肝泡球蚴病的非根治性手术治疗观察

目的 探讨非根治性手术对肝泡球蚴病的治疗价值.方法 对2000-2005年收治的38例行非根治性手术治疗肝泡球蚴病的患者进行回顾性调查分析.结果 38例患者中,12例行肝切除术,23例行经皮穿刺液化坏死引流,3例行经皮肝穿刺胆管引流.所有患者同时结合服用阿苯达唑(15 mg·kg~(-1)·d~(-1)).未行根治性切除的原因包括:病灶同时浸入肝左右叶、肝门部、横膈及并发腔静脉受阻等.术后随访1～3年,1例行经皮肝穿刺胆管引流患者在随访过程中死于肝功能衰竭.8例行肝叶切除及17例行经皮穿刺液化坏死引流患者随访期间无明显临床症状,2例行经皮肝穿刺胆管引流患者术后症状无明显改善,其余10例患者术后存在轻微症状.8例患者术后因持续性胆瘘行二次手术.结论 非根治性切除术可改善肝泡球蚴病患者症状,提高生存质量.行非根治性切除结合药物治疗对于不能行根治性切除的肝泡球蚴病患者是一种较好的选择.

Observation of palliative surgery for the treatment of hepatic alveolar echinococcosis

Objective To investigate the value of palliative surgery in the treatment of hepatic alveolar echinococcosis. Methods The clinical and follow-up data of 38 patients with hepatic alveolar echinococcosis admitted between 2000 and 2005 were retrospectively analyzed. Results Among 38 patients, 12 cases were treated by hepatectomy, 23 cases underwent drainage of purulent necrotic cavities, and 3 cases underwent percutaneous reason for palliative surgery was massive involvement of the parasitic disease in both lobes of the liver, porta hepatis, retrohepatic vena cava and diaphragm. Patients were followed up for 1 - 3 years. One patient who underwent percutaneous transhepatic biliary drainage died during the follow-up period from hepatic failure. Eight patients who underwent hepatectomy and 17 patients who underwent drainage of purulent necrotic cavities were symptom-free and lived a normal life. There was little symptomatic improvement in 2 patients who underwent percutaneous transhepatic biliary drainage. Ten patients lived a normal life with mild symptoms. Eight patients were reoperated for persistent biliary fistula. Conclusions Palliative surgery may play an important role in improving the patients' symptoms and life quality. Palliative surgery combined with albendazole therapy might be a strategy for the treatment of advanced disease, especially when complete resection could result in significant morbidity or mortality.