25例肝包虫囊肿破入胆道的诊治体会

目的探讨肝包虫囊肿破入胆道的诊断及治疗方式。方法回顾分析我院2001年～2011年行手术治疗的25例肝包虫囊肿破入胆道患者的临床表现、实验室检验、影像学检查、手术方式及治疗效果。结果超声、CT、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP)对于肝包虫囊肿破入胆道均具有良好的诊断价值,其中ERCP诊断价值最高,确诊率可达100%。25例患者中22例手术方式为胆囊切除、胆总管探查、T管引流+肝包虫残腔引流,其余3例行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除。所有患者均痊愈出院。结论超声因普及易行,应作为诊断肝包虫囊肿破入胆道的首选辅助检查,MRCP检查具有诊断准确率高和无创等优点,ERCP则对肝包虫囊肿破入胆道诊断率最高。胆囊切除、胆总管探查、T管引流+肝包虫残腔引流应作为肝包虫囊肿破入胆道首选手术方式,对于部分复杂病例可行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除,效果良好。

Intrabiliary rupture of hepatic hydatid cysts: Diagnosis and treatment of 25 cases

Objective To discuss the diagnosis and treatment of intrabiliary hepatic hydatid cyst rupture.Methods Twenty-five patients admitted to our hospital between 2001 and 2011 with hepatic hydatid cysts that had ruptured into the biliary tract were retrospectively reviewed.Each patient′s clinical manifestations,laboratory tests,imaging examinations,operation methods,and treatment outcome were extracted from medical records for investigation.Results Intrabiliary hepatic hydatid cyst rupture was diagnosed by ultrasonography(USG),computed tomography,magnetic resonance cholangiopancreatography(MRCP) and endoscopic retrograde cholangiopancreatography(ERCP).ERCP clearly showed hepatic hydatid cyst rupture into the biliary fistula and had a 100% accuracy rate of diagnosis.Twenty-two patients underwent cholecystectomy,common bile duct exploration,and T-tube drainage with hepatic hydatid residual cavity drainage.The remaining three patients underwent cholecystectomy,common bile duct exploration,and T-tube drainage with hepatic hydatid foci radical resection.All patients were cured.Conclusion USG is the preferred method for diagnosis of intrabiliary hepatic hydatid cyst rupture at our institute,despite the fact that MRCP has the advantages of being non-invasive and having high diagnostic accuracy.ERCP,however,is the gold standard for diagnosis of intrabiliary rupture of hepatic hydatid cysts.While most cases can be cured by a surgical regimen of cholecystectomy,common bile duct exploration,and T-tube drainage with hepatic hydatid residual cavity drainage,more complicated cases benefit from liver hydatid foci radical resection following the T-tube drainage procedure.