肝细粒棘球蚴病合并胆瘘的手术治疗——附203例分析

Surgical treatment in 203 patients of hepatic hydatidosis with biliary fistula

目的比较治疗肝细粒棘球蚴病合并胆瘘的不同手术方式。方法回顾性研究1990年1月￣2005年3月收治手术治疗的203例囊性肝包虫病合并胆瘘病例,观察传统的内囊摘除术联合大网膜填塞术、内囊摘除术联合囊内胆瘘缝扎术和新术式——外膜内完整摘除术的疗效,比较术后平均住院天数、残腔或创面外引流置管时间及残腔胆漏、残腔感染及周围胆管损伤的情况。结果外膜内完整摘除术术后平均住院天数、残腔或创面外引流置管时间及残腔胆漏、残腔感染及周围胆管损伤的发生率均明显低于传统术式。结论肝包虫“外膜”内完整摘除术术后并发症发生率低,能在直视下根据不同胆瘘特点可靠地处理胆瘘的胆管,可根治性治疗肝细粒棘球蚴病合并胆瘘。

[Objective] To compare the different operative methods in 203 patients of hepatic hydatidosis with biliary fistula. [Methods] To carry out the retrospective study of the 203 eases of hepatic hydatidosis with biliary fistula from 1990.1 to 2005.3. To compare the information about mean hospitalization days, drainage time, infection rate, and damage of surrounding bile duct of different operative methods. [Results] Compared with the traditional operative method, the sub advititalperieysteetomy has the advantage of lower infection rate, less drainage time, less chance of injury of the surrounding bile duct in deal with the different characteristics of biliary fistula of hepatic hydatidosis. [Conclusion] The sub advititalperieysteetomy has the lower rate of complication. It can treat the biliary fistula accurately according to its characters under the straight sight. The sub advititalperieysteetomy is an ideal radical surgical therapeutic method for hepatic hydatidosis with biliary fistula.