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。

Study on total cystectomy for the treatment of hepatic hydatid cyst(attached 58 cases reports)

Objective： To investigate the operative methods, indication and therapeutic effect of total cystectomy for treatment of hepatic cystic echinococcosis. Methods： To summarize the surgical technique, efficacy, and explore the indications of surgery by separating the hydatid cyst outer wall with normal liver tissue stripping of the 58 patients with Hepatic Hydatidosis. Results： Totally 58 patients with Hepatic Hydatidosis, in which hydatid cyst had 65 lesion, cured without death cases. Intraoperative and postoperative complications were as following： 6 cases were massive hemorrhage during surgery （bleeding 〉 1 500 mL） and recovered by blood transfusion therapy. 8cases of Bile leakeage were recovered by intraperitoneal drainage exhaustively, until none, and re-view of abdominal B-no effusion. Two cases of VII or VIII stage hydatid cyst surgery stripped a small amount of postoperative right pleural effusion, the pleural fluid was absorbed after 7 to 14 days＇ symptomatic anti-infection treatment. Conclusion： Total cystectomy for treatment of hepatic cystic echinococcosis brings less complication and can cure all lesions. With the improvement of the doctors＇experiences, bleeding, bile leakage and other complications can be reduced to a minimum, so it is worthy of further promotion.