合并囊内胆漏的肝细粒棘球蚴病患者手术方式的分析  

Various surgical interventions in cases of complicated hepatic echinococcosis with intracystic bile leakage

作　　者：朱江 黄海军 张望 梅虎 朱时雨 宋思凯 张军 ZHU Jiang;HUANG Hai-jun;ZHANG Wang;MEI Hu;ZHU Shi-yu;SONG Si-kai;ZHANG Jun(Department of Abdominal Surgery,The Third People Hospital of Xinjiang,Urumqi 830000,China;Department of General Surgery,The People Hospital of Shufu in Xinjiang,Kashgar 844000,China)

机构地区：[1]新疆维吾尔自治区第三人民医院腹部外科,乌鲁木齐830000 [2]新疆喀什疏附县人民医院,喀什844000

出　　处：《中国寄生虫学与寄生虫病杂志》2022年第1期50-55,共6页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：新疆维吾尔自治区自然科学基金面上项目(2020D01A113);新疆维吾尔自治区第三人民医院科研基金(2019ZYBYK01)。

摘　　要：目的探讨合并囊内胆漏的肝细粒棘球蚴病患者有效的手术治疗方式。方法回顾性分析新疆维吾尔自治区第三人民医院2015年1月—2021年2月合并囊内胆漏的肝细粒棘球蚴病患者的临床资料,按照手术治疗方式不同分为3组,行肝细粒棘球蚴病内囊摘除残腔引流术为对照组,手术中加行经胆总管T管引流术为T管引流组,手术中行加经内镜胆道内支架引流术(ERBD)为ERBD组;3组患者术中均常规缝合残腔内可见胆漏。采用SPSS 22.0统计学软件对比分析3组间的手术时间、手术出血量、残腔引流管滞留时间、T管/内支架滞留时间、住院时间、总重返住院次数,以及术后短期并发症和并发症导致重返住院的发生率。结果共收集合并囊内胆漏的肝细粒棘球蚴病患者70例,其中男性44例,女性26例;对照组26例,T管引流组24例,ERBD组20例,3组间一般资料的差异无统计学意义(χ_(性别)^(2)=0.24、F年龄=1.12、χ_(病灶数量)^(2)=1.56、χ_(病灶最大直径)^(2)=0.36、χ_(病灶主要位置)^(2)=0.45、χ_(病灶类型)^(2)=2.61,P>0.05)。对照组、T管引流组和ERBD组,手术时间分别为(154.42±27.14)、(188.13±17.62)和(205.00±22.48)min,组间差异有统计学意义(F=29.62,P<0.05);术中出血量分别为(203.85±43.37)、(218.33±43.61)和(210.00±38.53)ml,组间差异无统计学意义(F=0.74,P>0.05);残腔引流管滞留时间分别为(9.15±9.95)、(2.38±0.49)和(2.80±0.83)周,T管引流组和ERBD组间差异无统计学意义(t=2.60,P>0.05),两组均短于对照组(F=9.55,P<0.05)。T管引流组和ERBD组的T管/内支架滞留时间分别为(4.96±0.69)和(7.15±2.32)周,差异有统计学意义(t=186.48,P<0.05)。对照组、T管引流组和ERBD组的住院时间(首次+末次)分别为(4.04±1.51)、(2.17±0.38)和(3.65±0.67)周,T管引流组和ERBD组间差异无统计学意义(t=8.28,P>0.05),两组均短于对照组(F=23.08,P<0.05)。对照组、T管引流组和ERBD组的总重返住院次数分别�Objective To explore an effective surgical intervention strategy for hepatic echinococcosis complicated with intracystic bile leakage.Methods The clinical data of patients of hepatic echinococcosis complicated with intracystic bile leakage were collected from January 2015 to February 2021 in the Third People Hospital of Xinjiang and analyzed retrospectively.The patients were divided into 3 groups according to different surgical procedures.The cases that had experienced residual cavity drainage after inner cyst excised were categorized into the control group.The cases that had received additional T-tube drainage via common bile duct during operation were categorized into the drainage group.The cases that had received endoscopic retrograde biliary drainage were categorized into the endoscopic retrograde biliary drainage(ERBD)group.Of all three groups of patients,visible bile leaks in the residual cavity were routinely sutured.Operation time,amount of blood loss during operation,indwelling time of residual drainage tube,indwelling time of T-tube/inner stent,time length of hospital stay,the total number of hospital re-entry,post-surgery short-term complication rate and the occurrence rate of returning to hospital due to complication were compared,using SPSS 22.0 statistical software.Results A total of 70 patients hepatic echinococcosis complicated with intracystic bile leakage were enrolled,including 44 males and 26 females,26 in the control group,24 in the drainage group,and 20 in the ERBD group.The differences in patient characteristics between the three groups were not statistically significant(χ_(Gender)^(2)=0.24,FAge=1.12,χ_(No.lesion)^(2)=1.56,χ_(Max diameter of lesion)^(2)=0.36,χ_(Primary location of lesion)^(2)=0.45,χ_(Type of lesion)^(2)=2.61;P>0.05).The operative time for the control group,the drainage group and the ERBD group were(154.42±27.14),(188.13±17.62),and(205.00±22.48)min,respectively,with statistically significant difference between the goups(F=29.62,P<0.05).The volume of blood loss during

关 键 词：肝细粒棘球蚴病 胆漏 T管引流 胆道内支架 

分 类 号：R532.32[医药卫生—内科学]