肝包虫病的外科治疗

目的 分析、探索肝囊型包虫病(cystic echinococcosis,CE)手术治疗的方式、适应证及其疗效。方法 分析我院2009-2013年手术治疗的肝囊型包虫患者216例。结果 内囊摘除术(A组) 术后平均住院d数、带管时间、术后残腔并发症等均显著高于其他3组(P＜0.01);手术D组的手术耗时及出血量、住院费用等均显著高于其他3组(P＜0.01)。结论 ①肝包虫外囊完整剥除术治疗可根除因内囊摘除术导致包虫复发和胆瘘等并发症;同肝切除相比具有创伤较小、并发症减少的特点,故可为CE手术治疗的首选;②对于邻近大血管、重要脏器组织或周围解剖层次不清的肝包虫,外囊次全切除术可在有效消灭残腔的同时,减少手术难度及外囊剥除术所引发手术风险。

Clinical applications of surgical treatment in cystic echinococcosis

In this study, we explored and discussed the methods, indication and effects of surgical treatment of cystic echinococcosis (CE). We compared and analyzed 216 cases of CE patients, who were chosen to have surgical treatment from January 2009 to December 2013. The length of hospital staying, time for intratracheal tube and the post operation residual cavity complication of Group A who had their capsula interna removed were higher than those of the other three groups (P＜0.01). The complete stripping treatment of the CE capsula externa could fundamentally uproot the complications caused by the removal of the capsula interna, such as echinococcosis flare-up and biliary fistula. Compared with the hepatectomy, the treatment leaved smaller degree of trauma and low complications. Therefore, it could be regarded as the top choice for the surgical treatment of CE. In terms of the echinococcosis near the great vessels and major viscera organs or echinococcosis whose peripheral dissection levels were not clear, the total removal of capsula externa could not only effectively eliminate the residual cavity, but also make the surgery easier and reduce the risks caused by the capsula externa stripping surgery.