肺细粒棘球蚴破裂与其临床症状及术后并发症的关联性研究

Clinical symptoms and postoperative complications in ruptured and complete hydatid groups:a comparative study

目的分析肺细粒棘球蚴病(以下简称肺包虫病)患儿肺细粒棘球蚴破裂与其临床症状及术后并发症的关联性。方法回顾性分析2016年1月1日至2021年12月31日在新疆医科大学第一附属医院接受手术治疗的63例肺包虫病患儿资料,通过入院时是否发生肺包虫破裂分为肺包虫破裂组(n=26)及肺包虫完整组(n=37);比较两组患儿的一般资料、临床症状、肺包虫所在肺叶、术后并发症以及不同肺叶的肺包虫大小。结果肺包虫破裂组与肺包虫完整组患儿年龄[(7.23±2.85)岁比(6.38±3.22)岁]、性别(男/女:16/10比24/13)、民族(汉族/维吾尔族/哈萨克族/其他:5/8/9/4比6/20/5/6)、包虫个数[(2.76±1.01)个比(3.15±1.57)个]、合并其他部位包虫(10/26比21/37)、术后并发症(5/26比9/37)、包虫大小[(6.50±2.37)cm比(7.86±4.32)cm]差异均无统计学意义(P>0.05)。肺包虫破裂组与肺包虫完整组患儿出现相关症状的人数比例(25/26比27/37)差异有统计学意义(P<0.05)。肺包虫破裂组中最常见的症状为咳嗽(23/26,88%),其次为发热(18/26,69%)、咳痰(17/26,65%)。肺包虫破裂组与肺包虫完整组患儿出现胸痛(13/26比10/37)、咯血(4/26比1/37)、肺实变表现(3/26比9/37)的比例差异均无统计学意义(P>0.05)。肺包虫直径≥10 cm与肺包虫直径<10 cm患儿胸痛发生率差异有统计学意义(P<0.05)。肺实变患儿的肺包虫直径为(9.33±5.23)cm,无肺实变患儿的肺包虫直径为(6.87±3.18)cm,差异有统计学意义(P<0.05)。右肺肺包虫感染发生率高于左肺,不同肺叶的肺包虫大小差异无统计学意义(P>0.05),肺包虫所在肺叶与肺包虫破裂无关(P>0.05)。两组患儿术后并发症发生率(5/26比9/37)差异无统计学意义(P>0.05)。结论肺包虫病患儿发生肺包虫破裂后会出现咳嗽、发热、咳痰,部分患儿可以出现胸腔积液、气胸、化脓性胸膜炎及脓毒血症等并发症,上述表现对诊断肺包虫破裂有一定的价值。术后并发症可能与手术方式有关,但需要在以后的研究中进一步明确。

Objective To explore the differences in general profiles,clinical symptoms and postoperative complications between children with complete pulmonary hydatid and those with pulmonary hydatid rupture.Methods From January 1,2016 to December 31,2021,retrospective review was performed for clinical data of operated children with pulmonary hydatid disease.They were assigned into two groups of pulmonary hydatid rupture and complete pulmonary hydatid by whether pulmonary hydatid rupture occurred at the time of presentation.General profiles,clinical symptoms,lobular locations of pulmonary hydatid and postoperative complications of two groups were compared.Results No significant inter-group differences existed in age[(7.23±2.85)vs.(6.38±3.22)years],gender(male/female:16/10 vs.24/13),ethnicity(Han/Uyghur/Kazakh/other:5/8/9/4 vs.6/20/5/6),number of hydatids[(2.76±1.01)vs.(3.15±1.57)],echinococcal worms in other parts(10/26 vs.21/37),postoperative complications(5/26 vs.9/37)or hydatid size[(6.50±2.37)vs.(7.86±4.32)cm](P>0.05).And significant inter-group difference existed in positive symptoms(25/26 vs.27/37)(P<0.05).The most common symptom were cough(23/26,88%),fever(18/26,69%)and sputum production(17/26,65%)in pulmonary hydatid rupture group;Symptoms were non-specific in complete pulmonary hydatid group.No significant inter-group differences existed in chest pain(13/26 vs.10/37),hemoptysis(4/26 vs.1/37)or pulmonary consolidation(3/26 vs.9/37)(P>0.05).Significant difference existed in the incidence of chest pain between≥10 cm diameter and<10 cm diameter of pulmonary hydatid(P<0.05).The diameter of pulmonary hydatid was(9.33±5.23)cm for pulmonary consolidation and(6.87±3.18)cm for lung hydatid without consolidation and the difference was statistically significant(P<0.05).The infection rate of hydatid infection was higher in right lung than that in left lung.Size of pulmonary hydatid was not statistically significant among different lobes(P>0.05)and lobular rupture of pulmonary hydatid was not statistically significant(P>0.05).No significant inter-group difference existed in postoperative complications(P>0.05).Conclusion Most children of pulmonary hydatids have symptoms of cough,fever and sputum after rupture.And there are also pleural effusion,pneumothorax,purulent pleurisy and sepsis.These manifestations may aid in diagnosing pulmonary hydatid rupture.Postoperative complications are correlated with surgical approaches.Further studies are required for clarifications.