肝泡型包虫病根治性切除163例回顾性分析

目的:探讨肝泡型包虫病根治性切除的治疗效果。方法:回顾性分析2013年1月—至2015年6月163例行根治性切除肝泡型包虫病患者的临床资料。结果:根治性手术平均时间(3.1±1.2)h,术中出血量(763±498)m L。术后携带腹腔引流管中位时间6 d,11例携带T管,术后1个月拔除。术后平均肛门排气时间(2.1±0.8)d、经口进食时间(2.7±1.1)d、住院时间(7.9±3.4)d。8例出现术后并发症,其中5例术后胆瘘,1例术区感染,2例术后腹水。术后电话或门诊随访1~6个月无死亡及包虫复发情况。结论:根治性切除是当前肝泡型包虫病患者的首选治疗方案。术前充分评估手术可行性,术中充分掌握肝脏血流控制、肝脏外科解剖、门静脉重建、胆管重建等技术,通过根治性手术切除可明显改善泡型包虫病患者的生存质量,延长患者的生存时间。

Radical resection for hepatic alveolar echinococcosis: a retrospective analysis of 163 cases

Objective: To assess the therapeutic effect of radical resection of hepatic alveolar echinococcosis. Methods: The clinical data of 163 patients with hepatic alveolar echinococcosis undergoing radical surgical resection between January 2013 and June 2015 were analyzed retrospectively. Results: The average operative time for radical surgery was (3.1±1.2) h, and intraoperative blood loss was (763±498) mL. The median time for the retention of intraperitoneal drainage tube was 6 d, and 11 patients underwent T-tube drainage that was removed one month after operation. The mean time to first passage of flatus and oral intake was (2.1±0.8) d and (2.7±1.1) d, respectively, and length of postoperative hospitalization was (7.9±3.4) d. Postoperative complications occurred in 8 patients, which included bile leakage in 5 cases, surgical site infection in one case, and ascites in 2 cases. Telephone contact or outpatient clinic follow-up was conducted for one month to 6 months postoperatively, and no death or recurrent echinococcosis was reported. Conclusion: Radical resection is still the first treatment option for hepatic alveolar echinococcosis. Based on adequate preoperative evaluation of the feasibility, and knowledge about the intraoperative techniques such as hepatic blood flow control, liver anatomy, and portal vein and biliary reconstruction, radical surgical resection can improve the quality of life and extend the survival time of the patients.