肝泡型包虫病术后并发症与Child-Pugh分级和手术方式关系研究  

Study on the relationship between postoperative complications of hepatic alveolar echinococcosis and Child-Pugh grading or surgical methods

作　　者：阿吉德 柴金萍 王皓[1] 高伟 王向前 田青山[1] 赵顺云[1] Ajide;CHAI Jin-ping;WANG Hao(Department of General Surgery,Qinghai Provincial People's Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院普外科,青海西宁810000

出　　处：《中国实用外科杂志》2020年第5期586-590,共5页Chinese Journal of Practical Surgery

基　　金：2017年青海省卫生计生系统科研项目(No.2017-wjzdx-23);青海省自然科学基金项目(No.2017-ZJ-914)。

摘　　要：目的探讨肝泡型包虫病术后并发症与手术方式、Child-Pugh分级之间的关系。方法回顾性分析2016年12月至2018年12月青海省人民医院包虫病诊疗中心行手术治疗的104例肝泡型包虫病人的临床资料,按Child-Pugh分级标准将病人分为A级组(73例)和B级组(31例)两组;按是否行根治性手术治疗将上述病例分为根治性手术组(52例),准根治性手术组(52例)两组。分别观察以上各组间病人术后并发症及临床客观指标。结果入院时,B级组病人术后发生切口感染、难治性腹水及腹腔感染等并发症发生率较A级组显著升高,差异有统计学意义(P<0.05);两组间术后1年病死率比较,差异有统计学意义(P<0.05)。根治性手术组病人术后难治性腹水率、肝功能不全、肝功能衰竭、黄疸、腹腔感染、腹腔脓肿等并发症发生率较准根治性手术组显著降低,差异有统计学意义(P<0.05);两组间术后1年病死率比较,差异无统计学意义(P>0.05)。结论肝泡型包虫病病人行根治性肝切除手术后,术后并发症发生率较行准根治性肝切除术低,Child-Pugh分级B级病人术后出现的并发症发生率较Child-Pugh分级A级组显著升高。Objective To investigate the relationship between complications of hepatic alveolar echinococcosis and surgical methods or Child-Pugh classification.Methods A total of 104 patients with hepatic alveolar echinococcosis who underwent operation in Hydatid Disease Diagnosis and Treatment Center,Qinghai Provincal People's Hospital from December 2016 to December 2018 were analyzed retrospectively.According to Child-Pugh classification criteria,the patients were divided into two groups:A grade group(73 patients)and B grade group(31 patients).However,the patients were also divided into two groups according to surgical methods:radical surgery operation group(52 cases)and quasiradical surgery operation group(52 cases).Objective clinical indicators and postoperative complications were observed respectively among the above groups.Results The incidence of incision infection refractory ascites and abdominal infection in B grade group was significantly higher than that of A grade group at admission(P<0.05),and there was a significant difference in mortality between the two groups at one year after operation(P<0.05).The incidence of complications such as refractory ascites,hepatic insufficiency,liver failure,jaundice,abdominal infection and abdominal abscess in the radical operation group was significantly lower than quasi-radical operation group(P<0.05),and there was no significant difference in mortality between the two groups at 1 year after operation(P>0.05).Conclusion After radical hepatectomy,the incidence of postoperative complications in patients with hepatic alveolar echinococcosis is lower than that of quasi-radical hepatectomy.The incidence of postoperative complications in children-pugh grade B patients is significantly higher than that in children-pugh grade A group.

关 键 词：肝泡型包虫病 CHILD-PUGH分级 手术方式 根治性手术 并发症 

分 类 号：R6[医药卫生—外科学]