Department of HBP and Liver Transplant Surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain.
J Gastrointest Surg. 2020 Feb;24(2):361-367. doi: 10.1007/s11605-019-04163-7. Epub 2019 Feb 26.
Hydatidosis is a chronic disease that is endemic and prevalent in certain regions of the world. Surgical treatment is the best option, although its main problem is that there is a high rate of recurrence. The objective of the present study was to assess its therapeutic management and the factors related to its postoperative morbidity and relapse.
A descriptive and retrospective study was made of 238 patients with hepatic hydatidosis operated from January 2006 to December 2017 at our center. An analysis was made of the variables associated with postoperative morbidity and relapse, and of the temporal pattern of that relapse.
Out of 238 patients, radical surgery was performed in 132 (55.5%) and partial cystectomy in 106 of them (44.3%). The postoperative morbidity was 42% (100/238) and the relapse rate was 7.2% (17/238). The factors associated with greater postoperative morbidity were partial cystectomy (OR, 2.83 (1.47-5.43); p = 0.002), ≥ 2 cysts (OR, 3.22 (1.51-6.86); p = 0.002), and biliary fistula (OR, 4.34 (2.11-8.91); p < 0.0001); and those associated with higher relapse rate were history of hydatidosis (OR, 4.98 (1.76-14.11); p = 0.003) and ≥ 2 cysts (OR, 3.23 (1.14-9.11); p = 0.027). The first relapses appeared after 14 months, with the greatest incidence between 14 and 36 months.
The surgical procedure applied is associated with morbidity but not with that of relapse. The observed relapse pattern demonstrates the need to maintain long-term follow-up, but with no follow-up being necessary in the first year. Broader multicenter and prospective studies are needed to establish more precise recommendations.
包虫病是一种在世界某些地区流行的慢性疾病。手术治疗是最佳选择，尽管其主要问题是复发率高。本研究旨在评估其治疗管理以及与术后发病率和复发相关的因素。
对 2006 年 1 月至 2017 年 12 月在我院接受肝包虫病手术的 238 例患者进行了描述性和回顾性研究。分析了与术后发病率和复发相关的变量，以及复发的时间模式。
238 例患者中，根治性手术 132 例（55.5%），部分囊肿切除术 106 例（44.3%）。术后发病率为 42%（100/238），复发率为 7.2%（17/238）。与较高术后发病率相关的因素包括部分囊肿切除术（OR，2.83（1.47-5.43）；p=0.002）、≥2 个囊肿（OR，3.22（1.51-6.86）；p=0.002）和胆瘘（OR，4.34（2.11-8.91）；p<0.0001）；与较高复发率相关的因素包括包虫病史（OR，4.98（1.76-14.11）；p=0.003）和≥2 个囊肿（OR，3.23（1.14-9.11）；p=0.027）。首次复发出现在 14 个月后，14-36 个月复发率最高。
应用的手术方法与发病率相关，但与复发率无关。观察到的复发模式表明需要进行长期随访，但在第一年不需要随访。需要进行更广泛的多中心和前瞻性研究，以制定更精确的建议。
