İskurt Yiğit, Yabaci Tak Aysegul, Destek Sabahattin, Akcakaya Adem, Bulbuloglu Ertan, Deger Kamuran Cumhur
Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, İstanbul-Türkiye.
Department of Biostatistics, Bezmialem Vakif University Faculty of Medicine, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 Jun;31(6):531-539. doi: 10.14744/tjtes.2025.50748.
This study aims to evaluate preoperative laboratory and radiological findings in patients with hydatid cysts to predict the severity of postoperative complications and identify markers of clinical deterioration. The goal is to refine treatment strategies, optimize clinical decision-making, and improve postoperative quality of life in the management of complicated hydatid disease.
This retrospective study included 74 patients who underwent surgical treatment for hydatid disease at our institution between September 2016 and September 2021. Patients with high American Society of Anesthesiologists (ASA) scores or hepatic lesions other than hydatid cysts were excluded. Based on the Clavien-Dindo classification, patients were categorized into two groups: Group 1 (mild complications) and Group 2 (severe complications). All patients received preoperative and postoperative albendazole therapy (15 mg/kg/day). Clinical, demographic, laboratory, and imaging data, along with cyst characteristics, surgical approach, complications, and postoperative morbidity, were analyzed to identify predictive factors for outcomes and complications.
Data from 74 patients who underwent surgery for hydatid disease were analyzed, with a median age of 43 years. The cohort was divided into two groups based on the Clavien-Dindo classification: Group 1 (mild complications, 81%) and Group 2 (severe complications, 19%). Statistically significant differences were observed in preoperative alkaline phosphatase (ALP) and hemoglobin (HGB) levels between the two groups (p<0.05). Most patients in Group 1 had simple cysts, while Group 2 showed a higher incidence of complicated cysts (p=0.023) and biliary fistulas (p=0.01). Postoperative complications, including percutaneous drainage, readmissions, and the need for endoscopic retrograde cholangiopancreatography (ERCP), were more frequent in Group 2 (p<0.001). Imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) identified biliary involvement as a significant predictor of severe morbidity. Additionally, elevated preoperative ALP levels (≥133 U/L) were found to be a significant risk factor for postoperative morbidity. Receiver operating characteristic (ROC) analysis showed that an ALP level ≥133 U/L had a sensitivity of 64.29% and a specificity of 86.67%, with an area under the curve (AUC) of 0.805. These findings underscore the importance of specific clinical and laboratory markers in predicting postoperative outcomes in hydatid disease surgery.
Effective management of liver hydatid cysts requires a multidisciplinary approach, combining surgical expertise, pharmacological treatment, and a comprehensive understanding of disease pathophysiology. Continued research is essential to refine treatment protocols, enhance surgical outcomes, and improve patients' quality of life. Our findings emphasize that specific clinical factors, such as cyst type, need for postoperative drainage, hospital readmissions, length of hospital stay, preoperative ALP levels ≥133 U/L, and biliary system involvement, are significant predictors of postoperative morbidity in patients undergoing surgery for hydatid disease.
本研究旨在评估包虫囊肿患者的术前实验室检查和影像学检查结果，以预测术后并发症的严重程度，并确定临床病情恶化的标志物。目标是优化治疗策略，完善临床决策，并改善复杂包虫病管理中的术后生活质量。
本回顾性研究纳入了2016年9月至2021年9月期间在我院接受包虫病手术治疗的74例患者。排除美国麻醉医师协会（ASA）评分高或有除包虫囊肿以外肝脏病变的患者。根据Clavien-Dindo分类，将患者分为两组：第1组（轻度并发症）和第2组（重度并发症）。所有患者术前和术后均接受阿苯达唑治疗（15mg/kg/天）。分析临床、人口统计学、实验室和影像学数据，以及囊肿特征、手术方式、并发症和术后发病率，以确定预后和并发症的预测因素。
对74例行包虫病手术的患者数据进行了分析，中位年龄为43岁。根据Clavien-Dindo分类，该队列分为两组：第1组（轻度并发症，81%）和第2组（重度并发症，19%）。两组术前碱性磷酸酶（ALP）和血红蛋白（HGB）水平存在统计学显著差异（p<0.05）。第1组大多数患者为单纯囊肿，而第2组复杂囊肿（p=0.023）和胆瘘（p=0.01）的发生率较高。第2组术后并发症，包括经皮引流、再次入院以及内镜逆行胰胆管造影（ERCP）的需求更为频繁（p<0.001）。超声、计算机断层扫描（CT）和磁共振成像（MRI）等影像学检查显示胆管受累是严重发病的重要预测因素。此外，术前ALP水平升高（≥133 U/L）被发现是术后发病的重要危险因素。受试者工作特征（ROC）分析显示，ALP水平≥133 U/L的敏感性为64.29%，特异性为86.67%，曲线下面积（AUC）为0.805。这些发现强调了特定临床和实验室标志物在预测包虫病手术术后结局中的重要性。
肝包虫囊肿的有效管理需要多学科方法，结合手术专业知识、药物治疗以及对疾病病理生理学的全面理解。持续研究对于完善治疗方案、提高手术效果和改善患者生活质量至关重要。我们的研究结果强调，特定临床因素，如囊肿类型、术后引流需求、再次入院、住院时间、术前ALP水平≥133 U/L以及胆管系统受累，是接受包虫病手术患者术后发病的重要预测因素。
