Athanassiadi K, Kalavrouziotis G, Loutsidis A, Bellenis I, Exarchos N
Department of Thoracic and Vascular Surgery, Evangelismos General Hospital, Athens, Greece.
Eur J Cardiothorac Surg. 1998 Aug;14(2):134-40. doi: 10.1016/s1010-7940(98)00144-4.
Human echinococcosis remains a serious health problem for the Mediterranean countries, among them Greece. As there is no effective medical therapy, surgery is still the treatment of choice.
We present our experience in the surgical management of hydatidosis by a transthoracic approach, based on 85 patients (49 male, 36 female, aged 4-86 years) treated during 1986-1996.
Twenty-one patients (26.3%) appeared with complications as: hydatidemesis (n = 5), hydropneumothorax (n = 3), cyst infection (n = 3), empyema thoracis (n = 8), cholebronchial (n = 3) and cholebronchopleural fistula (n = 1). The location of the cysts was: 61 in the lungs (right, 29; left, 24; bilateral, eight), 31 on the liver dome, six in the pleural cavity, two in the mediastinum, and one in each of pericardium, chest wall, and right pararenal space. Surgical approach involved a thoracotomy or median sternotomy in all cases. Pulmonary endocystectomy and capitonnage was the procedure of choice in the surgical management. Hepatic cysts were approached through a right thoracophrenotomy and were managed with evacuation of the main and daughter cysts, suture of the diaphragm to the margins of the cyst, and drainage of the cystic and pleural cavities. There was no in-hospital mortality. Major postoperative complications were: empyema thoracis (n = 3), biliary fistula (n = 2), and bronchopleural fistula (n = 1). Five patients presented later with seven recurrences of the disease.
Transthoracic approach is a good and safe choice in surgical treatment of both the intrathoracic and the (concomitant or not) hydatid cysts on the upper surface of the liver.
人类棘球蚴病对包括希腊在内的地中海国家而言仍是一个严重的健康问题。由于尚无有效的药物治疗方法，手术仍是首选的治疗方式。
我们介绍了经胸入路手术治疗包虫病的经验，该经验基于1986年至1996年间治疗的85例患者（男性49例，女性36例，年龄4至86岁）。
21例患者（26.3%）出现并发症，包括：包虫吐（5例）、液气胸（3例）、囊肿感染（3例）、脓胸（8例）、胆支气管瘘（3例）和胆支气管胸膜瘘（1例）。囊肿的位置分布为：肺内61个（右侧29个，左侧24个，双侧8个），肝顶部31个，胸腔内6个，纵隔内2个，心包、胸壁及右肾旁间隙各1个。所有病例的手术入路均采用开胸术或正中胸骨切开术。肺内囊肿切除术及囊腔缝合术是手术治疗的首选方法。肝囊肿通过右侧胸腹联合切口处理，主要操作包括排空主囊和子囊、将膈肌缝合至囊肿边缘以及对囊腔和胸腔进行引流。住院期间无死亡病例。主要术后并发症包括：脓胸（3例）、胆瘘（2例）和支气管胸膜瘘（1例）。5例患者随后出现了7次疾病复发。
经胸入路是手术治疗胸内及肝脏上表面（无论是否合并）包虫囊肿的一种良好且安全的选择。
