Vâlcea Sebastian, Dumitriu Bogdan Cristian, Beuran Mircea, Feier Catalin Vladut Ionut
Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania.
Department of Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania.
Healthcare (Basel). 2025 May 6;13(9):1077. doi: 10.3390/healthcare13091077.
Cystic echinococcosis (CE) remains a significant health concern in endemic areas, including Romania, where hepatic hydatid cysts frequently require surgical treatment. Surgery represents the cornerstone of therapy, particularly in large, complicated, or symptomatic cysts, where medical or minimally invasive options may be insufficient. This study aims to investigate the clinical characteristics, risk factors, and postoperative evolution of patients undergoing surgical intervention for hepatic CE in a tertiary care center over a five-year period.
This retrospective study examined data from 62 patients who underwent surgical procedures for hepatic CE during a 5-year period. The analysis focused on demographic parameters, cyst morphology, surgical techniques employed, and postoperative complications, with particular attention to the frequency, management, and outcomes of biliary fistulas.
The study cohort had an average age of 44.1 years, with a slight predominance of female patients (51.6%). The majority of cysts (62.9%) were located in the right hepatic lobe, with an average diameter of 10.9 cm. Postoperative complications were recorded in 25.8% of cases, with biliary fistulas being the most frequent (12.9%). Patients who developed biliary fistulas presented significantly larger cysts (152.13 ± 105.68 mm vs. 102.20 ± 37.86 mm, = 0.012) and required an extended length of hospitalization, particularly in high-output cases (29 vs. 9.3 days, = 0.045). Hospital stays and treatment expenses were notably higher among patients with biliary fistulas.
Biliary fistulas were observed exclusively in patients who underwent partial cystectomy. This finding highlights the need for increased caution when performing partial cystectomy, especially in cases involving large or recurrent cysts, where the risk of postoperative biliary fistulas is higher. Tailoring the surgical technique based on cyst characteristics and incorporating intraoperative strategies to manage or prevent biliary leakage may help reduce morbidity. Early identification and multidisciplinary management of high-risk cases are key to improving outcomes in hepatic CE.
在包括罗马尼亚在内的流行地区，囊性棘球蚴病（CE）仍然是一个重大的健康问题，在这些地区，肝包虫囊肿常常需要手术治疗。手术是治疗的基石，特别是对于大型、复杂或有症状的囊肿，在这些情况下，药物或微创治疗方案可能并不充分。本研究旨在调查一家三级医疗中心在五年期间接受肝CE手术干预患者的临床特征、危险因素及术后病情演变。
这项回顾性研究检查了5年间62例接受肝CE手术患者的数据。分析集中在人口统计学参数、囊肿形态、所采用的手术技术及术后并发症，特别关注胆瘘的发生率、处理及结果。
研究队列的平均年龄为44.1岁，女性患者略占多数（51.6%）。大多数囊肿（62.9%）位于肝右叶，平均直径为10.9厘米。25.8%的病例记录有术后并发症，其中胆瘘最为常见（12.9%）。发生胆瘘的患者囊肿明显更大（152.13±105.68毫米对102.20±37.86毫米，P=0.012），并且需要更长的住院时间，特别是在高流量病例中（29天对9.3天，P=0.045）。胆瘘患者的住院时间和治疗费用明显更高。
胆瘘仅在接受部分囊肿切除术的患者中观察到。这一发现凸显了在进行部分囊肿切除术时需要更加谨慎，特别是在涉及大型或复发性囊肿的病例中，这些病例术后发生胆瘘的风险更高。根据囊肿特征调整手术技术并纳入术中策略来处理或预防胆漏可能有助于降低发病率。对高危病例进行早期识别和多学科管理是改善肝CE治疗效果的关键。
