破裂肝包虫囊肿的处理(附149例报告)

Management of ruptured liver hydatid cyst:a report of 149 cases

目的探讨破裂肝包虫囊肿的诊治方法。方法回顾分析我院1960年6月至2003年6月手术治疗的破裂肝包虫囊肿149例。其中破入腹腔13例(8·72%),消化道穿破8例(5·37%),泌尿道5例(3·36%),肝包虫囊肿-胆道-支气管瘘8例(5·37%),破入胸膜腔9例(6·04%),胆道穿破103例(69·13%),其他部位穿破3例(2·01%),均经手术治疗。结果术后伤口感染14例(9·40%),横结肠瘘1例(0·67%),肝包虫复发12例(8·05%),腹腔内复发10例(6·71%),复发病例均经再次或多次手术治愈,死亡3例(2·01%),远期治愈144例(96·64%)。结论肝包虫囊肿破裂是较常见的并发症之一,可引起急腹症、过敏性休克,以破入胆道者为多,可致胆道梗阻甚至急性梗阻性化脓性胆管炎(AOSC),破入消化道、泌尿道、胸腔甚至形成包虫囊肿、胆道、支气管瘘等,治疗多较困难,且易复发,故肝包虫囊肿应早期诊断及尽早手术治疗,以防破裂,进一步开展对包虫病的防治则更为重要。

Objective To find a method for diagnosis and treatment of hepatic hydatid cyst. Methods The clinical data of 149 patients with ruptured hepatic hydtid cyst surgically treated in our hospital from July 1960 to July 2003 were retrospectively analyzed. The cyst ruptured to peritoneal cavity in 13 patients （8.72%）, to gastrointestinal tract in 8 and to urinary tract in 5 （3.3%）. Hepatic hydatid cyst-biliary-bronchial fistula was found in 8 patients （5.37%） and the cyst ruptured to thoracic cavity in 9 （6.04%）. Cyst-biliary fistula was found in 103 patients and other types of fistula in 3 （2.01%）. Results Postoperative wound infection occurred in 14 patients （9.04%） and transverse co- lon fistula in 1 （0.67%）. Recurrence of liver hydatidosis was seen in 17 patients （11.41%） and recurrence of the hydatidosis in the peritoneal cavity was seen in 10 （6.71%）. All the patients with recurrence of hydatidosis underwent reoperation. Three patients died. The long-term curative rate was 96.64%. Conclusions The rupture of liver hydatid cyst is frequent and it can result in acute abdomen and sensitive shock. The hydatid cyst ruptured to biliary tract can cause obstruction of biliary tract or AOSC. Rupture to gastrointestinal tract, urinary tract and thoracic cavity can result in hydatid cystbiliary-bronchial fistula etc. It is difficult to treat the disease and it is easy to recur. Therefore, the liver hydatid cyst should be diagnosed and operated early to prevent its rupture.