkaya Fahri
J Cardiothorac Surg. 2013 May 3;8:121. doi: 10.1186/1749-8090-8-121.
Hydatid cyst disease is still a problem in many countries. Surgical removal is currently the generally accepted choice of treatment for lung hydatidosis. However, operating on bilateral widespread lung hydatidosis is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral multiple hydatid disease of the lung.
In this study, we reviewed our experience in the surgical treatment of 17 (3.7%) patients with bilateral, and at least three, lung hydatid cysts. These 17 patients (8 male, 9 female), with an average age of 34.6 years (range 12-58 years), underwent bilateral staged thoracotomy.
In total 105 lung cysts were removed from 17 patients who underwent staged thoracotomies. The mean count of cysts was 6.7 (range 3-20 cysts). Most of the cysts (38.2%) were located in the right lower lobe. The mean interval between thoracotomies was 4.2 (range 3-5) days. Two patients (11.7%) had cysts associated with hepatic hydatidosis and one (5.8%) had cysts associated with the spleen; they were treated via phrenotomy during thoracotomies. All cysts were removed without lung resection. We observed some complications such as prolonged air leaks (n = 2), atelectasis (n = 3) and empyema (n = 2). No further surgery was required for management of complications. The mean hospital stay was 9.3 days. (range 7-23 days). Oral albendazole was started on the 2nd post operative day after the first thoracotomy in the dose of 10-20 mg/kg and was continued for 3 months with a gap of 1 week after each 21 days. No recurrences or deaths occured during the follow-up period.
Although staged thoracotomy applied in 3-5 days after the initial thoracotomy increases the total hospital stay, it decreases the chance of possible complications can occur in cysts in the other lung when long intervals are preferred between the first and the second thoracotomy. In our experience, bilateral staged thoracotomy is an appropriate surgical option because morbidity rates are minimal and the hospital stay is acceptable for the treatment of bilateral widespread lung hydatidosis, even in patients who had a total of 20 hydatid cysts.
包虫囊肿病在许多国家仍然是一个问题。手术切除是目前治疗肺包虫病普遍接受的选择。然而,对双侧广泛肺包虫病进行手术仍存在争议。本回顾性研究的目的是评估双侧多发性肺包虫病的手术治疗结果。
在本研究中,我们回顾了17例(3.7%)双侧且至少有3个肺包虫囊肿患者的手术治疗经验。这17例患者(8例男性,9例女性),平均年龄34.6岁(范围12 - 58岁),接受了双侧分期开胸手术。
17例接受分期开胸手术的患者共切除105个肺囊肿。囊肿平均数量为6.7个(范围3 - 20个囊肿)。大多数囊肿(38.2%)位于右下叶。两次开胸手术之间的平均间隔为4.2天(范围3 - 5天)。2例患者(11.7%)的囊肿与肝包虫病相关,1例(5.8%)的囊肿与脾包虫病相关;在开胸手术期间通过膈切开术进行治疗。所有囊肿均未行肺切除而被切除。我们观察到一些并发症,如持续漏气(n = 2)、肺不张(n = 3)和脓胸(n = 2)。并发症处理无需进一步手术。平均住院时间为9.3天(范围7 - 23天)。在第一次开胸手术后第2天开始口服阿苯达唑,剂量为10 - 20 mg/kg,并持续3个月,每21天服用后间隔1周。随访期间无复发或死亡病例。
虽然在初次开胸手术后3 - 5天进行分期开胸手术会增加总住院时间,但与在第一次和第二次开胸手术之间选择较长间隔相比,它降低了另一侧肺囊肿可能出现并发症的几率。根据我们的经验,双侧分期开胸手术是一种合适的手术选择,因为发病率极低,对于双侧广泛肺包虫病的治疗,即使是囊肿总数达20个的患者,住院时间也是可以接受的。