肝包虫残腔处理的几种方法

包虫病是农牧区常见病 ,其中肝包虫病最常见 ,肝包虫病的诊断治疗并不困难 ,但是肝包虫病手术后常有包虫残腔胆汁瘘、残腔感染、残腔出血、残腔内包虫复发等并发症。对农牧区广大人民生活、工作学习和经济带来很大的负担 ,所以肝包虫病的治疗关键在于包虫残腔的处理 ,然而肝包虫残腔的处理非常棘手 ,目前为止尚无有效的处理方法。故一直被国内外许多专家所关注 ,我们利用肝包虫高发地区优势 ,近几年对肝包虫残腔的处理积累了较丰富的经验。现介绍如下 :1　临床资料我院 1 990～ 2 0 0 0年共收治肝包虫病 1 2 0 0例 ,术后肝包虫残腔胆汁瘘 36…     

肝包虫残腔置管引流61例体会

1 .一般资料 :1990年 10月至 1999年 9月共选择 6 1例囊肿直径 9～ 18ｃｍ巨大肝包虫囊肿及合并严重感染者行残腔置管闭式引流术。本组男 38例 ,女 2 3例 ,年龄 16～ 6 3岁 ,平均 42岁。2 .手术及治疗结果 :全组均按“无瘤手术”操作原则严密隔离 ,对未合并感染的单囊包虫常规穿刺抽液后注入适量 3%双氧水 ,5～ 10ｍｉｎ后抽液 ,切开外囊 ,清除内囊 ,以双氧水纱布反复擦拭囊壁 ,生理盐水冲洗。对多子囊合并感染坏死 ,囊液粘稠不能穿刺吸出者 ,直接切开外囊壁以粗吸引管吸出或以勺舀出 ,再以双氧水纱布擦拭处理 ,有明确胆漏处可用细丝线“8”…     

大网膜移植治疗巨大肝包虫残腔胆汁瘘30例报告

1990～ 1998年我科采用大网膜移植填充巨大肝包虫残腔并胆汁瘘 ,疗效满意。临床资料本组追踪随访 30例 ,占同期 (46例 )随访率 6 5 %。男性18例 ,女性 12例 ,年龄 7～ 6 4岁 ,平均 32岁。包虫残腔10ｃｍ× 10ｃｍ～ 2 0ｃｍ× 13ｃｍ ,平均 16ｃｍ× 12 5ｃｍ ,单腔 2 1例 ,双腔 9例。内囊摘除后即出现胆瘘 2 3例 (76 7% ) ,瘘口直径 0 5～ 3ｍｍ ,均为多发瘘 ,术中证实内囊感染 6例。肝功能测定 :胆红素代谢异常 18例 ,转氨酶类均有不同程度改变。Ｃａｓｏｎｉ皮内试验阳性率 90 %以上。肝包虫内囊摘除后 ,用 2 8%高渗盐水杀灭头节 5～ …     

肝包虫病残腔的处理

肝包虫病术后，在肝内遗留外囊残腔，如果处理不当，可并发残腔积液，若有胆渗则使积液增多，病人出现肝区隐痛、食欲不振等症状。如继发感染形成肝脓肿，则需再次手术引流。目前处理残腔的常用方法有；缝闭外囊、置管体外引流、外囊开放和大网膜移植等。我院从1986年至1988年共收治192例肝包虫病人，采用上述四种方法进行治疗。现分析如下。     

巨大肝包虫病人的麻醉处理

肝包虫病是畜牧区的一种常见病 ,治疗方法以手术为主。本院近期收治 1例肝包虫病人 ,现将麻醉经过报告如下。一般资料　男性 ,34岁 ,因腹部高度膨隆 ,气短 ,弯腰受限 ,进行性消瘦 ,无法入眠 4年 ,以肝包虫病收住入院。拟在连续硬膜外麻醉下行包虫内囊摘除术。术前血常规、肾功能均正常。胸片示 :右侧膈肌明显升高至 3～ 4前肋间 ,纵隔向左移位。Ｂ超示 :于右腋中线第 6肋间、腋前线脐下 5ｃｍ水平 ,右锁中线脐下约 2ｃｍ水平范围内可见巨大无回声区 ,壁厚约 0 3～ 0 4ｃｍ ,其内有多个分隔 ,其左侧壁紧密相连 78～6 2ｍｍ ,无回声 ,壁厚约…     

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.     

处理肝包虫残腔几种术式的体会

包虫病是农牧区常见病 ,其诊断治疗并不困难 ,但肝包虫病手术后包虫残腔胆汁瘘、残腔感染、残腔出血、残腔内包虫复发等并发症常见。所以肝包虫病的治疗关键在于包虫残腔的处理 ,然而肝包虫残腔的处理非常棘手 ,目前为止尚无有效的处理方法。我院于 1990年 3月 - 2 0 0 0年 4月共收治肝包虫病 12 0 0例 ,术后并发症 5 2 6例 ,取得了一定经验。现介绍如下 :1　一般资料　　我院 1990 - 2 0 0 0年共收治肝包虫病 12 0 0例 ,男性 791例 ,女性 4 0 9例 ,年龄最大的 72岁 ,最小的 7岁。术后并发症5 2 6例 ,其中胆瘘 36 0例 (30 % )、感染 6 0例 (…     

复杂性肝内胆管残石的联合内镜治疗

目前．对肝内胆管结石病的治疗的仍十分困难，仅凭外科手术很难取尽治愈，其残石率高达30．36％。是胆道外科临床上的难题。本文报道我院1991～1995年，采用联合内镜治疗37例复杂性肝内胆管残石病例，临床效果满意。     

乳腺良性肿瘤切除术后不同残腔处理方法效果比较

目的探讨乳腺良性肿瘤切除术后不同残腔处理方法的效果。方法随机将2014-12—2016-12间在罗山县妇幼保健院接受乳腺良性肿瘤切除术的112例患者分为2组,各56例。A组保留残腔,B组将残腔缝闭。比较2组术后疼痛视觉模拟评分(VAS)、切口甲级愈合率和术后乳房外形变化情况。结果 B组患者术后第3天的VAS评分、切口甲级愈合率及乳房外形均优于A组,差异均有统计学意义(P0.05)。结论乳腺良性肿瘤切除术后缝闭残腔可有效减轻患者术后疼痛,利于切口愈合并较好保持乳房外形。     

Follow-up problems and changes in obliteration of the residual cystic cavity after treatment for hepatic hydatidosis

Background/Purpose. In this prospective open clinical study, we investigated the problems that might arise during the obliteration of the residual cavity in hepatic hydatidosis. These problems might be related to the duration of the obliteration period and to the effects of omentoplasty on the residual cavity. Methods. We operated on 54 hepatic hydatidosis patients with cystodrainage and omentoplasty. We followed these patients for a period of 8 years after the operation. We used ultrasonography (US) to evaluate the obliteration of the cystic cavity; evaluations were made by serological tests as well (hemagglutination test, IHA, and IgE radioallergosorbent test, RAST). Results. Most of the reductions in the size of the cystic cavity were observed within the first 30 days following the operation (69.7%). At the end of the first postoperative year, cystic cavity obliteration was not complete in 34 patients, and 5 of these cases had positive indirect IHA and IgE RAST tests for Echinococcus granulosus. These patients were treated with extension of albendazol therapy. In 2 of these 5 patients, obliteration of the cystic cavity was complete within 12 months; their serological tests became negative at 15 and 21 months, respectively. In the remaining 3 whose serological tests were still positive at the end of the first year, obliteration of the cystic cavity was complete by 27, 33, and 45 months respectively. Of these 3 patients, the tests became negative at 30 and 52 months for the first 2 patients; the last patient is still serologically positive although we have not determined any findings related to the recurrence of the cyst. Conclusions. Omentoplasty is the preferred method in the surgical treatment of hepatic hydatidosis. However, we should keep the following facts in mind while following these patients with US: the technique can be insufficient, the obliteration of the residual cavity takes time and can be misdiagnosed as a recurrence, and ultrasonographic appearances can mimic some other diseases whether they are benign or malignant. Moreover, follow-up studies should be complemented with the serological tests. Thus, all these steps will minimize a misdiagnosis and unnecessary reoperations for hepatic hydatidosis.     

Surgical management of complicated pulmonary hydatidosis]

1954-1988, 680 patients with pulmonary hydatid cysts were operated upon at our hospital. 320 of the patients were classified as having complicated pulmonary hydatidosis (CPH). The criteria for CPH are as follows: (1) huge in size, occupied 2/3 or one side of the chest; (2) ruptured hydatid cyst or cysts, with or without secondary infection; (3) multiple lesions involving both lungs, sometimes combined with liver involvement; (4) the presence of hepato-pleural and/or hepato-bronchial fistulae. We advocated intact endocystectomy and saucerization of the residual actocystic pit for individual lesion. The diagnosis and management of different CPH, especially those with hepato-pleural or hepato-bronchial fistulae were discussed in detail. There were 2 operative deaths. The mortality rate of the whole series was 0.29%, and of those with CPH was 0.6%.     

Management of residual cavity after partial cystectomy for hepatic hydatidosis: comparison of omentoplasty with external drainage.

OBJECTIVE: To investigate the role of two approaches to the operative treatment of hepatic hydatid cysts. DESIGN: Prospective study. SETTING: University and teaching hospital, Turkey. SUBJECTS: 108 patients with single uncomplicated hydatid cysts who were operated on in two clinics between 1990 and 1995. INTERVENTION: Introflexion and omentoplasty or external drainage after partial cystectomy in single uncomplicated hydatid cysts more than 5 cm in size. MAIN OUTCOME MEASURES: Morbidity, mortality, and hospital stay. RESULTS: The median hospital stay after introflexion and omentoplasty was 8 days (range 3-15), which was significantly shorter than that after external drainage (12 days, range 7-20). There were 2/35 postoperative complications in the former group compared with 17/73 in the drainage group (p = 0.03). There was one death after introflexion and omentoplasty. CONCLUSION: Introflexion and omentoplasty after partial cystectomy for a single uncomplicated hydatid cyst caused significantly fewer complications than external drainage, and patients left hospital sooner.     

肝棘球蚴病内囊摘除后外囊残腔开放术与残腔引流术对比分析

目的对比肝棘球蚴病两种手术方式的优劣。方法分析我科十余年来收治肝棘球蚴病例,比较两种术式(内囊摘除术、外囊残腔开放术117例,内囊摘除术、外囊残腔引流术144例)的手术时间、术中出血量、住院天数、体温恢复时间、拔管时间、术后并发症的发生率等指标。结果残腔开放术在住院时间、术中出血量与残腔引流术相比差异无统计学意义(P>0.05);在手术耗时、体温恢复时间和拔管时间与残腔引流术相比差异有统计学意义(P<0.05);两种术式术后并发症发生率差异有统计学意义(P<0.05)。结论内囊摘除、外囊残腔开放手术术式具有简单、安全、有效等优点,可以满足大部分肝棘球蚴病外科手术治疗需要。     

Complications of hepatic hydatidosis]

Fifty cases of complicated hydatid cyst of the liver on a total of 250 cases of hydatid cyst observed were analyzed. The Authors describe the several complications observed (compression, infection, rupture into biliary tract or into the thorax or into the peritoneal cavity, the diagnostic and therapeutic procedures. Total mortality was about 7.6% (3 cases) 2 patient died for intraperitoneal rupture and one for rupture in the biliary tract. Surgical treatment should be as radical as possible performing total or subtotal pericystectomy, hepatic resection is reserved to selected cases. Drainage by Kehr tube of biliary tract is necessary of rupture of the cyst in the biliary tract, while we limit the indication for a papillostomy to the sphincter duct stenosis.     

乳腺良性肿瘤切除术中保留残腔与缝闭残腔的临床疗效对比

目的对比评价乳腺良性肿瘤切除术中保留残腔与缝闭残腔的临床疗效。方法将58例患者随机分为保留残腔组和缝闭残腔组。术后观测指标:乳腺外形、手术时间、术后疼痛、术后积液及切口愈合等情况。结果保留残腔组和缝闭残腔组相比,前者术后乳腺外形基本不受影响(P<0.01);手术时间有所缩短(16～32minP<0.05);疼痛持续时间短(1d～3dP<0.05)。术后切口的甲级愈合率及积液情况和缝闭残腔组比较没有统计学意义。结论保留残腔的乳腺良性肿瘤切除术是一种美观、安全、有效、痛苦小、并发症少的新技术,值得临床进一步研究和推广。