肝包虫病手术治疗的疗效评价

目的 评价肝包虫外膜内外囊完整摘除术与其他不同术式的疗效.方法 对我院1999年11月至2007年11月间收治的244例肝包虫病手术患者的疗效进行分析,188例获得随访,随访中位时间为36个月(3～96个月).术式分为传统术式(保留外囊组)和根治性术式组(切除外囊组),根治性术式组又分肝包虫外膜内外囊完整摘除术组和以肝切除技术为基础的外囊完整切除术组.观察指标为术后并发症、死亡率、原位复发率、生存率、生活质量.并对各组数据行统计学分析.结果 外囊切除术的术后残腔并发症及原位复发率均低于保留外囊术式组(P<0.01).而闭合性肝包虫外膜内外囊完整摘除术并发症低于其他根治性术式.外囊完整切除术生存率高、生活质量高于传统术式.结论 肝包虫外膜内外囊完整摘除术可降低残腔并发症发生率与原位复发率,而闭合性肝包虫外膜内外囊完整摘除术安全、有效、预后佳,应首选.     

紧邻肝内外大血管肝包虫囊肿的外科治疗

目的 探讨手术治疗紧邻肝内、外大血管细粒棘球蚴包虫囊肿的效果.方法 回顾性分析1999年11月至2007年1月行手术治疗的36例共45个紧邻肝内、外大血管包虫囊肿的疗效.结果 39个包虫囊肿成功行外囊完整摘除术,6个行外囊大部分摘除术,肝内、外囊肿周围大血管均保存完整,无并发症发生.结论 外膜内、外囊完整摘除术和内囊摘除+外囊大部分摘除术治疗紧邻肝内、外大血管包虫囊肿安全、有效.     

肝包虫病的手术治疗体会：附212例报告

目的总结肝包虫病212例手术治疗的经验。方法对1999—2009年收治的212例肝包虫病患者的临床资料进行回顾分析。结果其中101例行内囊摘除,外囊内翻缝合或填入大网膜缝合关闭死腔术,84例行包虫外膜内完整摘除的根治性手术,27例行经皮肝脏囊肿穿刺术行内囊去除加残腔引流,均临床治愈。结论外科手术是肝包虫病的主要治疗方法,依据病情和医生的工作经验可采用内囊摘除,外囊内翻缝合或填入大网膜缝合关闭死腔术。包虫外囊完整摘除的根治性手术;经皮肝脏囊肿穿刺术行内囊摘除加残腔引流,均是治疗肝包虫病的有效方法。     

肝包虫内囊摘除术后引流不当致并发症的分析

肝包虫病是我国西北牧区常见的肝脏寄生虫病，肝包虫囊肿完整摘除或肝包虫外膜内完整摘除术，已基本解决了残腔积液及包虫复发等并发症，但仍不能代替传统手术，我院近年收治3例不能行包虫囊肿完整摘除的病人，而改行传统手术，术后由于引流管处理不当，而致并发症，现报告如下。[第一段]     

腹腔镜治疗肝包虫病:附120例报告

目的　总结腹腔镜治疗肝包虫病的临床经验。方法　回顾性分析腹腔镜肝包虫内囊摘除术 12 0例的临床资料。结果　手术均获成功。未发生肝包虫囊液溢出及过敏性休克。无手术死亡。 4例术后复发 (非原发部位 ) ,8例术后胆漏 ,8例残腔积液 ,1例术后出血 ,均获治愈。结论　腹腔镜肝包虫内囊摘除术是治疗肝包虫病安全、有效的微创方法     

肝包虫囊完整剥除术的手术技术与适应证探讨:附64例临床报告

目的探讨肝包虫囊完整剥除术治疗肝包虫病的适应证与疗效评价。方法从2002年6月至今，采用肝包虫囊完整剥除术治疗64例肝包虫病病人。结果全组病人术后恢复良好、无术后残腔积液、出血、感染等较严重并发症，其中2例出现胆瘘（3．13％），术后分别于第9和第12天愈合，随访4～32个月，目前尚无一例原位复发。结论肝包虫囊完整剥除术治疗肝包虫病可消除以往传统的内囊摘除术导致残腔复发和胆汁瘘等问题；与肝叶切除相比具有并发症少、创伤较小、操作较易掌握；根据本组临床治疗和随访，可认为是根治性治疗肝包虫的合理而可行的新术式。     

肝包虫囊肿完整摘除体会

肝包虫病是西北牧区常见的人畜共患的肝脏寄生虫病,目前治疗以包虫囊肿摘除术为主,但术后常出现残腔积液及包虫囊肿复发而再次手术。肝包虫囊肿完整摘除,作为一种新的手术,国内报道还不多。我院自2000年7月至今对16例肝包虫病施行囊肿完整摘除术,解决了残腔积液及包虫复发,效果满意,报告如下。     

肝包虫囊肿手术方法的改进

本文介绍我科1953～1990年间1181例肝包虫囊肿手术治疗的结果,阐述了各种手术的方法、操作要点和适应证,并重点介绍了外囊敞开术和完整内囊摘除术。作者认为肝包虫囊肿外囊敞开术和完整内囊摘除术是治疗肝包虫囊肿的两种较理想的手术方法。     

肝包虫囊肿压迫下腔静脉的外科治疗

目的探讨肝包虫囊肿压迫下腔静脉的外科治疗。方法采用回顾性描述性研究方法。收集2013年5月至2018年5月石河子大学医学院第一附属医院收治的10例肝包虫囊肿压迫下腔静脉病人的临床资料;男7例,女3例;年龄为(46±5)岁,年龄范围为38~51岁。根据术中肝包虫囊肿与下腔静脉的贴合程度以及囊肿完整切除的难易程度,分别行外膜内外囊完整切除术、外膜内外囊次全切除术、外膜内外囊完整切除联合下腔静脉部分切除术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,于术后3、6、12、24个月门诊随访1次。行彩色多普勒超声检查了解病人肝包虫囊肿复发及下腔静脉栓塞情况。随访终点为术后2年,随访次要终点为肝包虫囊肿复发。随访时间截至2020年5月。正态分布的计量资料以x±s表示。计数资料以绝对数表示。结果(1)手术情况:10例病人均顺利完成手术,7例行外膜内外囊完整切除术,2例行外膜内外囊次全切除术,1例行外膜内外囊完整切除联合下腔静脉部分切除术。10例病人术中无大出血及感染性休克发生。10例病人手术时间为(99±27)min;术中出血量为(99±48)mL。(2)术后情况:10例病人术后2~5 d拔除引流管,无术后出血、术后残腔感染、术后胆瘘发生,无围术期死亡病人,术后住院时间为(7.1±1.8)d。(3)随访情况:10例病人中,9例完成终点随访,随访时间内均无肝包虫囊肿复发及下腔静脉栓塞形成;1例病人于术后12个月,第3次随访失访,此病人术后3、6个月随访未发现肝包虫囊肿复发及下腔静脉栓塞。结论外膜内外囊完整切除术、外膜内外囊次全切除术、外膜内外囊完整切除联合下腔静脉部分切除术均能完整切除肝包虫囊肿。     

肝包虫破入胆道致化脓性胆管炎100例诊治体会

包虫病是我国西北牧区常见的寄生虫病,尤以肝包虫病最为常见.肝包虫破入胆道是包虫病常见的并发症之一,肝包虫囊肿完整摘除~([1])或肝包虫外膜完整摘除术~([2]),基本解决了肝包虫破入胆道术后残腔积液及包虫复发等并发症.我院1996-2008年共收治此类患者100例,现将诊治体会报告如下.     

Hepatic hydatid cyst ruptured in the peritoneum

Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.     

Hydatid cyst in the biceps and gluteus muscles: case report

BACKGROUND: Primary hydatid disease in the muscle is extremely rare. Usually, intramuscular hydatid cysts are secondary, resulting either from the spread of cysts spontaneously or after operations for hydatidosis in distant regions. METHODS: Report of two unusual cases of primary hydatid cysts in the gluteus and biceps brachii muscles, behaving as enlarging soft-tissue tumors, with review of the pertinent English-language literature. RESULTS: Magnetic resonance imaging and ultrasound examinations revealed an intramuscular cyst in the anterior aspect of one patient's biceps brachii and the other patient's gluteus maximus muscle; and no cyst existed in any other location. The cysts were excised totally, and the diagnosis of muscular hydatidosis was confirmed by histopathologic examination. In followup of two years after the operation, there has been no recurrence in either patient. CONCLUSION: In geographic regions where hydatidosis is endemic, hydatid cyst should be included in the differential diagnosis of a cystic mass in the muscle to avoid fine-needle biopsy and the consequences of spillage of cyst contents.     

Secondary gallbladder hydatidosis and nonfragmanted germinative membrane sourced obstructive jaundice caused by intrabiliary ruptured hepatic hydatid cyst (a case report): two rare complication of the intrabiliary ruptured hepatic hydatid cyst

Intrabiliary rupture is the most frequently seen complication of the hepatic hydatid cysts. Obstructive jaundice can be seen as a complication of the intrabiliary ruptured hepatic hydatid cysts due to the migrated cystic content into bile ducts. In this study, we present two rare complications seen in a patient who has intrabiliary ruptured hepatic hydatid cyst. Obstructive jaundice and secondary gallbladder hydatidosis depending on to the intrabiliary ruptured hepatic hydatid cyst in a 58-year-old man patient were diagnosed and treated. A large choledochal nonfragmanted germinative membran was found in the choledochus as the reason of biliary obstruction. Hepatic hydatid cyst is a world-wide disease. Intrabiliary rupture must be kept in mind in the patients who has hepatic hydatid cyst and biliary tract problems.     

Uncommon abdominal sites of hydatid disease. Our experience with the surgical treatment of 15 cases

The aim of this retrospective study is to report on a series of 15 patients with abdominal hydatid disease in uncommon sites submitted to surgery in our unit over the period 1974-2003. Eight women and 7 men (mean age: 48.4 years) were included in the study. The hydatid cysts were located in the peritoneum in 8 patients, in the spleen in 5, in the kidney in 1 and in the retroperitoneum in 1. In 4 cases the peritoneal cysts were solitary, while 4 patients in this subgroup presented multiple cysts and 2 had concomitant liver hydatidosis. The splenic cysts were solitary in 2 cases, associated with a hepatic cyst in 2 and with a lung cyst in 1. The renal and retroperitoneal cysts were both solitary. The diagnosis was made at operation in 3 cases, while in 12 patients it was made by serological tests, ultrasonography and/or CT. All patients were operated on: we performed a total cystectomy in 7 patients with peritoneal cysts and in the patient with a retroperitoneal location, splenectomy in the 5 splenic cysts and a partial cystectomy with external drainage of the residual cavity in 1 peritoneal cyst and in the renal location. The postoperative course was regular with no mortality and no major morbidity in 14 patients, while 1 patient submitted to splenectomy developed a subphrenic abscess that required surgical drainage. Two recurrences occurred in patients with peritoneal cysts 71 and 20 months, respectively, after the first operation and these were managed by total cystectomy. The diagnosis of uncommon abdominal sites of hydatid disease is more accurate today because of the new imaging techniques, which are often able to show specific radiological signs of hydatid disease. The treatment of choice is surgical and complete removal of the cyst is the gold standard, but its feasibility is related to the location of the cyst.     

Hydatid cysts of liver and portal hypertension

Two cases of portal hypertension due to hydatid cysts of the liver are reported. In one of the patients, symptoms were secondary to obstruction of inferior vena cava and hepatic outflow tract. The other patient was operated on with a diagnosis of extrahepatic presinusoidal portal hypertension caused by extrinsic compression of the liver by an hydatid cyst. Although hydatidosis is a benign disease, it can produce serious complications as in these reported cases. Therefore hydatidosis should be remembered amongst the causes of portal hypertension in countries where the disease is endemic.     

Isolated unilocular renal hydatid cyst: a rare diagnostic difficulty with simple cyst

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision.     

Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review

Primary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach.We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of follow-up. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations.     

Massive splenic hydatid cyst

Hydatid disease can involve any organ of the body and a high suspicion of this disease is justified in endemic regions. A case of massive splenic hydatid cyst with hepatic hydatidosis presented with 5 years history of abdominal distension with discomfort is reported. Clinically she had massive splenomegaly with hepatomegaly. Laboratory and radiological findings were diagnostic of hydatid disease of the liver and spleen. Peroperatively huge (35 x 20 cm) splenic hydatid cyst with two liver cysts was seen. Splenectomy was performed and hepatic lesions were subjected to endocystectomy with capsulorrhaphy.     

Simultaneous operation for right pulmonary and liver echinococcosis

Of 156 patients referred in 1977-1987 for pulmonary hydatid cyst, nine were found to have simultaneous affection of the right lung and the liver. The diagnosis of concomitant liver cyst was made from radiographic dumbbell elevation of the diaphragm (3 cases), by preoperative ultrasound scan and computed tomography in (5 cases), and by intraoperative palpation through the diaphragm (1 case). The hepatic cysts were removed via the thoracotomy performed for removal of the lung cyst in seven patients and via thoracolaparotomy in two. The postoperative course was satisfactory and no recurrence of cyst has been observed, although mebendazole was not given. In cases of hydatidosis of the right lung, preoperative search should be made for subdiaphragmatic concomitant liver cyst which can be removed through the same thoracotomy.     

Our experience in the surgical treatment of peritoneal hydatid disease

The Authors report on a series of 9 patients with peritoneal hydatidosis submitted to surgery during the period between 1974 and 2003. In 5 cases the cyst was solitary, while in 3 patients the cysts were multiple, in 1 spread and in 2 there was a concomitant liver hydatidosis. In 2 patients the disease was asymptomatic, while 4 cases were revealed by pain and 3 by an abdominal mass. The diagnosis was made at the operation in 3 patients, while it was performed by ultrasonography in 1 case, by CT scan in 4 and by both methods in 1. All patients were operated on: 7 underwent total cystectomy and partial cystectomy with external drainage of residual cavity was performed in one; the spread disease was managed by omentectomy, ovariectomy and appendectomy. Postoperative course was regular without mortality and major morbidity in all patients. Two recurrences occurred 71 and 20 months after removal of the primary cysts and they were managed by total cystectomy. The Authors believe that the diagnosis of peritoneal hydatid disease is today more accurate because of the new image techniques and the surgical procedure should be tailored to each patient depending on size, location and complications of the cyst, although the results of radical treatment are better.