Deo Kunal B, Kumar Rahul, Tiwari Govinda, Kumar Hemanth, Verma Ganga R, Singh Harjeet
Division of Surgical Gastroenterology, Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
HPB (Oxford). 2020 Oct;22(10):1457-1462. doi: 10.1016/j.hpb.2020.03.003. Epub 2020 Mar 28.
Surgical management is considered one of the effective treatment modality for liver hydatid. However the choice of surgery is debatable. This study aims to compare the outcome of radical surgery (RS) and conservative surgery (CS) in liver hydatid disease.
This is retrospective analysis of prospectively maintained institutional data of surgically treated liver hydatid from January 2012 to January 2019. The basis of diagnosis was typical imaging, confirmatory Hydatid serology and/or Intraoperative details. The clinical presentation, radiological data, operative detail, post-operative outcome, post-operative recurrence data was analysed.
Sixty-four patients underwent surgery during the study period and were included. RS was done in 27 (42.2%) patients and CS in 37 (57.8%) patients. The mean age was 35.6 (13-72) years. The mean size of the cyst was 10.3 ± 2.9 cm. The cyst location was peripheral in 81.5% and 56.8% in RS and CS groups respectively. Intraoperative Cyst biliary communication was detected in 48.1% of RS & 35.1% in CS group of patients. The post-operative bile leak was significantly less in RS group (7.4% vs 27.0%, p = 0.047). Postoperative endoscopic stenting for persistent biliary fistula was necessitated in five of CS and only one patient from RS group. None of RS patients had recurrence while 3 patients of CS developed recurrence.
Radical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.
手术治疗被认为是肝包虫病的有效治疗方式之一。然而，手术方式的选择仍存在争议。本研究旨在比较肝包虫病根治性手术（RS）和保守性手术（CS）的疗效。
这是一项对2012年1月至2019年1月期间接受手术治疗的肝包虫病患者的前瞻性机构数据进行的回顾性分析。诊断依据为典型影像学表现、确诊的包虫血清学检查和/或术中细节。分析了临床表现、放射学数据、手术细节、术后结果、术后复发数据。
研究期间64例患者接受了手术并被纳入研究。27例（42.2%）患者接受了根治性手术，37例（57.8%）患者接受了保守性手术。平均年龄为35.6岁（13 - 72岁）。囊肿平均大小为10.3 ± 2.9厘米。囊肿位置在根治性手术组和保守性手术组中分别有81.5%和56.8%位于周边。术中发现根治性手术组48.1%的患者和保守性手术组35.1%的患者存在囊肿与胆管相通。根治性手术组术后胆漏明显较少（7.4%对27.0%，p = 0.047）。保守性手术组有5例患者因持续性胆瘘需要术后内镜支架置入，而根治性手术组只有1例患者需要。根治性手术组患者均无复发，但保守性手术组有3例患者复发。
根治性手术可减少术后胆漏并预防复发，可能优于保守性手术。
