小儿肝囊性包虫病的诊断与外科治疗（附67例报告）

Diagnosis and treatment of hepatic hydatid cyst in children （67 cases of report）

目的总结小儿肝囊性包虫病的诊断与外科治疗经验。方法回顾性分析中心2002年1月至2010年1月期间收治的67例14岁以下（包含14岁）肝囊性包虫病患儿，对其临床表现、治疗方法及术后并发症进行分析。结果67例患儿均行手术治疗，行传统内囊摘除术47例，行完整外囊剥离术式11例，行外囊次全切除术6例，行肝叶切除术3例，术后肺部感染1例，1例患儿术后11d因反复应激性溃疡出血伴发多器官功能衰竭死亡，随访1～8年，包虫残腔积液7例，残腔积液合并感染2例，1例患儿术后3年包虫原位复发再次行手术治疗治愈。结论小儿肝囊性包虫具有生长快，囊壁薄，较易合并其他脏器等特点，超声、CT及实验室检查等可明确术前诊断，内囊摘除术为有效治疗肝囊性包虫术式，内囊次全切除术及术中胆道造影可有效降低术后残腔并发症。

Objective The aim of this study was to summarize the diagnosis and surgical management for hepatic hydatid cysts in children. Methods The clinical data from 67 cases （less than 14 year old） of hepatic hydatid cyst who underwent surgery in our centre were targeted, clinical manifestations, imaging examination results and therapeutic etticacy as well as the postoperative complications in them, were retrospectively reviewed. Results All patients included 44 boys and 23 girls, the mean age 8. 86 years old （ranging from 3 to 14 years）. The cysts in 31 patients located in liver right lobe （46. 27%）, 17 were in liver left lobe （25.37%） ,and 19 were in both lobes （28. 36%）. Single hepatic cysts were found in 35 patients （52. 24%） and multiple hepatic cysts were seen in 32 patients （47. 76 %）, 11 cases of all patients were found accompanied cysts in other organs. All the patients underwent surgery, in which 47 cases were treated with conservative therapy, 11 cases were for total pericystectomy and 3 cases were {or liver resection. 1 patient was complicated with pulmonary infection after surgery, 7 cases and 2 cases were respectively complicated with cystic effusion and abscess. Furthermore, recurrent cysts were found in I patient and 1 children died due to multiple system organ failure. Conclusions Conservative surgery is still the important strategy for hepatic hydatid cysts, the subtotal pericystectomy and selective intraoperative cholangiography could contribute to reduce the complications caused by residual cavity.