Shalayiadang PaiZula, Muzaffar Iqbal, Turxun Ajim, Nannan Cui, Wen Hao
Hepatogastroenterology. 2014 Mar-Apr;61(130):431-5.
BACKGROUND/AIMS: Intrabiliary rupture (IBR) is the most common and serious complication of hepatic hydatid cyst (HHC). The aim of this retrospective study was to evaluate postoperative short-term and long-term outcome of patients treated surgically for complicated liver hydatid cysts.
A total of 168 cases with biliary communication of hydatid cyst were analyzed retrospectively, 92 of which had biliary communication with an occult rupture while 76 (45.23%) had Frank biliary rupture. Preoperative demography, ultrasonic cyst features, postoperative short-term complications, postoperative follow-up (long-term) complications and hospital stay were recorded and analyzed.
There were no differences in the demographic characteristics and preoperative cyst features in Frank and occult group. Compared with the Frank group 9.34 +/- 1.25 (days), the postoperative stay in occult 6.97 +/- 1.62 (days) were relatively shorter. The incidence of overall postoperative short-term complications and long-term complications were insignificantly lower in occult group (22.82%) than Frank group (30.26%) with P = 0.275. Incidence of postoperative biliary leakage 8 (8.69%) and abscess 5 (5.43%) in occult group was insignificantly more common than Frank rupture with biliary leakage 5 (6.5%) and abscess 2 (2.63%) with P value was 0.609 and 0.365 respectively while long-term biliary stricture is significantly greater in Frank group (10.52%) then occult group (0%) with P = 0.01.
Frequency of occurrence of postoperative short-term complications biliary fistula and abscess is relatively more common in occult rupture with transcystic drain due to its indolent course, inability to find and suture the rupture orifice, and incomplete decompression while biliary stricture is significantly more common in Frank group due to its involvement of major bile ducts.
背景/目的：肝内破裂（IBR）是肝包虫囊肿（HHC）最常见且最严重的并发症。本回顾性研究的目的是评估接受手术治疗的复杂肝包虫囊肿患者的术后短期和长期结局。
回顾性分析168例存在包虫囊肿胆瘘的病例，其中92例为隐匿性破裂胆瘘，76例（45.23%）为明显胆瘘。记录并分析术前人口统计学资料、超声囊肿特征、术后短期并发症、术后随访（长期）并发症及住院时间。
明显胆瘘组与隐匿性胆瘘组在人口统计学特征和术前囊肿特征方面无差异。与明显胆瘘组的术后住院时间9.34±1.25（天）相比，隐匿性胆瘘组的术后住院时间6.97±1.62（天）相对较短。隐匿性胆瘘组术后短期并发症和长期并发症的总发生率（22.82%）略低于明显胆瘘组（30.26%），P = 0.275。隐匿性胆瘘组术后胆漏发生率为8例（8.69%），脓肿发生率为5例（5.43%），略高于明显胆瘘组的胆漏发生率5例（6.5%）和脓肿发生率2例（2.63%），P值分别为0.609和0.365，而明显胆瘘组的长期胆管狭窄发生率（10.52%）显著高于隐匿性胆瘘组（0%），P = 0.01。
隐匿性破裂经皮肝穿刺置管引流术后，由于病程隐匿、难以找到并缝合破裂口以及减压不完全，术后短期并发症胆瘘和脓肿的发生率相对较高；而明显胆瘘组因累及主要胆管，胆管狭窄的发生率显著更高。
