Koc Cemalettin, Akbulut Sami, Sahin Tevfik Tolga, Tuncer Adem, Yilmaz Sezai
Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.
Ulus Travma Acil Cerrahi Derg. 2020 Sep;26(5):789-797. doi: 10.14744/tjtes.2020.32223.
The primary aim of this study was to present our experience on intraperitoneal rupture of the hydatid cyst in guidance of literature data.
Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with an indication of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retropectively.
Among the 29 patients with an age range of from 16 to 79 years ( median= 39, IQR=25.5), 16 were male (55.2%) and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in 7 (24.13%) (2 of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median= 90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in right lobe. Among the ruptured cysts of liver, 20 (80%) of them underwent conservative surgery (partial pericystectomy etc), remaining 5 patients (20%) underwent a radical surgical treatment (pericystectomy etc). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence.
Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock cases require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity account for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.
本研究的主要目的是结合文献数据介绍我们在肝包虫囊肿腹腔内破裂方面的经验。
回顾性分析2003年1月至2020年7月在我院接受手术治疗的29例有肝包虫囊肿腹腔内破裂指征患者的人口统计学、临床、影像学及术后随访数据。
29例患者年龄在16至79岁之间（中位数=39，四分位间距=25.5），其中男性16例（55.2%），女性13例（44.8%）。肝包虫囊肿腹腔内破裂21例（72.4%）为自发性，7例（24.13%）为外伤性（其中2例为医源性），1例因猎枪伤导致。绝大多数患者在出现症状和体征后的24小时内被送往急诊科。白细胞计数在8600至30900/mm³之间（中位数=12100，四分位间距=5700）。破裂囊肿位于肝脏25例（86.2%）、脾脏2例（6.89%）或盆腔2例（6.89%），直径在40至200mm之间（中位数=90，四分位间距=50）。在肝脏破裂的囊肿中，19例（76%）位于右叶。在肝脏破裂的囊肿中，20例（80%）接受了保守手术（部分囊肿切除术等），其余5例（20%）接受了根治性手术（囊肿切除术等）。12例（48%）患者在手术探查时在囊肿腔或肝脏切面上诊断出胆管开口。胆总管扩张或囊肿腔内可见胆管开口的患者接受了胆总管探查和T管引流术（n=6，24%）。1例患者术后第1天因囊肿破裂继发心肺并发症死亡。在中位1416天的术后随访期间，7例（24.1%）患者被诊断为疾病复发。
肝包虫囊肿腹腔内破裂是肝包虫囊肿病的一种危及生命的并发症，对此需及时诊断并把握手术治疗时机。过敏性休克病例需要迅速启动抗过敏治疗。尽管使用了杀头节剂，但囊泡播散至腹腔是疾病复发的主要危险因素。因此，应谨慎探查腹腔。
