肝包虫术后残腔并发症的防治(附173例报告)

Prevention and management of complications of retained cavity of postoperative hydatidosis (a report of 173 patients)

目的讨论肝包虫内囊摘除术后残腔并发症的防治方法。方法回顾分析我院1960年1月至2004年1月肝包虫内囊摘除术后外囊残腔并发症173例,占同期肝包虫手术的17.49%(173/989)。其中残腔感染104例(60.12%),残腔出血2例(1.16%),残腔胆汁漏51例(29.48%),钙化残腔不闭合13例(7.51%),残腔消化道瘘3例(1.73%)。87例(50.29%)经再次手术治疗。结果术后腹腔感染7例(8.05%),伤口感染11例(12.64%),肺部感染4例(4.6%),死亡3例(1.73%)。本组治愈率为98.27%。结论肝包虫内囊摘除术后残腔并发症发生率较高,其中以残腔感染及胆汁漏最为常见,部分病例治疗甚为困难,严重影响病人的生活质量甚至生命。包虫囊肿完整切除可有效地预防术后残腔并发症。近来有人提出包虫外囊与肝组织之间有一层疏松的结缔组织称为“外科膜”,该膜有利于包虫囊肿完整切除。作者认为包虫囊肿完整切除应根据病人的全身及局部情况和术者的经验而定,不可盲目从事。

Objective To discuss better methods for prevention and treatment of retained cavity complications post-evacuation of liver hydatid cyst retained external cavity complications post-evacuated internal cavity of hepatic hydatid cyst.Methods and method One hundred seventy-three patients with retained external cavity complications post-evacuated internal cavity of hepatic hydatid cyst were treated at our hospital from January 1960 to January 2004. This condition accounted for 17.49% (173/989) of hydatidosis operation at the period. Among whom infected retained cavity in 104 patients (60.12%), bleeding onto retained cavity in 2 cases (1.16%),retained cavity with biliary tract (bile duct) fistula in 51 patients (29.48%). Calcification retained cavity was not close in 13 patients (7.51%),retained external hydatid cavity-gastrointestinal tract fistula in 3 cases (1.73%).Eighty-seven patients of them were treated by re-operation.Results After operation the peritoneal cavity infected in 7 patients (8.05%), wound abscess in 11 patients (12.64%), pulmonary infection in 4 cases(4.6%).Three patients died(1.73%). The healing rate is 98.27%.Conclusion The complications retained cavity of post-evacuated of liver hydatid cyst is high. Among of them infection and bile leakage is most frequently. It is difficultly treating some patients. The complications affect living quality and are seriously imperilling life. The total remove hydatid cyst can prevent retained cavity complication post operation. Recently, somebody reported that it has a surgical membrane between external cyst and liver tissue which benefited total removing the hydatid cyst. Author think that total remove hydatid cyst depend on general and local condition of patient and experience of surgeon, which must be considered.