不同术式治疗原发性脾囊型包虫病的效果及安全性分析

目的分析并比较脾切除术和保脾手术(内囊摘除术或外囊次全切除术)治疗原发性脾囊型包虫病的安全性及效果,以明确最佳的术式选择。方法收集2002年4月-2017年6月收治于新疆医科大学第一附属医院并手术治疗的29例原发性脾囊型包虫病患者的临床和病理资料。按术式分为A组(脾切除术)和B组(保脾术),分析不同术式的手术耗时、术中出血量、术后肛门首次排气时间、术后带管时间、术后住院天数、住院费用、残腔并发症及复发情况。计量资料两组间比较采用t检验,计数资料两组间比较采用χ^2检验。结果A组手术耗时(167.50±41.85)minvs(125.84±28.88)min,t=3.41,P=0.002)]和术中出血量(189.00±50.65)mlvs(113.16±59.73)ml,t=3.15,P=0.004]明显高于B组。A组术后带管时间(5.00±2.36)dvs(3.16±1.34)d,t=2.70,P=0.012]和术后住院天数(7.90±1.91)dvs(5.47±1.61)d,t=3.42,P=0.004]明显高于B组。两组的术后首次排气时间、住院费用、残腔积液发生率比较差异均无统计学意义(P值均>0.05)。结论保脾手术(内囊摘除术、外囊次全切除术)治疗原发性脾囊型包虫病较脾切除术更为安全有效。

Efficacy and safety of different surgical procedures in treatment of primary splenic hydatid cysts

Objective To investigate the safety and efficacy of splenectomy versus spleen-preservation surgery (endocystectomy or subtotal pericystectomy) in the treatment of primary splenic hydatid cysts,and to determine the optimal surgical procedure for this disease.Methods A retrospective analysis was performed for the clinical and pathological data of 29 patients with primary splenic hydatid cysts who were admitted to The First Affiliated Hospital of Xinjiang Medical University from April 2002 to June 2017 and underwent surgical treatment.According to the surgical procedure,the patients were divided into group A (splenectomy) and group B (endocystectomy or subtotal pericystectomy).The two groups were compared in terms of time of operation,intraoperative blood loss,time to first flatus after surgery,catheter indwelling time after surgery,length of postoperative hospital stay,hospital costs,residual complications,and recurrence.The t -test was used for comparison of continuous data between the two groups,and the chi-square test was used for comparison of categorical data between the two groups.Results Compared with group B,group A had a significantly longer time of operation (167.50±41.85 min vs 125.84±28.88 min,t=3.41,P =0.002) and a significantly higher intraoperative blood loss (189.00±50.65 ml vs 113.16±59.73 ml,t=3.15,P =0.004).Group A had significantly longer catheter indwelling time after surgery and length of postoperative hospital stay than group B (catheter indwelling time: 5.00±2.36 d vs 3.16±1.34 d,t=2.70,P =0.012;length of postoperative hospital stay: 7.90±1.91 d vs 5.47±1.61 d,t=3.42,P =0.004).There were no significant differences between the two groups in time to first flatus after surgery,hospital costs,and incidence rate of residual cavity effusion (all P >0.05).Conclusion Spleen-preserving surgery (endocystectomy and subtotal pericystectomy) is safer and more effective than splenectomy in the treatment of primary splenic hydatid cysts.