Kune G A, Schellenberger R
Department of Surgery, University of Melbourne, Repatriation General Hospital, Heidelberg, Vic.
Med J Aust. 1988 Jul 4;149(1):26-30. doi: 10.5694/j.1326-5377.1988.tb120479.x.
During the 10-year period July 1977 to June 1987, 23 patients were referred to one surgical department with hepatic hydatid cysts. Accurate diagnosis in all but one case was possible by hydatid serology (hydatid immunoelectrophoresis and enzyme-linked immunosorbent assay), and ultrasonography or computed tomography which showed the presence of daughter cysts. Endoscopic retrograde cholangiography demonstrated the presence of hepatic-duct hydatid cysts in one case. The probable source of the hydatid infection was identified in all 23 cases. The surgical management was standardized and included the use of a suction cone to prevent spillage; the closure of biliary communications under vision; 0.5% silver nitrate solution as the scolicidal agent; primary closure of the residual cavity without drainage; omentoplasty for infected cysts; and bile-duct exploration and operative choledochoscopy for choledochal hydatid cysts. Two hepatic wedge resections were performed for hydatid cysts in a Riedel's lobe, but formal liver resection, in which normal liver tissue was sacrificed, was not necessary. There was no mortality and there were no postsurgical hepatobiliary complications such as biliary fistulas, biliary sepsis or jaundice. Three (13%) recurrences were recognized; all three recurrences occurred about five years after the removal of hydatid cysts with numerous daughter cysts, which were located in multiple cavities in both lobes of the liver. Postsurgical surveillance for several years by annual clinical review, hydatid immunoelectrophoresis testing and ultrasonography is recommended.
在1977年7月至1987年6月的10年期间，有23例肝包虫囊肿患者被转诊至某一外科科室。除1例病例外，通过包虫血清学检查（包虫免疫电泳和酶联免疫吸附测定）以及超声检查或计算机断层扫描显示存在子囊，均可做出准确诊断。内镜逆行胆管造影在1例病例中显示存在肝管包虫囊肿。在所有23例病例中均确定了包虫感染的可能来源。手术管理实现了标准化，包括使用吸引锥以防止囊液外溢；直视下封闭胆管交通；使用0.5%硝酸银溶液作为杀头节剂；对残留腔进行一期缝合而不置引流管；对感染性囊肿行网膜成形术；对胆总管包虫囊肿进行胆管探查和术中胆管镜检查。对位于Riedel叶的包虫囊肿进行了2次肝楔形切除术，但无需进行牺牲正常肝组织的正规肝切除术。无死亡病例，也未出现诸如胆瘘、胆源性败血症或黄疸等术后肝胆并发症。确认有3例（13%）复发；所有3例复发均发生在切除有大量子囊的肝包虫囊肿约5年后，这些子囊位于肝脏两叶的多个腔隙内。建议通过每年的临床复查、包虫免疫电泳检测和超声检查进行数年的术后监测。
