Xanthakis D S, Katsaras E, Efthimiadis M, Papadakis G, Varouchakis G, Aligizakis C
Thorax. 1981 Jul;36(7):497-501. doi: 10.1136/thx.36.7.497.
In the last 10 years we have operated on 33 cases of hydatid cyst of the liver with intrathoracic rupture. Twenty-one out of 33 cases ruptured into bronchi, in seven the rupture affected the pleural cavity, and in six simultaneous rupture into the bronchus and pleural cavity occurred. Laboratory tests were not carried out in all cases. The Casoni intradermal test was carried out in 23 cases and was positive in 18. A liver scan was performed in 10 and was positive in all. Conservative operations were carried out in 22 patients. In these the hepatic cavity was evacuated and separately drained. This was followed by suturing the diaphragmatic rupture and also closing the bronchial opening if present. Lung resections were performed in 11 out of 33 cases. In eight lobectomy was carried out and in three segmental resections. Resection was necessary when suppuration and bronchiectatic changes affected the lung. Ruptured cyst into the pleural cavity requires emergency thoracotomy after the anaphylactic shock is over. Removal of the parasite, re-expansion of the lung, and drainage of the pleural and hepatic cavities is necessary. Immediate and late complications occurred in 13 patients. In two postoperative haemorrhage occurred and in two postoperative empyema developed. Recurrent haemoptysis was seen in five, persistent bile fistula in one, and dissemination of hydatid cyst in three. In the remaining 20 cases there was no complication. Operative mortality was nil.
在过去10年里，我们对33例肝包虫囊肿伴胸腔内破裂的患者进行了手术。33例中有21例破裂入支气管，7例破裂累及胸腔，6例同时破裂入支气管和胸腔。并非所有病例都进行了实验室检查。23例进行了卡索尼皮内试验，18例呈阳性。10例进行了肝脏扫描，均呈阳性。22例患者进行了保守手术。术中先将肝腔内容物清除并分别引流，接着缝合膈肌破裂口，如有支气管开口也予以封闭。33例中有11例进行了肺切除术，其中8例行肺叶切除术，3例行肺段切除术。当肺出现化脓和支气管扩张性改变时，有必要进行切除。囊肿破裂入胸腔者，在过敏性休克过后需紧急开胸手术。必须清除寄生虫、使肺复张并引流胸腔和肝腔。13例患者出现了近期和远期并发症。2例术后发生出血，2例术后出现脓胸。5例出现反复咯血，1例出现持续性胆瘘，3例出现包虫囊肿播散。其余20例无并发症发生。手术死亡率为零。
