Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain.
Department of HBP, General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain.
Langenbecks Arch Surg. 2021 Jun;406(4):1139-1147. doi: 10.1007/s00423-020-02070-z. Epub 2021 Jan 2.
Echinococcosis, also known as hydatidosis, is a zoonosis that is endemic in many countries worldwide. Liver hydatid cysts have a wide variety of clinical manifestations, among which obstructive jaundice is one of the rarer forms. The aims of the study were to analyze the preoperative management of these patients and to record the kind of surgical treatment performed and the short- and long-term postoperative results.
A retrospective two-center observational study of patients operated upon for liver hydatidosis with initial symptoms of obstructive jaundice. Preoperative characteristics, surgical data, and postoperative complications, including biliary fistula, were recorded.
Of 353 patients operated upon for liver hydatidosis, 44 were included in the study. Thirty-five patients (79.6%) were defined as CE2 or CE3 in the World Health Organization (WHO) classification. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 25 patients (56.8%) and identified intrabiliary communication in 29. Radical surgery was carried out in 29 of the total sample (65.9%). Severe postoperative complications (Clavien-Dindo grade IIIA or higher) were recorded in 25% of patients. The factors associated with greater postoperative morbidity were age above 65 (HR 8.76 [95% CI 0.78-97.85]), cyst location (HR 4.77 [95% CI 0.93-24.42]), multiple cysts (HR 14.58 [95% CI 1.42-149.96]), and cyst size greater than 5 cm (HR 6.88 [95% CI 0.95-50]).
The presentation as obstructive jaundice causes greater postoperative morbidity. The main postoperative complication in these cases, despite radical surgery, is biliary fistula. In our series, routine preoperative ERCP did not show any benefit.
包虫病又称棘球蚴病，是一种在世界许多国家流行的人畜共患疾病。肝包虫囊肿有多种临床表现，其中阻塞性黄疸是较为罕见的一种。本研究旨在分析这些患者的术前管理，并记录所进行的手术治疗类型以及术后短期和长期结果。
对因初始症状为阻塞性黄疸而行手术治疗的肝包虫病患者进行回顾性的双中心观察性研究。记录术前特征、手术数据和术后并发症，包括胆瘘。
在 353 例因肝包虫病而行手术的患者中，有 44 例被纳入本研究。在世界卫生组织（WHO）分类中，35 例患者（79.6%）被定义为 CE2 或 CE3。25 例患者（56.8%）进行了术前内镜逆行胰胆管造影术（ERCP），其中 29 例（100%）确定存在胆管内交通。在总样本中，29 例（65.9%）进行了根治性手术。25%的患者记录到严重的术后并发症（Clavien-Dindo 分级 IIIA 或更高）。与更高术后发病率相关的因素包括年龄大于 65 岁（HR 8.76 [95%CI 0.78-97.85]）、囊肿位置（HR 4.77 [95%CI 0.93-24.42]）、多个囊肿（HR 14.58 [95%CI 1.42-149.96]）和囊肿大小大于 5cm（HR 6.88 [95%CI 0.95-50]）。
表现为阻塞性黄疸会导致更高的术后发病率。尽管进行了根治性手术，但这些病例的主要术后并发症是胆瘘。在我们的系列研究中，常规术前 ERCP 并未显示出任何益处。
