根治性肝包虫外囊剥除术27例报告

作者自2001年8月始实施肝包虫外囊剥除术共27例,均达到根治的效果,现报告如下。临床资料1.一般资料:本组27例中,男性11例,女性16例。年龄15~76岁,平均41岁。其中,15例为二次手术,4例为三次及以上手术。共计51个包虫囊肿,直径在2·5~22cm。其中6例病人10个囊肿分别突入左右胸腔。2.方法:以上病例均采用气管插管全麻,3例左肝外叶包虫囊肿(4个)取左侧肋缘下切口,3例左、右肝多发包虫囊肿(其中一例合并脾包虫)取上腹部“人”字形切口,其余均取上腹部正中切口并向右侧腰部之“L”型复合切口。于肝包虫外囊与肝实质交界处切开肝被膜,用电刀头仔细…     

肝包虫囊肿外囊完整剥除术的探讨(附58例报告)

目的:探讨外囊完整剥除术治疗肝包虫病的手术方式、适应证及疗效评价。方法:对58例肝包虫病患者利用在包虫囊肿外囊壁与正常肝组织之间的间隙剥离,将包虫囊肿完整剥除,总结手术技巧,观察疗效,探讨手术适应证。结果:全组58例共完整剥除65个包虫囊肿,患者均治愈,无死亡。术中大出血(出血量>1 500 mL)6例,经输血等治疗痊愈;术中出现过敏反应1例,经及时抗过敏治疗,术后痊愈;术后胆汁漏8例,经腹腔引流管充分引流至无,复查腹腔B超无积液,拔出引流管痊愈;2例Ⅶ、Ⅷ段包虫囊肿剥离术后右侧胸腔少量积液,经对症抗感染支持治疗,7～14 d后复查胸片,胸水吸收痊愈。结论:外囊完整剥除术治疗肝包虫病具有并发症少、根治病变的效果。随着施术者经验技术的提高,掌握适应证,出血、胆汁漏等并发症可以降到最低,值得临床进一步推广。     

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.     

肝包虫囊完整剥除术的手术技术与适应证探讨:附64例临床报告

目的探讨肝包虫囊完整剥除术治疗肝包虫病的适应证与疗效评价。方法从2002年6月至今，采用肝包虫囊完整剥除术治疗64例肝包虫病病人。结果全组病人术后恢复良好、无术后残腔积液、出血、感染等较严重并发症，其中2例出现胆瘘（3．13％），术后分别于第9和第12天愈合，随访4～32个月，目前尚无一例原位复发。结论肝包虫囊完整剥除术治疗肝包虫病可消除以往传统的内囊摘除术导致残腔复发和胆汁瘘等问题；与肝叶切除相比具有并发症少、创伤较小、操作较易掌握；根据本组临床治疗和随访，可认为是根治性治疗肝包虫的合理而可行的新术式。     

肝包虫囊外切除术25例报告

对肝包虫的治疗 ,目前仍较多采用肝包虫内囊摘除术 ,该术式术后产生许多不可避免的并发症 ,使其效果仍不能令人满意。为减少肝包虫内囊摘除术后并发症 ,提高病人术后生活质量 ,我们 2 0 0 1年 3月～ 2 0 0 2年 2月对 2 5例肝包虫病人施行了肝包虫囊外切除术 ,近期效果满意 ,报告如下。临床资料本组 2 5例 ,男 17例 ,女 8例 ,年龄 10～ 5 5岁 ,术前 B超、CT检查确诊。包虫位于肝右前叶 12例 ,肝左叶 6例 ,两叶多发7例。包囊大小为 5 .6 cm× 5 .1cm～ 11.7cm× 7.8cm。手术方法 :在肝包虫囊与正常肝组织间找到一极微小间隙 ,其间可见许多肉…     

肝包虫外囊与膈肌粘连术中处理:附15例报告

在外科治疗肝包虫病中，肝包虫外囊剥除术已逐渐成为一种能够最有效地避免以往术后残腔积液、感染、胆瘘，肝包虫复发以及腹腔种植等并发症发生的术式，并且已有较多成功病例报道。但对于肝包虫外囊与膈肌形成粘连情况下的外囊剥除术，目前尚未见详细报道。仅见于贺宪报道6例与膈肌粘连之肝包虫外囊剥除术。我们在总结以往病例的基础上，自2002年4月至2005年3月成功完成15例23个与膈肌粘连的肝包虫外囊完整剥除术，现报告如下。     

腹腔镜下肝包虫外囊剥除术治疗肝囊性包虫病的疗效分析

目的:探讨腹腔镜肝包虫外囊剥除术治疗肝囊性包虫病的临床疗效及应用价值。方法:分析2016年4月至2019年2月为23例肝囊性包虫病患者行腹腔镜肝包虫外囊剥除术的临床资料。术前充分评估,术中沿包虫与肝组织间隙剥除肝包虫外囊,并在可能渗漏囊液处放置高渗盐水纱条。仔细处理汇入包虫囊壁的管道,切除外囊置入标本袋取出。结果:23例手术均获成功,无中转开腹及围手术期死亡病例,未发生术中过敏反应。术中出血量50～800 mL,平均(263.2±242.5)mL,3例患者术中输血。手术时间120～420 min,平均(240.3±80.5)min。术后住院4～13 d,平均(6.8±2.1)d。术后发生1例胆漏,经延长引流时间后治愈。结论:腹腔镜治疗肝囊性包虫病是安全、可行的,其手术指征及患者选择十分重要,对于位置表浅、易于暴露、无复杂毗邻关系的肝囊性包虫病灶,在有腹腔镜肝脏手术基础、肝囊性包虫病治疗经验的医院,腹腔镜手术治疗可作为首选术式。     

肾包虫外囊完整剥除术的临床分析

目的探讨肾包虫外囊完整剥除术在肾包虫病治疗中的临床价值。方法选择合适病例,对5例肾包虫行外囊完整剥除术,总结临床治疗效果。结果 5例患者均取得良好疗效,患者术后恢复良好,无尿漏、出血、感染等并发症,术后随访6月～24月,无复发。结论肾包虫外囊完整剥除术可以有效防止术中囊液外漏、残腔形成及术后复发,达到根治肾包虫病的目的。     

肝包虫囊肿外囊切除的价值及术式选择

目的分析肝包虫囊肿切除的价值及外囊手术实施的方式。方法回顾性分析我院收治的300例肝包虫病患者的手术资料,根据不同术式将患者分为保留带囊术组(41例)和带囊切除术组(259例)。结果外囊切除术患者术后原位复发率和残腔并发症发生率均低于保留外囊术组(P0.01)。以肝切除技术为基础的外囊切除术组患者的出血量高于外膜内外囊切除术组(P0.05)。结论肝包虫囊肿外囊切除可有效降低原位复发率和残腔并发症发生率,但手术的风险性与难度也随之增加。外囊切除手术选择外膜内外囊切除术安全、有效。     

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.     

Drainage of hepatic hydatid cyst with a surgiport

This article describes the safe and effective technique of hepatic hydatid cyst drainage.     

闭合式全囊切除术治疗囊性肝包虫的手术体会

目的探讨闭合式全囊切除在治疗囊性肝包虫的临床意义。方法对我院2010年01月~2013年04月期间34例囊性肝包虫均行闭合式全囊切除术治疗,并与51例同期间行传统手术患者比较住院及手术指标。结果闭合式全囊切除手术组的手术时间及术中出血量高于传统手术组(P0.05)。闭合式全囊切除手术组的带引流管时间、术后残腔积液、术后感染,术后胆汁瘘及复发例数均低于传统手术组(P0.05)。结论闭合式全囊切除治疗囊性肝包虫病时安全、可靠,可明显、有效的降低术后复发。     

The management of hepatic hydatid cysts: Review of 94 cases

In this retrospective study, 94 patients operated for hepatic hydatid cysts were reviewed to compared the advantages and disadvantages of different operative techniques. The patients were divided into four groups according to the type of operation. Group I consisted of 33 patients with peripherally located small cysts, eligible for excision, who underwent cystectomy. Group II consisted of 28 patients with cysts smaller than 5 cm, not suitable for complete removal, who underwent partial cystectomy with capitonnage. Group III were 21 patients with cysts larger than or equal to 5 cm, not suitable for complete removal, who underwent partial cystectomy with omentoplasty. Infection and biliary communication were not seen in groups II and III. Group IV were 12 patients with infected cyst or intrabiliary rupture who underwent partial cystectomy with external drainage. In group IV, hospital stay was longer than in the other groups (P < 0.05). Group I had the shortest hospital stay (P < 0.05). Group IV had the highest morbidity and recurrence rates (P < 0.05). We concluded that cystectomy is the technique of choice in selected patients, as it is associated with low morbidity, low recurrence rates, and short hospital stay. Omentoplasty is preferred if cystectomy is not feasible. If there is biliary contamination and infection, external drainage, rather than omentoplasty, should be performed. Received for publication on June 24, 1997; accepted on Dec. 3, 1997     

Management of hydatid disease of the liver—10 years'' experience in a non-endemic area

The incidence of hydatid disease of the liver caused byEchinococcus granulosus in Austria, a nonendemic region in central Europe, is documented over a 10-year period. Since 1984, 28 patients (24 women, 4 men) with hydatid disease of the liver have undergone surgery in our department. A definitive diagnosis was established by combining serological tests (an enzyme-linked immunosorbent assay withEchinococcus multilocularis antigen and an indirect hemagglutination assay withEchinococcus granulosus antigen) and abdominal imaging (computed tomography scan and ultrasonography). Twenty-four patients (85.7%) had uncomplicated echinococcosis; in most of them (16) total closed pericystectomy was done. Four patients (14.3%) had complicated echinococcosis, suffering from intrabiliary rupture and spontaneous perforation into the peritoneal cavity, and in two of these patients (7.1%) pyogenic transformation, one with abscess perforation, occurred. Postoperative complications were significantly more common in patients with complicated echinococcosis and included two bile leaks (necessitating prolonged tube drainage), pleural effusion, atelectasis, and wound infection. One recurrence of hydatid infection due to previous spontaneous perforation required reoperation 4 years after the primary event. The low recurrence rate of uncomplicated echinococcosis (0%) over a mean period of 5.6 years and of 3.6% when peritoneal echinococcosis was included may be the result of the radical surgical technique employed.     

Primary hydatid cyst of the breast: A case report

We describe herein the rare case of a hydatid cyst found in the breast of a 26-year-old woman. Clinically, the mass was at first suspected of being a fibroadenoma, but fine needle aspiration cytology (FNAC) yielded clear fluid only. Histopathologic examination of the resected speciman confirmed that it was a hydatid cyst.     

Unusual locations of hydatid disease and surgical approach

BACKGROUND: Hydatid disease is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, the disease can be seen anywhere in the body. In the present study, we present our experience with uncommonly located hydatid disease diagnosed and treated between 1983 and 1999 in the Sixth Surgical Department of Ankara Numune Training and Research Hospital, Ankara, Turkey. METHODS: Forty-nine patients with unusually located hydatid disease were retrospectively analysed. There were 21 men and 28 women in the present series. Of those, 26 patients were harbouring both hepatic and extrahepatic cysts, while 23 had only extrahepatic cysts. Peritoneal cavity, spleen, retroperitoneum, thyroid gland, anterior abdominal wall, thigh, kidney, presacral space and pancreas were the organs or tissues involved in the cases. Spleen and peritoneal cavity were the two most frequent locations in the present series. RESULTS: Partial or total cystectomy with or without tube drainage or omentopexy was the operation of choice for hydatid cyst of the peritoneal cavity. Splenectomy was performed for splenic hydatidosis. Mean postoperative stay was 7 days (4-23). Three diaphragmatic and one inferior vena cava lacerations occurred during operations that were repaired successfully in the same sessions. No mortality occurred in the present series. CONCLUSION: Hydatid disease can affect any organ or area throughout the body and suspicion of this disease should be justified in patients presenting with a cystic mass in endemic areas.     

Calcified cerebral hydatid cyst

A case of calcified cerebral hydatid cyst recently treated in our neurosurgical service is reported. The frequency of calcified cerebral hydatid cyst (CCHC) is less than 1% of cerebral hydatid cysts. A review of the literature disclosed 13 cases of calcified cerebral hydatid cysts. The clinical presentation and radiological findings are discussed. The present case is, to the best of our knowledge, the first case studied by computerized tomography.     

Cardiac involvement of hydatid disease

Objectives|Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.Subjects and Methods: Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40±5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.Results: In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4±2.5 years. No mortality or recurrence was observed during the follow-up period.Conclusions: When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst.