根治性及准根治性手术治疗终末期肝泡型包虫病  

Radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis

作　　者：邵英梅[1,2] 蒋铁民[1,2] 吐尔干艾力·阿吉[1] 冉博[1] 温浩[1,2] 

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 [2]新疆包虫病临床研究所、新疆包虫病基础医学研究重点实验室

出　　处：《中华消化外科杂志》2011年第4期296-298,共3页Chinese Journal of Digestive Surgery

基　　金：乌鲁木齐市科技局科技攻关项目（G08231001）

摘　　要：目的比较根治性及准根治性手术治疗侵犯肝周重要血管及脏器的终末期肝泡型包虫病的临床疗效。方法回顾性分析2002年1月至2010年1月新疆医科大学第一附属医院收治的41例肝泡型包虫病患者的临床资料。根据是否对重要血管行重建修补，将患者分为根治性手术组（13例）和准根治性手术组（28例），比较两组患者手术时间、出血量、住院时间、病灶复发及转移、胸腔及腹腔积液、胆道并发症及死亡情况。计量资料采用t检验，计数资料采用X^2检验。结果根治性手术组和准根治性手术组患者的出血量、住院时间、病灶复发及转移、梗阻性黄疸和远期死亡例数分别为（326±115）ml、（22±18）d、0、0、0例和（24±20）rnl、（15±12）d、10、10、10例，两组比较，差异有统计学意义（t=13．41，1.47，X^2=4．36，4．36，4．36，P〈0．05）。根治性手术组和准根治性手术组患者手术时间、胸腔及腹腔积液、术后胆汁漏、胆管炎及围手术期死亡例数分别为（407±146）min、4、0、1、1例和（263±93）min、2、2、2、1例，两组比较，差异无统计学意义（t=3．81，X^2=2．30，0．04，0．34，0．04，P〉0．05）。结论根治性手术是重要血管受侵犯但经修整后可达到重建条件的肝泡型包虫病患者的首选治疗方法。准根治性手术有避免伤及大血管，手术风险相对较小的优点。Objective To compare the efficacy of radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis （HAE） with involvement of major blood vessels and viscera. Methods The clinical data of 41 patients with end-stage HAE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to January 2010. All patients were divided into radical hepatectomy group （13 patients） and quasi-radical hepatectomy group （28 patients） according to whether blood vessels were recon- structed and repaired. The operation time, blood loss, length of hospital stay, recurrence and metastasis of HAE, pleural effusion, ascites, biliary complications and death between the 2 groups were compared. All data were analyzed by using the t test or chi-square test. Results The volume of blood loss, length of hospital stay, number of patients with recurrence and metastasis of HAE, obstructive jaundice and number of dead patients were （326 ± l15）ml, （22±18）days, 0, 0, and 0 in the radical hepatectomy group, and were （24±20）ml, （15±12）days, 10, 10 and 10 in the quasi-radical hepateetomy group, there were significant differences between the 2 groups （t = 13.41, 1.47 ; X^2 = 4.36, 4.36, 4.36, P 〈 0.05 ）. The operation time, number of patients with pleural effusion and aseites, bile leakage, cholangitis and number of patients died perioperatively were （407 ± 146） minutes, 4, 0, 1 and 1 in the radical hepatectomy group, and （263 ± 93） minutes, 2, 2, 2 and 1 in the quasi-radical hepatec- tomy group, there were no significant differences between the 2 groups （t = 3.81 ; X^2 = 2.30, 0.04, O. 34, 0.04, P 〉 O. 05）. Conclusions Radical hepatectomy should be the first choice when construction of infringed vessels can be achieved. Quasi-radical hepatectomy has lower operation risks for avoiding important vessels injury.

关 键 词：肝泡型包虫病 肝切除术 手术治疗 

分 类 号：R532.32[医药卫生—内科学] R657.3[医药卫生—临床医学]