849例肝包虫囊肿超声引导下穿刺硬化治疗的疗效评价

目的对比分析我院19年间849例肝包虫囊肿患者1116个肝包虫囊肿超声引导下穿刺硬化治疗的疗效。方法 1992年7月至1999年12月我院门诊及住院的257例肝包虫囊肿患者共321个包虫囊肿,均采用传统的经超声引导穿刺硬化治疗,为传统组。2000年1月至2010年6月我院门诊及住院的592例肝包虫囊肿患者共795个包虫囊肿,均采用改进和规范的经超声引导穿刺硬化治疗,为规范组。传统组与规范组的肝包虫囊肿均在超声引导与监视下进行穿刺完成硬化治疗的全过程。规范组在技术操作中注意选择最佳路径、一次进针到位、进针抽吸同步、立即迅速减压、务必抽净囊液、选用无水乙醇、注入总量要多、多次硬化治疗、滞留时间须长、适当变动体位、避免气体进入及应保留硬化剂等关键环节。结果 849例患者穿刺成功率为99.76%(847/849);传统组与规范组的穿刺治疗有效率分别为97.28%(250/257)及99.16%(587/592);传统组与规范组的穿刺并发症发生率分别为3.11%(8/257)及1.35%(8/592),规范组明显低于传统组,差异有统计学意义(P<0.01);传统组与规范组的穿刺治疗后复发率分别为1.94%(5/257)及0.34%(2/592),规范组亦低于传统组,差异有统计学意义(P<0.01);单纯囊肿型(含内囊分离型即Ⅰ和Ⅱ型)635例(74.79%)、子囊型214例(25.21%),治疗有效率分别为99.37%(631/635)及96.26%(206/214);肝包虫囊肿直径≤49mm161例(18.96%)、50～99mm610例(71.85%)、≥100mm78例(9.87%)者治疗有效率分别为99.38%(160/161)、98.85%(603/610)、94.87%(74/78)。结论超声引导穿刺是治疗肝包虫囊肿的首选手段,注意规范技术操作中的各个环节,可显著提高疗效。

Therapeutic evaluation of percutaneous sclerotherapy of liver hydatid cysts guided by ultrasound

Objective A total of 849 cases with 1116 liver hydatid cysts treaded by percutanous puncture and sclerotherapy under ultrasound guidance were reported. Methods The patients were classified into the traditional and standard groups. In the standard group, the best pathway was adopted during the puncture sclerotherapy guided by ultrasound. The quickly aspirated cystic liquid reduced the cystic pressure when the puncture needle entry into the cyst. The pure alcohol was injected in the cystic cavity and stayed long time with changing the body position after the cystic liquid was entirely drawn, then a pure alcohol should be preserved in the cystic cavity. Results The successful puncture rate was 99.76% in two groups. The effective rate was 97.28% and 99.16%, respectively; The complication rate was 3.11% and 1.35%, respectively and the rate in the standard group was lower than that in the traditional group （P0.01）; The relapse rate was 0.51% in the traditional group, lower than that in the standard group （1.56%）, respectively （P0.01）. The effective rates of the liver hydatid cysts were 99.37% （ the pure cystic type） and 96.26% （the daughter type）; The effective rates of the size of the liver hydatid cysts were 99.38%（≤49 mm） and 98.85% （50-99 mm） and 94.87%（≥100 mm）. Conclusion The Puncture sclerotherapy was the first choice to treat liver hydatid cysts.The improving effect could be enhanced by operation skills.