Pinna A D, Marongiu L, Cadoni S, Luridiana E, Nardello O, Pinna D C
Istituto di Chirurgia, University of Cagliari, Italy.
Surg Gynecol Obstet. 1990 Mar;170(3):233-8.
Of a total of 77 patients affected by hydatid cysts of the liver observed between 1983 and 1988, we examined a group of 25 patients with cysts that had migrated into the thorax. The main characteristic of these patients was the hydatid hepatic cyst, which was situated in the right hepatic lobe in every patient, involving one or more right hemithoracic structures. In 24 patients, there were different combinations of symptoms, but only ten were thoracic. In those with advanced intrathoracic evolution of the hydatid cyst, we not only found a destruction of the hemidiaphragm, but also the presence of pleural effusion, empyema, atelectasis and multiple pleural hydatidosis caused by the development of a cystic fistula in the pleural cavity. Analysis of these instances allowed us to see that ultrasonograms of the liver and roentgenograms of the thorax are often the most sensitive and reliable diagnostic procedures for showing the intrathoracic evolution of the cyst. We believe that the surgical treatment must be carried out with simultaneous right thoracoabdominal access, which, besides exposing the thoracic lesions, also permits adequate treatment of the hepatic hydatid cyst and the possible associated biliary complications.
在1983年至1988年间观察到的77例肝包虫囊肿患者中，我们检查了一组25例囊肿已迁移至胸部的患者。这些患者的主要特征是肝包虫囊肿，每位患者的囊肿均位于肝右叶，累及一个或多个右半胸结构。24例患者有不同的症状组合，但只有10例有胸部症状。在那些包虫囊肿在胸腔内进展到晚期的患者中，我们不仅发现了半膈肌的破坏，还发现了胸腔积液、脓胸、肺不张以及由于胸腔内囊肿瘘形成导致的多发性胸膜包虫病。对这些病例的分析使我们看到，肝脏超声检查和胸部X线检查通常是显示囊肿在胸腔内进展的最敏感和可靠的诊断方法。我们认为手术治疗必须采用同时经右胸腹部入路，这除了能暴露胸部病变外，还能对肝包虫囊肿及可能相关的胆道并发症进行充分治疗。
