两型肝包虫病手术疗效547例临床分析  

Clinical analysis of surgical treatment for human hepatic cystic and alveolar echinococcosis

作　　者：温浩[1] 邵英梅[1] 赵晋明[1] 吐尔干艾力[1] 李海涛[1] 买买提江·阿不都卡得尔[1] 

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心肝胆包虫外科,乌鲁木齐830054

出　　处：《中华消化外科杂志》2007年第1期13-18,共6页Chinese Journal of Digestive Surgery

基　　金：新疆维吾尔自治区高校科研创新研究群体基金资助项目（XJEDU2004G10）

摘　　要：目的探讨两种类型肝包虫病即肝囊型包虫病（cystic echinococcosis，CE）和肝泡型包虫病（alveolar echinococcosis，AE）手术治疗的方式、适应证及其疗效。方法对我院2002年6月到2006年11月手术治疗的肝囊型包虫患者519例和1995～2006年手术治疗的28例肝泡型包虫病患者手术方式进行比较分析。结果（1）CE组：CE内囊摘除术（A组）术后残腔并发症、带管时间等均显著高于其他3组（P〈0．01），其术后平均住院天数则低于肝切除术（D组）（P〈0．01）；手术D组的平均住院天数、肝功不全发生率、手术耗时及出血量等均显著高于其他3组（P〈0．01）。临床治愈518例（99．8％），死亡1例（0、2％）。（2）AE组：28例中AE行根治性手术治疗19例，其10年存活率100％，而姑息性手术治疗9例，10年存活率44％（P〈0．01）。结论（1）肝包虫外囊完整剥除术治疗可根除因内囊摘除术所致包虫复发和胆瘘等并发症，与肝切除相比具有创伤较小、并发症少的特点，故可认为是CE的首选术式；（2）对于邻近大血管、重要脏器组织或周围解剖层次不清的肝包虫，外囊次全切除术可在有效消灭残腔的同时，减少了手术难度及外囊剥除术所致手术风险；（3）扩大半肝切除胆道血管重建术是治疗AE有效根治手段，其技术关键是应按无瘤术的原则切除病灶并行胆道血管重建，而AE患者术前综合评估尤其肝血管和胆道成像可明显提高根治性切除率。Objective To evaluate and discuss the indications and efficacy of various surgical methods for human cystic echinococcosis （CE） and alveolar echinococcosis （AE）. Methods Surgical procedures were categorized and compared between 519 cases with CE surgically treated from June 2002 to January 2006 and 28 cases with AE treated from 1995 to 2006 in our hospital. Results （ 1 ） CE group, following classic endocystectomy （Group A） , postoperative complications with residual cavity and draining time was significantly higher than other three groups （ P 〈 O. O1 ） , while the mean postoperative hospital stay was much shorter than that in liver resection group （Group D） （ P 〈0.01 ）. Groups A, B and C was superior to Group D in the postoperative hospital stay, blood loss, operation time and postoperative liver function （ P 〈0. O1 ）. A total of 518 CE cases （99.8%） were cured and 1 （0.2%） died. （2） AE group： 19 cases were treated with radical surgery, with lO-year survival rate of 100%. Nine cases were dealt with palliative surgery, with 10-year survival rate of 44% （ P 〈 0. 01 ）. Conclusions （ 1 ） Total cystectomy can be considered as radical and practicable surgical method for CE, for it has better results for control of CE recurrence and biliary leakage in regard of classic endocystectomy as well as safety and microsurgical procedures compared to liver resection. （2） Subtotal cystectomy may not only be extinct residual cavity, but also effectively decrease the risk of the total cystectomy for cases with AE, without a dissection potential space between outer wall and hepatic porta, important biliary tract or large vessel. （3） Extended radical hepatectomy with biliary reconstruction can be considered as one of effective surgical procedures for treatment of AE, the key point for which is that the foci should be removed and biliary vessels reconstructed under tumor-nil principles. Radical excision rate can be markedly improved with preoperative comprehensive a

关 键 词：肝囊型包虫病 肝泡型包虫病 肝包虫外囊完整剥除术 内囊摘除术 肝切除术 

分 类 号：R686[医药卫生—骨科学]