Kornaros S E, Aboul-Nour T A
Third Department of Surgery, Tzanio Teaching Peripheral Hospital, Piraeus, Greece.
J Am Coll Surg. 1996 Nov;183(5):466-70.
Frank intrabiliary rupture of hydatid hepatic cyst is a common complication in patients with echinococcal cysts of the liver. The early diagnosis of this condition with early and appropriate operative intervention can save a high number of these patients from death.
Of 208 patients with hydatid cysts of the liver, 27 patients (13 percent) had intrabiliary rupture of the cyst. These 27 patients were managed as follows. Intrabiliary lavage of the debris remnants and biliary contents was done first, followed by radical treatment of the hepatic cyst, and finally safe drainage of the biliary tree through a T tube, choledochoduodenal anastomosis, or sphincterotomy. For radical treatment of the cyst and the residual cavity, we performed an excision of the dome and external drainage of the cavity in 17 cysts, a marsupialization in nine cysts, a partial pericystectomy in three cysts, and a reduction of the cavity and external drainage in two cysts.
The patients were followed up for as many as 14 years, and with the exception of one patient, no complications related to the method of treatment occurred.
The ideal treatment for intrabiliary rupture of hydatid hepatic cyst after early diagnosis is traditional lavage of the biliary tree, followed by radical treatment of the cyst and free drainage of the bile ducts. With this method, hepatectomy and cystojejunostomy and their drawbacks and complications are avoided.
肝包虫囊肿的胆内破裂是肝棘球蚴囊肿患者的常见并发症。早期诊断并进行早期适当的手术干预可使大量此类患者免于死亡。
在208例肝包虫囊肿患者中，27例（13%）出现囊肿胆内破裂。这27例患者的治疗如下。首先对碎片残余物和胆汁内容物进行胆内灌洗，然后对肝囊肿进行根治性治疗，最后通过T管、胆总管十二指肠吻合术或括约肌切开术对胆管进行安全引流。对于囊肿和残余腔的根治性治疗，我们对17个囊肿进行了穹顶切除和腔外引流，对9个囊肿进行了袋形缝合术，对3个囊肿进行了部分囊肿切除术，对2个囊肿进行了腔缩小和外引流。
对患者进行了长达14年的随访，除1例患者外，未发生与治疗方法相关的并发症。
肝包虫囊肿胆内破裂早期诊断后的理想治疗方法是对胆管进行传统灌洗，然后对囊肿进行根治性治疗并使胆管自由引流。采用这种方法可避免肝切除术和囊肿空肠吻合术及其缺点和并发症。
