Freixinet J L, Mestres C A, Cugat E, Mateu M, Gimferrer J M, Catalán M, Callejas M A, Letang E, Sánchez-Lloret J
Thoracic Surgery Service, Hospital Clínico y Provincial, University of Barcelona, Spain.
Ann Thorac Surg. 1988 Apr;45(4):426-9. doi: 10.1016/s0003-4975(98)90018-2.
Between 1970 and 1985, seven patients were referred to us for surgical treatment of simultaneous hydatid cysts in the liver and the chest. Their mean age was 45.4 years (age range, 23-73 years), and they represented 46% of patients with hydatid cysts in the liver and thorax. Three patients had hepaticopleural involvement, and 3 patients had symptoms of pulmonary origin. In a single patient, only the diaphragm was involved along with the liver. Liver scintigraphy and ultrasonography were equally helpful in delineating the extent of the disease, but computed tomographic scanning is now the method of choice. The operations were through a thoracolaparotomy in 3 patients and a thoracotomy alone in 3 patients. A single patient had a thoracotomy with a transdiaphragmatic laparotomy. Complete drainage or excision of hydatid cavities was accomplished in all patients. Hydrogen peroxide instilled into the cysts was satisfactory for control of spread potentially secondary to possible intraoperative spillage. There have been no postoperative deaths. Follow-up has ranged from 6 months to 8 years, and 2 patients had relapsing hydatid disease 3 years postoperatively. These results suggest that, when hydatid disease of the liver is complicated by transdiaphragmatic extension and simultaneous pleural or pulmonary cysts, early surgical repair is indicated. Complete drainage and cyst excision are recommended.
1970年至1985年间，有7例患者因肝脏和胸部同时存在包虫囊肿而被转诊至我院接受手术治疗。他们的平均年龄为45.4岁（年龄范围为23至73岁），占肝脏和胸部有包虫囊肿患者的46%。3例患者有肝胸膜受累，3例患者有肺部症状。1例患者仅膈肌与肝脏同时受累。肝脏闪烁扫描和超声检查在明确疾病范围方面同样有帮助，但计算机断层扫描现在是首选方法。3例患者通过胸腹联合切口手术，3例患者仅行开胸手术。1例患者行开胸手术并经膈肌剖腹手术。所有患者均完成了包虫囊肿腔的完全引流或切除。向囊肿内注入过氧化氢对控制可能因术中溢出而继发的扩散效果良好。术后无死亡病例。随访时间为6个月至8年，2例患者术后3年出现复发性包虫病。这些结果表明，当肝脏包虫病合并经膈肌扩展及同时存在胸膜或肺囊肿时，应尽早进行手术修复。建议进行完全引流和囊肿切除。
