肝包虫内囊摘除术后胆漏再手术治疗9例  

Reoperation for biliary leakage after hepatic hydatid cyst removal

作　　者：陈长义[1] 陈耀堂[1] 李慧明[1] 田希兰 张志红[1] 时煜山 

机构地区：[1]宁夏回族自治区固原市人民医院普外科,宁夏回族自治区固原市756000

出　　处：《世界华人消化杂志》2014年第9期1285-1288,共4页World Chinese Journal of Digestology

基　　金：宁夏固原市科技发展计划基金资助项目;No.2012-06~~

摘　　要：目的:总结肝包虫内囊摘除术后长期带管患者再行手术治疗的效果.方法:固原市人民医院2011-01/2013-10收治肝包虫内囊摘除术后长期带肝包残腔引流管且引流管口反复感染患者9例,患者一般情况良好,无严重心肺疾病者,均可再次手术.9例患者均行择期手术,其中3例残腔璧钙化明显,位于肝右叶及左外叶,行肝包残腔外囊完整剥除+肝下引流术.另外6例因囊肿残腔靠近第一、二肝门,行残腔囊外完整剥除风险大,采用直视下残腔内胆漏口缝闭+残腔大网膜填塞+残腔引流+胆总管T管引流术.结果:本组9例患者再手术后有2例前3 d每日残腔引流管引流量约10-50 mL,到第5天降至每日5-10 mL,至第7天无引流物拔除.其余7例术后1-3 d引流量每日约5-10 mL,呈每日递减,一般均在5 d内拔除.9例患者出院后月均行彩超复查,肝包术区术后改变,无积液.电话随访6 mo-3年,除2例死于其他疾病外,其余7例工作生活正常,恢复良好.结论:肝包虫术后残腔胆漏长期带管患者,再次手术解决胆漏并去除引流管效果较好.AIM： To summarize the efficacy of reoperation for biliary leakage after hepatic hydatid cyst re- moval. METHODS： A total of 9 patients with hepatic echinococcosis who underwent hepatic hydatid cyst removal, required long term tube drainage and had recurrent infections at Guyuan City People＇s Hospital from January 2011 to October 2013 were included in this study. These pa- tients were in good general condition and had no serious heart or lung diseases. Nine patients underwent elective surgery, of whom three had evident residual cavity wall calcification in the right lobe and left lateral lobe and underwent total external cystectomy and hepatic drainage,and the remaining 6 underwent suturing for bile leak, residual cavity omentum filling and common bile duct T tube drainage because of a potential risk of total external cystectomy due to the fact that the residual cyst cavity was too close to the first and second porta hepatis. RESULTS： In 2 of the 9 patients who underwent reoperation, the daily volume of drainage was about 10-50 mL in the first 3 d after reopera- tion, and decreased to 5-10 mL on day 5, and the drainage tube was removed on day 7. In the remaining 7 cases, the daily volume of drainage was about 5-10 mL in the first 3 days and di- minished gradually, and the drainage tube was removed on day 5. After discharge, all patients underwent follow-up ultrasound each month, and no abnormal changes in the surgical area or effusion were observed. During a telephone follow-up period of 6 mo to 3 years; 2 patients died of other diseases, and the remaining 7 cases recovered well. CONCLUSION： Reoperation is effective in the management of biliary leakage after hepatic hy- datid cyst removal.

关 键 词：肝包虫 胆漏 手术 

分 类 号：R657.3[医药卫生—外科学]