Davoodabadi Abdoulhossein, Najjarian Fatemeh, Azadchehr Mohammad Java, Abdorrahhmkashi Esmail, Davoodabadi Hassan, Alijanpour Aboulhassan, Haghpanah Babak
Department of General and Thoracic Surgery, Kashan University of Medical Sciences, Kashan, Iran.
Departments of General Surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
Tanaffos. 2024 Apr;23(4):355-363.
There are some controversies on surgical options for pulmonary hydatid cysts. We analyzed our experience in lung tissue preservation during the surgical treatment and optimal surgical options.
This observational cohort analysis was conducted from July 2008 to July 2022. The Age, sex, clinical manifestation, recurrent rate, hospital length of stay, postoperative complications, and long-term results in each group were assessed. The American Society of Anesthesiologists Physical Status, Charlson Co-Morbidity Index (CCI), Complexity of surgery, and Clavien-Dindo score were also determined.
Out of 138 patients, 81case (53.5%) had intact cysts (G1), and the rest were infected cysts which in turn were subdivided into early infected (G2) and cavity suppurated=28 cases (18.4%) as (G3). Group G3 required special attention because the pericyst surface was severely inflamed, dirty, and had pus, so they were subdivided into 3 distinctive groups including G3a, undergone cystectomy, bronchial opening closure alone, G3b group, undergone cystectomy, capitonnage+bronchial opening closure and G3c group, in which pericystectomy also added to previously mentioned procedures. Major complications in the subgroups of G3a were 2 patients and G3b 3 patients, but in the subgroup of G3c, no considerable complications were seen. Cystectomy, closure of major bronchial opening, and capitonnage were done in intact, and early infected cysts. The results of both were the same, with no considerable major complication.
Capitonnage significantly decreased the complication rate. The optimized approach in both G1 and G2 was: cystectomy, closure of major bronchial opening, and capitonnage. In G3, bronchial opening closure, pericystectomy, and capitonnage were the preferred procedures.
肺包虫囊肿的手术选择存在一些争议。我们分析了手术治疗过程中肺组织保留的经验以及最佳手术选择。
本观察性队列分析于2008年7月至2022年7月进行。评估了每组患者的年龄、性别、临床表现、复发率、住院时间、术后并发症及长期结果。还确定了美国麻醉医师协会身体状况评分、查尔森合并症指数（CCI）、手术复杂性及Clavien-Dindo评分。
138例患者中，81例（53.5%）为完整囊肿（G1组），其余为感染性囊肿，后者又细分为早期感染（G2组）和空洞化脓性囊肿28例（18.4%）为（G3组）。G3组需要特别关注，因为囊肿周围组织表面严重发炎、污秽且有脓液，因此将其细分为3个不同组，包括G3a组，仅行囊肿切除术及支气管开口闭合术；G3b组，行囊肿切除术、填塞术+支气管开口闭合术；G3c组，除上述操作外还加行了囊肿周围组织切除术。G3a亚组有2例主要并发症，G3b亚组有3例，但G3c亚组未见明显并发症。完整囊肿和早期感染性囊肿均行囊肿切除术、主要支气管开口闭合术及填塞术。两者结果相同，均无明显主要并发症。
填塞术显著降低了并发症发生率。G1组和G2组的优化方法是：囊肿切除术、主要支气管开口闭合术及填塞术。在G3组，支气管开口闭合术、囊肿周围组织切除术及填塞术是首选手术方式。
