肝囊型包虫破裂的外科治疗110例  

Surgery of ruptured human hepatic cystic echinococcosis

作　　者：温浩[1] 邱斌玉[1] 吐尔干·艾力[1] 邵英梅[1] 赵晋明[1] 李海涛[1] 冉博[1] 

机构地区：[1]新疆医科大学第一附属医院肝胆包虫外科,乌鲁木齐830054

出　　处：《中华普通外科杂志》2010年第4期273-276,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（30520001）;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：目的分析肝囊型包虫破裂外科手术治疗方式的演变及其对患者预后的影响。方法回顾性分析1990年1月至2008年12月外科手术治疗的肝囊型包虫破裂110例，按不同手术综合处理方法分为3组；A组22例：内囊摘除＋甲醛或双氧水局部杀虫＋残腔锁边缝合或大网膜填塞或残腔内翻缝合引流；B组65例：内囊摘除＋高渗盐水局部杀虫＋外囊肝外部分切除＋残腔胆漏缝合＋残腔开放引流；C组23例：外囊全部或次全剥除＋高渗盐水局部杀虫＋术区引流。分析3种外科综合手术治疗方式的效果。结果术后A组、B组、C组残腔并发症发生率分别为40．9％、16．9％、0．0％（P〈0．05），复发率分别为18．2％、4．6％、0．0％（P〈0．05）；带管引流时间A组〉B组〉C组；手术耗时及术中出血量，A组、B组均低于C组，B组与A组相比无明显差别；高渗盐水腹腔处理后包虫腹腔种植率低于单纯生理盐水处理组，差异无统计学意义。结论外囊全部或次全剥除＋高渗盐水局部杀虫＋术区引流的处理方式是目前最佳的治疗肝囊型包虫破裂的外科方法。Objective To investigate the evolution of surgical treatment and it＇s influence on prognosis in reptured liver cystic echinococcosis. Method Clinical data of 110 surgically treated cases of reptured liver cystic echinoeoccosis from January 1990 to December 2008 were retrospectively analysed, and these cases were divided into three groups by different surgical approach; Group A （22 cases） ： removal of internal capsule, with formaldehyde or hydrogen peroxide regional anthelminthic, with residual cavity side edge of lock stitching or greater omentum filling or drainage after residual cavity closure; Group B （65 cases） ： Removal of internal capsule, with hypertonic saline regional anthelminthic, with external capsule extrahepatic partial resection,with residual cavity bile leakage sutured, and with residual cavity open drainage, Group C （23 cases） ： the total or subtotal external capsule stripping operation, with hypertonic saline regional anthelminthic and drainage. Result The rate of overall postoperative complications of residual cavity was 40. 9% , 16. 9% ,0. 0% （ P 〈 0. 05 ） respectively and the recurrence rate was 18.2% , 4. 6% ,0. 0% （P 〈 0. 05 ） respectively; drainage time needed was the longest in group A, and shortest in group C, whereas the operation time was the longest in group C and it costed higher blood loss. Intraabdominal implantation of the hydatid significantly decreased with hypertonic saline treatment. Conclusion Total or near total removal of the external capsule of the hydatic cyst and hypertonic saline treatment with postoperative external drainage is the therapy of choice for reptured liver cystic echinococcosis.

关 键 词：棘球蚴病 肝 外科手术 破裂 

分 类 号：R657.3[医药卫生—外科学]