Gunay K, Taviloglu K, Berber E, Ertekin C
Surgical Emergency and Trauma Department, Istanbul Faculty of Medicine, Istanbul University, Turkey.
J Trauma. 1999 Jan;46(1):164-7. doi: 10.1097/00005373-199901000-00028.
Trauma as a cause of hydatid cyst rupture leads to various clinical sequelae. However, extensive data in the current literature regarding clinical presentation and management of such patients are lacking.
This article is a retrospective review of 16 patients with traumatic rupture of hydatid cysts treated at a university hospital in an endemic area.
Falls (44%) were the most common cause of trauma. The ruptured cysts were located in the liver in 13 patients (81%), in the spleen in 2 patients, and in the lung in 1 patient. Computerized tomography had a sensitivity of 100% in demonstrating cyst rupture; whereas, ultrasonography had a sensitivity of 85%. Ten patients (62%) had rupture into the peritoneal cavity and 5 patients (31%) into the biliary tree. Five (31%) of the cysts were infected. Surgical procedures included introflexion (five patients), pericystectomy-choledochoduodenostomy (three patients), external drainage-choledochoduodenostomy (two patients), unroofing-external drainage (two patients), splenectomy (two patients), unroofing (one patient), and right hepatectomy (one patient). Mean length of hospitalization was 15.9 days (range, 5-61 days). One patient (6%) died, and eight patients (50%) developed complications. Nine patients (56%) were followed-up for an average of 30 months (range, 3-72 months), and there was no recurrence.
Computed tomography is currently the most sensitive diagnostic tool for demonstrating hydatid cyst rupture. The surgical options vary depending on intraoperative findings. Allergic reactions and recurrence as a result of intraperitoneal spillage are not as common as once believed. Biliary rupture is associated with an increased rate of wound infection.
创伤作为包虫囊肿破裂的一个原因会导致各种临床后遗症。然而，当前文献中缺乏关于此类患者临床表现及治疗的广泛数据。
本文是对某流行地区一所大学医院收治的16例创伤性包虫囊肿破裂患者的回顾性研究。
跌倒（44%）是最常见的创伤原因。破裂的囊肿位于肝脏的有13例患者（81%），位于脾脏的有2例患者，位于肺脏的有1例患者。计算机断层扫描在显示囊肿破裂方面的敏感性为100%；而超声检查的敏感性为85%。10例患者（62%）囊肿破裂进入腹腔，5例患者（31%）进入胆管树。5个（31%）囊肿发生感染。手术方式包括内翻术（5例患者）、囊肿切除术 - 胆总管十二指肠吻合术（3例患者）、外引流 - 胆总管十二指肠吻合术（2例患者）、开窗引流术（2例患者）、脾切除术（2例患者）、开窗术（1例患者）和右肝切除术（1例患者）。平均住院时间为15.9天（范围5 - 61天）。1例患者（6%）死亡，8例患者（50%）出现并发症。9例患者（56%）接受了平均30个月（范围3 - 72个月）随访，无复发情况。
计算机断层扫描目前是显示包虫囊肿破裂最敏感的诊断工具。手术方式因术中发现而异。腹膜内溢出导致的过敏反应和复发并不像曾经认为的那么常见。胆管破裂与伤口感染率增加有关。
