肝包虫囊肿保守性手术后的术后发病风险因素：151例肝包虫囊肿的回顾性研究
Postoperative morbidity risk factors after conservative surgery of hydatic cyst of the liver: a retrospective study of 151 hydatic cysts of the liver.
作者信息
Ghannouchi Mossaab, Rodayna Hawas, Ben Khalifa Mohamed, Nacef Karim, Boudokhan Moez
机构信息
Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia.
出版信息
BMC Surg. 2022 Mar 30;22(1):120. doi: 10.1186/s12893-022-01570-7.
BACKGROUND
The purpose of the present paper is to assess the morbidity specifics risk factors of hepatic hydatid cyst after conservative surgery.
METHODS
We conducted a retrospective study of 102 patients over a period of 13 years, from 2006 to 2019. We included all patients operated on hydatid cyst of the liver, complicated and uncomplicated, in the Department of General Surgery in Tahar Sfar hospital, Mahdia, Tunisia. We excluded patients who received an exclusive medical treatment and those who have other hydatic cyst localizations.
RESULTS
The cohort was composed of 102 patients with a total of 151 cysts operated on using conservative surgery, among them there was 75 women (73.5%) and 27 men (26.5%). The median age was 43, with extremes ranging from 12 to 88 years. The majority of patients (94.1%) were from rural areas. The cysts were uncomplicated in about half of the cases (48%), elsewhere complications such as compression of neighboring organs (25.5%), opening in the bile ducts (16.7%), infection (9.8%), and rupture in the peritoneum (2%) were found. Conservative surgery was the mainstay of treatment with an overall mortality rate of 1.9%. The overall morbidity rate was 22%: 14% specific morbidity and 8% non-specific morbidity. External biliary fistula was the most common postoperative complication (9%). The predictive factors of morbidity in univariate analysis were: preoperative hydatid cyst infection (P = 0.01), Compressive cysts (P = 0.05), preoperative fever and jaundice, (respectively P = 0.03 and P = 0.02), no one achieved statistical significance in the multivariate model.
CONCLUSIONS
Preoperative hydatid cyst infection, compressive cysts and preoperative fever and jaundice could be predictor factors of morbidity after conservative surgery for liver hydatid cyst. They must be considered in the treatment and the surgical decision for patients with hydatid cyst.
背景
本文旨在评估保守性手术后肝包虫囊肿的发病特征及危险因素。
方法
我们对2006年至2019年期间的102例患者进行了为期13年的回顾性研究。纳入了突尼斯马赫迪耶塔哈尔·斯法尔医院普通外科所有接受肝包虫囊肿手术的患者，包括复杂和不复杂的病例。排除了仅接受药物治疗的患者以及有其他包虫囊肿定位的患者。
结果
该队列由102例患者组成，共151个囊肿接受了保守性手术，其中女性75例（73.5%），男性27例（26.5%）。中位年龄为43岁，年龄范围为12至88岁。大多数患者（94.1%）来自农村地区。约一半的病例（48%）囊肿无并发症，其他地方发现了如邻近器官受压（25.5%）、胆管开口（16.7%）、感染（9.8%）和腹膜破裂（2%）等并发症。保守性手术是主要治疗方法，总死亡率为1.9%。总发病率为22%：特异性发病率为14%，非特异性发病率为8%。外部胆瘘是最常见的术后并发症（9%）。单因素分析中发病的预测因素为：术前包虫囊肿感染（P = 0.01）、压迫性囊肿（P = 0.05）、术前发热和黄疸（分别为P = 0.03和P = 0.02），在多变量模型中均未达到统计学意义。
结论
术前包虫囊肿感染、压迫性囊肿以及术前发热和黄疸可能是肝包虫囊肿保守性手术后发病的预测因素。在对包虫囊肿患者进行治疗和手术决策时必须考虑这些因素。
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