囊性肝包虫病合并胆瘘的手术治疗

目的 探讨治疗囊性肝包虫病合并胆瘘的不同手术方式及疗效。方法 回顾性分析经手术治疗的203例囊性肝包虫病合并胆瘘病例，对比传统的内囊摘除术＋大网膜填塞术、内囊摘除术＋囊内胆瘘缝扎术和新术式——外膜内完整摘除术的疗效，比较术后平均住院天数、残腔或创面外引流置管时间及残腔胆漏、残腔感染、周围胆管损伤的情况。结果 外膜内完整摘除术术后平均住院天数、残腔或创面外引流置管时间及残腔胆漏、残腔感染、周围胆管损伤的发生率均明显低于传统术式。结论 肝包虫外膜内完整摘除术术后并发症发生率低，能在直视下根据不同胆瘘特点可靠地处理发生胆瘘的胆管，可根治性治疗囊性肝包虫病合并胆瘘。

Surgical treatment of cystic hepatic echinococcosis with biliary fistula

Objective To compare the different operative methods for cystic hepatic echinococcosis with biliary fistula.Methods 203 cases of cystic hepatic echinococcosis with biliary fistula were retrospectively studied.The therapeutic effects of traditional excision of internal capsule+packing of greater omentum and internal capsule+intracystic suture ligature and excision of adventitia were observed.The information about mean hospitalization days,drainage time,infection rate,and damage of surrounding bile duct of different operative methods was compared.Results The mean hospitalization days,drainage time,infection rate,and incidence of damage of surrounding bile duct were obviously lower by excision of adventitia than traditional operative methods.Conclusion The excision of adventitia has the lower incidence rate of complication.It can treat the biliary fistula accurately according to its characteristics under the straight sight and is an ideal radical surgical therapeutic method for cystic hepatic echinococcosis with biliary fistula.