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脾包虫囊肿的手术治疗:单中心经验

Surgical approach to splenic hydatid cyst: single center experience.

作者信息

Eris Cengiz, Akbulut Sami, Yildiz Mehmet Kamil, Abuoglu Hasan, Odabasi Mehmet, Ozkan Erkan, Atalay Suleyman, Gunay Emre

机构信息

1 Department of Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.

出版信息

Int Surg. 2013 Oct-Dec;98(4):346-53. doi: 10.9738/INTSURG-D-13-00138.1.

Abstract

The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

摘要

脾包虫囊肿(SHC)手术的益处和风险仍存在争议。我们旨在分享我们关于SHC手术方法的经验。对2006年1月至2012年7月期间在我院接受开放性脾切除术的16例连续性SHC疾病患者进行回顾性评估。收集患者的人口统计学特征、临床发现、放射学和血清学诊断方法以及手术和药物治疗选择等数据,并用于生成诊断、治疗过程和结果的描述性概况。患者群体包括6名女性和10名男性,年龄范围为18至79岁(平均年龄:47.0±18.0)。放射学检查发现仅脾脏有包虫囊肿(n = 7)或脾脏和肝脏均有包虫囊肿(n = 9)。术前血清学检测确定13例患者IHA阳性。除1例患者外,所有患者均接受了10至21天的术前阿苯达唑治疗疗程,且所有患者在手术前一周接受了疫苗接种。7例患者接受了脾切除术。其余患者接受了脾切除加部分囊肿切除术和网膜固定术(n = 6)、部分囊肿切除术和囊肿开窗术(n = 1)、囊肿外膜切除术(n = 1)或囊肿外膜切除术加部分肾切除术(n = 1)。除1例患者外,所有患者均接受了10至45天的术后阿苯达唑治疗疗程。随访期间无患者出现严重并发症或复发迹象。我院SHC疾病的临床概况包括通过放射学方法进行诊断,根据患者症状、囊肿大小、数量和位置以及相邻器官受压情况采用简单或联合手术进行脾切除治疗,以及辅助接种疫苗以降低术后感染并发症的风险。该概况与低并发症风险和高治疗效果相关。

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