肝囊型包虫病并发胆管支气管瘘的诊治  

Surgical therapy for bronchobiliary fistula due to hepatic cystic echinococcosis

作　　者：周京涛[1] 吐尔干艾力·阿吉[1] 邵英梅[1] 李刚 刘佳 商少华[1] 温浩[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 [2]新疆油田公司明园职工医院

出　　处：《中华普通外科杂志》2013年第11期839-841,共3页Chinese Journal of General Surgery

基　　金：长江学者与创新团队培育计划“棘球绦虫致病机制与综合防治研究”基金资助项目（IRTl181）

摘　　要：目的探讨肝囊型包虫引起的胆管支气管瘘（bronchobiliaryfistula，BBF）的诊治疗效。方法新疆医科大学第一附属医院1992--2012年间收治肝囊型包虫病BBF患者39例，按收治时间分为A组（1992-2001年）、B组（2002-2012年），2组患者的治疗情况进行对比分析。结果39例肝包虫囊肿并发支气管胆管瘘患者术后3例死亡，均为严重感染引起感染性休克。2组肝包虫囊肿并发支气管胆管瘘手术患者的年龄（t=0．84，P=0．554）、性别构成（P=1．0）、每日痰量（t=0．98，P=0．703）、包虫直径（t=1．11，P=0．406）、手术时间（t=0．451，P=0．651）、胸腔感染（P=1．0）、死亡率（P=0．235）等结果比较差异无统计学意义（P〉0．05）。术中出血量（t=2．73，P=0．01）、术后平均住院天数（t=7．64，P=0．000）、术后残腔并发症（P=0．001）、术后带管引流时间（t=6．747，P=0．01）、复发率（P=0．022）、胸腔播散种植（P=0．018）、再次手术率（P=0．049）等指标B组明显优于A组，2组比较差异有统计学意义（P〈0．05）。结论肝囊型包虫引起的胆管支气管瘘目前仍然以手术为首选治疗手段，应尽可能行一次性手术。Objective To explore the diagnosis and treatment efficacy of bronchobiliary fistula due to hepatic cystic echinocoecosis. Methods A retrospective evaluation of 39 patients with BBF was performed during 1992 to 2012. We divided the 39 patients into group A treated before 2001 and group B after 2002. A retrospective analysis was made. Results There were three deaths among the 39 BBF patients due to hepatic hydatid disease. The cause of death was septic shock due to severe infection. There were no statistical differences in the basic factors, age （ t = O. 84, P = O. 554 ） , gender （ P = 1.0 ） , and sputum volume （ t = O. 98, P = 0. 703 ）, hydatid diameter （ t = 1.11, P = 0. 406 ）, operation time, chest infection （ P = 1.0 ）, mortality （ P = 0. 235 ） between the two groups （ P 〉 O. 05 ）. While postoperative length of stay（ t = 7.64, P = O. 000 ） , postoperative complications of residual cavity （ P = 0. 001 ）, length of tube drainage（ t = 6. 747, P = 0. 01 ）, recurrence of bronchial fistula （ P = 0. 022 ）, pleural dissemination （ P = 0. 018 ） , reoperation rate （ P = 0. 049 ） were all in favour of group B （ P 〈 0. 05 ）. Conclusions Surgery is the choice of therapy for BBF due to hepatic hydatid disease, and one-stage procedure is expected to achieve the best outcomes.

关 键 词：棘球蚴病 肝 支气管瘘 胆瘘 

分 类 号：R657.4[医药卫生—外科学]