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。     

185例肝囊型包虫病破裂的急诊救治分析

目的 探讨肝囊型包虫病破入腹腔和胆道的急诊诊治疗效.方法 根据2002年新疆医科大学第一附属医院包虫病专业组提出包虫病规范化治疗方案,本院1994年至2009年急诊收治的185例肝囊型包虫病破裂患者分为两组,对其临床资料进行回顾性分析,并加以对比.结果 肝囊型包虫病破入腹腔患者中,传统内囊摘除组(A1组)术后残腔并发症、带管引流时间、术后平均住院天数、原位复发率、腹腔播散种植等均显著高于改良内囊摘除组(B1组)(P＜0.05),而A1组与B1组手术耗时、术中出血量等无差异(P＞0.05).肝囊型包虫病破入胆道患者中,传统内囊摘除组(A2组)术后残腔并发症、带管引流时间、术后平均住院天数、原位复发率等亦明显高于改良内囊摘除组(B2组)(P＜0.05),而A2组与B2组手术耗时、术中出血量、腹腔播散种植等无差异(P＞0.05).在185例肝囊型包虫病破裂患者中,因过敏性休克抢救无效死亡1例,死亡率为0.54％.结论 肝囊型包虫病破裂患者应在积极抗休克、抗感染、抗过敏治疗的同时,积极完善术前检查实施急诊手术.改良内囊摘除术的术后复发、残腔并发症等明显低于传统内囊摘除术.肝囊型包虫病破裂患者术后应服用抗包虫药,以防治复发.     

肝包虫外囊剥除术临床应用与评价

目的 评价肝囊型包虫手术改进方式的临床应用效果.方法 将包虫外囊次全切除组(65例)作为实验组,肝包虫内囊摘除组(71例)及包虫外囊完整剥除组(62例)作为对照组进行回顾性对比研究.结果 包虫外囊次全切除组的体温恢复时间、术后住院时间、残腔形成、胆瘘、原位复发、每日引流量、引流管拔出时间、肝门阻断时间、破人胸腔、反应性胸腔积液、出血等均显著短或少于内囊摘除组及外囊完整剥除组(P＜0.01).结论 肝包虫外囊次全切除术是一种安全、方便、损伤小、并发症少的根治性术式,有利于在基层医院推广应用.     

肝囊性包虫病的三种术式比较

目的 探讨外囊剥除术(包括外囊完整剥除术及外囊次全切除术)治疗肝囊性包虫病的体会及治疗价值.方法 回顾分析近6年来开展的外囊剥除术治疗肝囊性包虫病的临床资料36例,并与38例传统内囊摘除手术病例加以比较,观察其术后住院天数、腹腔引流天数、残腔置管天数、残腔积液、残腔感染、胆汁漏、原位复发率等临床指标.结果 外囊剥除术治疗肝囊性包虫病,其手术彻底、安全,平均住院天数及腹腔引流天数明显少于传统内囊摘除术组且术后无胆漏、残腔积液、残腔感染、原位复发等并发症发生.结论 外囊剥除术(包括外囊完整剥除术及外囊次全切除术)是目前治疗肝囊性包虫病的一种比较理想的新的根治方法.     

肝包虫破入胆道的诊断与治疗

目的探讨肝包虫破入胆道的诊断和治疗方法。方法回顾分析了32例肝包虫破入胆道病例的临床表现、影像诊断、外科手术处理、术后并发症及病理特点。结果核磁共振胆胰管造影(MRCP)对高度可疑肝包虫破入胆道病例是准确、无创、有效的诊断方法,内镜逆行胰胆管造影(ERCP)有确诊意义;31例施行肝包虫内囊摘除及残腔引流,其中30例胆总管探查"T"型管引流术,1例Roux-en-Y胆总管空肠吻合术,视术中是否缝合胆瘘口而分缝合组和未缝合组,缝合组14例中2例出现术后残腔胆瘘,而未缝合组17例中出现8例。缝合组平均住院11 d(9～13 d),未缝合组18 d (14～27 d)(P<0.05);1例在外院施行肝包虫内囊摘除术后出现严重残腔胆瘘病人施行ERCP十二指肠乳头切开清理胆道引流术。结论MRCP对肝囊型包虫破入胆道病人具有诊断准确和无创等优点,ERCP不仅对肝包虫破入胆道有确诊意义,而且又可对该病术后并发症实施有效的治疗。根据本组临床治疗观察认为缝合胆瘘,胆总管减压是治疗肝包虫破入胆道的简单、安全、有效、并发症少的方法,而术中胆道造影是发现胆瘘口的有效手段。     

腹腔镜包虫内囊摘除、外囊敞开术55例报告

目的:探讨应用腹腔镜技术行肝包虫内囊摘除、外囊敞开术的疗效。方法:回顾分析我院为55例肝包虫病患者行腹腔镜包虫内囊摘除、外囊敞开术的临床资料。结果:手术均获成功,未发生肝包虫囊液溢出、过敏性休克及手术死亡病例。术后5例复发(非原发部位),2例胆漏,3例残腔积液,经对症治疗均痊愈。结论:腹腔镜包虫内囊摘除、外囊敞开术是治疗肝包虫病有效、安全的微创术式。     

胆道镜探查和鼻胆管引流治疗复杂肝包虫合并胆瘘临床研究

目的 评价胆道镜和鼻胆管引流治疗复杂肝包虫病合并胆瘘的应用价值.方法 回顾性总结分析复杂肝包虫合并胆瘘144例的临床资料.其中肝包虫内囊摘除+术中胆道镜探查和鼻胆管引流术组68例(治疗组),传统的内囊摘除术组76例(对照组),比较两组术式平均住院天数、残腔引流置管时间及残腔胆漏、残腔感染等指标.结果 两组比较,治疗组T管使用率、残腔感染、术后胆瘘发生率明显低于对照组;住院时间、带管出院率和平均带管天数明显小于对照组,差异均有统计学意义(P＜0.05).结论 复杂肝包虫手术中使用胆道镜检查和引导鼻胆管引流,可减少包虫内容物残留和胆瘘漏诊,能可靠地处理胆瘘,减轻胆道压力,部分胆漏患者可以一期缝合胆总管,术后胆瘘和残腔感染发生率低,技术难度低,值得推广.     

肝包虫病的诊断与术式选择

目的：提高肝包虫病的诊断和治疗水平。方法：对452例肝包虫病的临床资料进行回顾性分析。结果：术前确诊449例（99．3％），误诊3例（0．7％），包虫破裂33例（7．3％）。包虫囊液皮试（Casoni试验）、B超、X线及放射性核素肝扫描有诊断价值。452例内囊均采用穿刺摘除，336例（74．3％）我囊腔缝合闭锁，79例（17．5％）外囊部分切除敞开，37例（8．2％）外事腔闭式引流。治愈451例（99．8％），死亡1例（0．2％）。结论：诊断肝包虫病的定位方法首选B超，包虫囊液皮试具有较高特异性，内囊穿刺摘除，外囊腔缝合闭锁及部分切除敞开，手术操作简单，疗效满意，并发症少。     

腹腔镜下肝包虫囊肿外囊完整摘除术3例报道

肝包虫病是细粒棘球蚴寄生在肝脏所致的一种寄生虫病,常见于我国西北及西南广大畜牧地区,外科手术是其治疗的主要手段[1],过去多采用开腹肝包虫内囊摘除,目前在临床上多采用腹腔镜下肝包虫内囊摘除、外囊开放术,但因为残腔的存在及包虫未能完全杀灭,导致复发。我们在顺利完成20余例腹腔镜下肝包虫内囊摘除、外囊开放术的基础上,开展腹腔镜下肝包虫囊肿外囊完整摘除术3例,效果良好,报道如下。1临床资料例1,女,41岁,以“开腹肝包虫内囊摘除术后9年,右腰背部胀痛4月余”入院。腹部CT示:肝脏右后叶见4.7cm×3.0cm椭圆形低密度影,考虑为肝包虫复发。于2005年8月16日在全麻下行腹腔镜肝包虫囊肿外囊摘除术,患者取平卧位,头高15°,左倾15°~30°。利用四孔法(与胆囊切除戳孔位置相似),见腹腔内有多处粘连,用超声刀及电凝钩分离粘连后,见肝包虫囊肿于肝脏右后叶下段,呈灰白色,表面光滑,大小约5cm×5cm。术中注意对于外囊表面的组织尽量保留,避免切开外囊。用胆囊抓钳提起肝包虫外囊顶部,用超声刀及电凝钩在肝包虫外囊与肝脏之间钝性加锐性分离,紧贴外囊,勿损伤过多肝组织,遇纤细管道用超声刀凝断,遇明显管道疑为较大血管或胆管均用...     

109例肝囊型包虫病破人腹腔的诊断与治疗

目的 探讨肝囊型包虫病破入腹腔的诊断和治疗方法.方法 回顾性分析1994年1月至2009年12月新疆医科大学第一附属医院收治的109例肝囊型包虫病破入腹腔患者的临床资料.根据流行病学史、典型临床表现、典型影像学特征和血清免疫学检查结果进行诊断.根据不同手术方式将108例行手术治疗的患者分为传统组(传统内囊摘除,67例)和改良组(改良内囊摘除,41例),比较两组患者手术时间、术中出血量、术后平均住院时间、术后带管引流时间、术后残腔并发症、胸腔积液、包虫原位复发、腹腔播散种植、死亡等情况.计量资料采用t检验,组间率的比较采用x2检验.结果 超声、CT、MRI检查确诊率分别为93%(101/109)、99%(70/71)、7/7;血清免疫学检查阳性率为100%(61/61).109例肝囊型包虫病破入腹腔患者中,1例因过敏性休克经抢救无效死亡,其余生存.传统组和改良组患者手术时间、术中出血量分别为(3.2±0.3)h、(104.0±11.5)ml和(3.3±0.4)h、(110.0±23.8)ml,两组比较,差异无统计学意义(t=-1.474,-L 758,P＞0.05);术后平均住院时间、术后带管引流时间分别为(15.3±4.3)d、(28.0 ±4.6)d和(9.3±1.2)d、(7.6±0.8)d,两组比较,差异有统计学意义(t=8.628,28.088,P＜0.05).传统组患者术后残腔积液、残腔感染、胆汁漏、包虫原位复发、腹腔播散种植发生率均显著高于改良组(x2=4.335,3.888,5.691,4.581,10.153,P＜0.05).确诊包虫原位复发或严重并发症再次手术患者21例.结论 流行病学史、典型临床表现、典型影像学特征和血清免疫学检查对于肝囊型包虫病破入腹腔的诊断具有重要作用;改良内囊摘除术+高渗盐水反复冲洗腹腔+术后正规服用抗包虫药物是目前肝囊型包虫病破入腹腔较理想的治疗方式.     

根治性全囊肿切除术治疗肝包虫病

目的 探讨根治性全囊肿切除手术在临床上治疗肝囊性包虫病的体会及治疗价值.方法 回顾分析近6年来开展的根治性全囊肿切除手术治疗肝囊性包虫病的临床资料86例,并与随机抽样的90例传统内囊摘除手术病例加以比较,观察其术后住院天数、腹腔引流天数、残腔置管天数、残腔积液、残腔感染、胆汁漏,原位复发率等临床指标.结果 根治性全囊肿切除手术治疗肝囊性包虫病,其手术彻底、安全,平均住院天数及腹腔引流天数明显少于传统内囊摘除术组(分别t=7.9915,59.86,均P＜0.001),且术后无胆漏、残腔积液、残腔感染、原位复发率等并发症发生,疗效显著.结论 根治性全囊肿切除手术其术后无残腔并发症、原位复发率发生,术后住院天数明显减少.是目前治疗肝囊性包虫病的一种比较理想的新的根治方法.     

腹腔镜治疗肝包虫病术中关键技术探讨

目的探讨腹腔镜肝包虫内囊摘除术关键技术要点.方法对56例肝包虫病患者行腹腔镜肝包虫内囊摘除术,术中常规采用3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查.结果56例均获成功,无一例中转开腹,手术时间45～150 min,平均60 min,术中出血量10～120 ml,平均70 ml.无并发症.56例随访1～12年,平均2年6个月,无肝包虫复发.结论3%过氧化氢溶液纱条保护、特制套管穿刺吸引器冲洗吸引、20%高渗盐水二次灭活和残腔探查处理技术的应用是手术成功的关键.     

Surgical treatment of suppurative hydatid echinococcosis of the liver]

Among 140 patients with hydatid echinococcosis of the liver complications were noted in 58 cases: suppuration of the cyst - in 38 (27.1%), cyst rupture in the anterior abdominal wall and abdominal cavity - in 4 (2.8%), in bile ducts - in 10 (7.1%), its rupture into the right lung lower lobe, calcification of the cyst was noted in 4 patients (2.8%). It is concluded that open echinococcotomy with partial excision of the fibrous capsule and drainage of the residual cavity with a rubber tube seem to be the most effective operation for suppurative echinococcosis of the liver.     

Surgical Management of Calcified Hydatid Cysts of the Liver

Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%.Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a “planned” reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification.     

复发性肝包虫和残腔积液的外科治疗

目的 减少或消灭肝包虫病术后复发及术后残腔积液等并发症。方法 ８年间手术治疗的３２０例肝包虫中筛选出２８例复发性肝包虫及术后残腔积液者,采用纤维胃镜探查、带蒂大网膜移植充填外囊腔、经皮肝穿刺抽液注入硬化剂,手术前后服抗包虫病药等综合性方法治疗。结果 本组２８例病人中未见包虫复发及残腔积液,治愈率达１００％。结论 上述３种方法对肝包虫病的“非接触手术技术”（ｕｎｔｏｕｃｈａｂｌｅ ｔｅｃｈｎｉｑｕｅ）具有明显的治疗价值。     

Surgical policy in echinococcosis of the liver with affection of bile ducts

Short-term results of surgical treatment of 277 patients with hepatic echinococcosis associated with affection of bile ducts are analyzed. If it is impossible, additional drainage of bile ducts and residual cavity is indicated. Pericystectomy is recommended when hydatid cyst has calcified fibrous capsule. It is demonstrated that rational surgical policy permits to achieve favorable results: postoperative complications were seen in 25.9% cases, lethality was 1.4%.     

肝包虫外囊完整剥除术在肝包虫病手术治疗中的价值

目的 探讨肝包虫外囊完整剥除术在肝包虫手术治疗中的价值。方法 对223例肝包虫病患者手术情况进行回顾性分析,分为囊肿切除组（98例）与保留外囊组（125例）;囊肿切除组又分外囊切除组（87例）与肝叶部分切除组（11例）。观察指标为术后平均住院日、术中出血量、残腔并发症发生率及原位复发率等。结果 囊肿切除组术后残腔并发症发生率及原位复发率均低于保留外囊组（P〈0．01）。外囊切除组的术中出血量及住院天数均低于肝叶部分切除组（P〈0．01）。结论 肝包虫外囊完整剥除术可有效降低术后残腔并发症的发生率及原位复发率,在治疗肝包虫病的手术中是一种首选的合理术式。     

Use of the CO2 laser in the surgical treatment of complicated echinococcosis of the liver

The article discusses experience in the use of high-energy CO2 laser in the treatment of 108 patients with complicated forms of echinococcosis of the liver. The diagnostic efficacy of instrumental methods of examination is determined. The most informative are ultrasonic echolocation (96.8%) and computered tomography (100%). They allow exact localization of the cyst, which is important in the choice of the operative approach. The use of the laser for excising the fibrous capsule and treating the residual cavity makes is possible to: abandon the traditional methods for completing echinococcectomy (drainage of the residual cavity, marsupialization, capitonnage), exclude suppuration of the residual cavity, reduce markedly the period of the patient's hospitalization.     

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??Evaluation of different surgical methods for treatment of hepatic cystic echinococcosis WANG Qi??DUAN Jian??LIN Jie??et al. Organ Transplantation Center??the First Affiliated Hospital of Kunming Medical University??Kunming 650032??China
Corresponding author??ZENG Zhong, E-mail??zzong@medmail.com.cn
Abstract Objective Evaluate the clinical effect of different surgical methods of hepatic cystic echinococcosis.Methods The clinical data of 77 cases of hepatic hydatid echinococcosis admitted between February 2010 and February 2015 in Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical University were divided into three groups. A group of 31 cases(Internal capsule excision + ectocyst closed drainage). 27 cases in group B(Excision of external capsule).19 cases in group C(Partial hepatectomy) Intraoperative operation, postoperative recovery and short term recurrence were compared and analyzed among the three groups. Measurement data using +S said, between the groups were compared with t test, between group rate using chi-square test. Results The basic situation of the three groups were similar??and there was no significant difference among the three groups (P> 0.05). The operation time of the three groups was (82.4±22.4) min??(102.9±18.6) min and (200.5±21.2) min P=0.007. The amounts of intraoperative bleeding were (57.3+17.2) mL??(213.5+60.6) mL and (287.9±95.7) mL, P=0.006. Abdominal drainage time was (12.6±3.3) days??(7.7±1.6) days and (6.5±1.8) days, P=0.021. The residual cavity complications were 11.1%, 0 and 0. Local recurrence rates were 7.4%??0 and 0. Anal exhaust time was (2.3± 1.2)days, (2.6±1.5) days and (2.7±1.6) days??P=0.008??. Eating time was (2.5±1.2) days??(2.9±1.4) days and (3.0±1.4) days??P=0.048??. The time of hospitalization was (7.3±1.1) days, (9.3±1.6) days and (9.9± 1.4) days??P=0.005??. The patients were followed up by telephone every three months after the operation,The longest time is 6 years, the shortest time is 1 and a half years. The patients in the A group appeared two cases of recurrence, the B and C groups had norecurrence. Conclusion Treatments of hepatic hydatid echinococcosis are varied??which should choose reasonable individualized surgical plan to gain better therapeutic efficacy according to the specific condition of patients .